Depression in the elderly
“The sun stopped shining for me, is all. The whole story is: I am sad. I am sad all the time, and the sadness is so heavy that I can’t get away from it. Not ever.” Nina LaCour, Hold Still
Depression is common among older people. It doesn’t mean it is normal – depression is a mental illness and isn’t normal at any age. It often happens that we fail to recognize symptoms of depression in elderly persons, assuming that it is just part of the ageing process. The aged may merely complain of having ‘’no energy or no interest in anything’’. It prevents older people from getting the help they need. Depression in older adults differs from depression in younger people because it often occurs with other medical illnesses and disabilities, and it lasts longer.
An increased life expectancy due to better healthcare and social conditions means the number of older people is rapidly increasing in our world.
In South Africa, the proportion of persons 60 years or older is almost double during 2000 – 2030. Credit: Jeffrey Moyo / IPS.
Fast facts on depression
- 6.5% of people in the world suffer from depression.
- 26.9% of men above 70 years old suffer from depression
- 45,2% of women above age 70 suffer from depression.
- Suicide rates are higher among adults 65+ of age than at any other time in life.
- The age group 85+ has the highest suicide rate of all adults.
- 70% of suicide victims over age 60 had a medical illness as the reason
- Although depression is a common illness in the elderly, only 2/3 of people will seek help
- Of those who seek help, more than 80% respond well to treatment
What are the red flags you should watch out for?
- Feelings of sadness and despair
- Unexplained or aggravated aches and pains
- Loss of interest in socializing or hobbies
- Weight loss or loss of appetite
- Feelings of hopelessness or helplessness
- Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
- Neglecting personal care (skipping meals, forgetting medication, neglecting personal hygiene)
“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.” Henry Wadsworth Longfellow
Is there is a difference between depression and grief?
Loss and grief is part of life. All of us at some stage might experience the loss of a loved one, a career, a beloved pet, maybe our health, mobility or sense of security. It is normal to grieve the loss.
What Are the Stages of Grief?
Your feelings may happen in phases as you come to terms with your loss. You can’t control the process, but it’s helpful to know the reasons behind your feelings. There are five common stages of grief:
Denial: When you first learn of a loss, it’s normal to think, “This isn’t happening.” You may feel shocked or numb. This is a temporary way to deal with the rush of overwhelming emotion. It’s a defence mechanism.
Anger: As reality sets in, you’re faced with the pain of your loss. You may feel frustrated and helpless. These feelings later turn into anger. You might direct it toward other people, a higher power, or life in general. To be angry with a loved one who died and left you alone is natural, too.
Bargaining: During this stage, you dwell on what you could’ve done to prevent the loss. Common thoughts are “If only…” and “What if…” You may also try to strike a deal with a higher power.
Depression: Sadness sets in as you begin to understand the loss and its effect on your life. Signs of depression include crying, sleep issues, and a decreased appetite. You may feel overwhelmed, regretful, and lonely.
Acceptance: In this final stage of grief, you accept the reality of your loss. It can’t be changed. Although you still feel sad, you’re able to start moving forward with your life.
Every person goes through these phases in his or her own way. You may go back and forth between them or skip one or more stages altogether. Reminders of your loss, like the anniversary of a death or a familiar song, can trigger the return of grief.
Grief and depression share many symptoms, and it is not always easy to distinguish between them. Grief is characterized by a bunch of emotions that come and go. A grieving person usually has good and bad days emotionally. Sadness comes and goes with moments of happiness in between. With depression, on the other hand, the feelings of emptiness and despair are constant.
“Mental pain is less dramatic than physical pain, but it is more common and also harder to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say, “My tooth is aching” than to say, “My heart is broken.”
What causes depression in older people?
- Health problems, for example, loss of mobility, chronic pain.
- Loneliness & isolation
- A feeling of having less value to the world
- Fears – can be fear of death, of loneliness, of illnesses or lack of finances
- Grief over a loved one or pet that passed away
The difference in how men and women experience depression
Women feel anxious and scared; men feel guarded.
Women blame themselves for the depression; men blame others
Women commonly feel sad, worthless, and apathetic when depressed; men tend to feel irritable and angry
Women are more likely to avoid conflicts when depressed; men are more likely to create conflicts
Women turn to food and friends to self-medicate; men turn to alcohol, TV, sex, or sports to self-medicate
Women feel lethargic and nervous; men feel agitated and restless
Women easily talk about their feelings of self-doubt and despair; men hide feelings of self-doubt and despair-considering it a sign of weakness
Depression is a mental disease. Kay Redfield Jamison describes it as: “Others imply that they know what it is like to be depressed because they have gone through a divorce, lost a job, or broken up with someone. But these experiences carry with them feelings.
”Depression, instead, is flat, hollow, and unendurable.”
It is also tiresome. People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try. Still, you know, and they know that you are tedious beyond belief: you are irritable and paranoid and humourless and lifeless and critical and demanding, and no reassurance is ever enough. You’re frightened, and you’re frightening, and you’re “not at all like yourself but will be soon,” but you know you won’t.”
How to recover from depression
The good news is that older people can learn new skills, make lifestyle adjustments and become involved in new activities. To manage mental illness is much the same as managing any medical illness. It involves not only taking prescribed medication but adjusting your lifestyle as well. It may be difficult for a person with depression to find the energy and will to do that, but if you set small-step goals for yourself, it is a good start.
It is essential to reach out and stay connected with the people around you.
Depression causes you to isolate yourself. You don’t feel like getting up, going out and talking to people. Isolation only makes depression worse. You cannot depend on feelings to guide you to get well. You have to set down rules for yourself and plan your day. If you don’t, a day will pass by where you had done nothing that matters. Rule one can be – when you wake up in the morning, get up and make your bed. Rule to have a morning coffee/tea outside in the sun. Rule three is to wash up and dress neatly. Then you are ready for the day.
A few ideas of what to do during a day: Consider going for a walk. (Exercise is a powerful way to fight depression.) Enjoy a coffee date with a friend, organize to play cards with a group, visit a museum, listen to a book reading or go to a concert.
Get involved with a charity or voluntary organization.
How does helping others benefit you? It takes the mind off your own problems. It gives you a sense of being valuable again. It is inspiring to help people or animals in need. Examples of what you can get involved with are – teach children to read, knitting, needlework or cooking classes, or help out at your nearest animal welfare organisation like the SPCA.
Get a pet
Caring for a pet can help you to feel less lonely. Walking your dog allows you to talk to people along the way. It is a great way to make new friends with similar interest.
Do a course
The skills you always wanted to learn – now is the time. Subscribe for a course in photography, baking, cake decorating or gardening. Do an online course. There are courses available today on anything you can imagine.
Depression can cause you to overeat, eat too little or eat unhealthy meals. Plan your meals. Make sure you eat little or no sugar or processed foods. Limit or avoid alcohol. Make sure you eat quality protein daily, as well as fruit and vegetables.
There is value in taking medication for depression. Anti-depressants and sleeping tablets to treat insomnia can be helpful. It is best prescribed and monitored by a psychiatrist. Medication does have side-effects. If your medication makes you feel more unwell and struggles to cope with the side effects, please don’t hesitate to make a follow-up appointment with your doctor. There are many products on the market. It is sometimes a bit of a trial and error journey to find the one that suits you. You have to look out for a medication that causes impaired alertness, drowsiness, confusion, a sudden drop in blood pressure when you get up (can lead to falls and fractures), and struggles to wake up in the morning.
Medication alone will not help an older person recover from depression, especially if the reason for depression is loneliness. Psycho-therapy and support groups are beneficial in talking about fears and problems and learning new coping skills to deal with them. It is also helpful for people who cannot take medication because of side–effects or interaction with other medicines.
Be aware of the symptoms of suicide.
The warning signs of suicide are indicators that a person may be in acute danger and may urgently need help.
Talking about wanting to die or to kill oneself;
Looking for a way to kill oneself;
Talking about feeling hopeless or having no purpose;
Talking about feeling trapped or being in unbearable pain;
Talking about being a burden to others;
Increasing the use of alcohol or drugs;
Acting anxious, agitated, or reckless;
Sleeping too little or too much;
Withdrawing or feeling isolated;
Showing rage or talking about seeking revenge; and
Displaying extreme mood swings.
Do a Quiz
Depression Quiz – Am I depressed?
You can chat with an online counsellor on our helpline: LIVE CHAT.
It is a text-based chat and you may remain anonymous.
“Depression is the most unpleasant thing I have ever experienced. . . . It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope.
That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It is a necessary thing to feel. Depression is very different.”