Old age is often portrayed as a time of rest, reflection, and opportunities to do things that were put off while raising families and pursuing careers. Unfortunately, the aging process is not always so idyllic. Late-life events such as chronic and debilitating medical disorders, loss of friends and loved ones, and the inability to take part in once-cherished activities can take a heavy toll on an aging personÃs emotional well-being. An older adult may also sense a loss of control over his or her life due to failing eyesight, hearing loss, and other physical changes, as well as external pressures such as limited financial resources. These and other issues often give rise to negative emotions such as sadness, anxiety, loneliness, and lowered self-esteem, which in turn lead to social withdrawal and apathy.
Another, more serious outcome is chronic depression or depression that is recurring and persistent. Chronic depression has both physical and mental consequences that may complicate an older adult existing health condition and trigger new concerns. There is evidence that some natural body changes associated with aging may increase a persons risk of experiencing depression. Recent studies suggest that lower concentrations of folate in the blood and nervous system may contribute to depression, mental impairment, and dementia. Researchers also suspect that there may be a link between the onset of late-life depression and AlzheimerÃs disease. Regardless of its cause, depression can have alarming physical effects on older people. The mortality rate for elderly men and women suffering from both depression and feelings of loneliness is higher than for those who are report satisfaction with their lives. Treatment programs for depressed elderly patients suffering from cardiovascular disease and other major illnesses usually take longer than normal and are less successful. In addition, the feelings of hopelessness and isolation that often spur thoughts of suicide are more prevalent among older adults, especially those with disabilities or confined to nursing homes.
A risk to daily living:
Depression can also have potentially harmful effects on an older adults health in other ways. Depression can lead to eating habits that result in obesity or, conversely, can cause a significant loss of appetite and diminished energy levels, sometimes resulting in a condition known as geriatric anorexia.
Depressed older adults also experience higher rates of insomnia and memory loss. They also have longer than normal reaction times, increasing the hazards associated with cooking, driving, self-medication, and other tasks that require full attention.
What you can do:
While aging is an inevitable part of life, depression need not be part of it. Researchers agree that early recognition, diagnosis, and treatment can counteract and prevent depression is emotional and physical consequences.
Here are some issues to consider in addressing depression in an older adult:
Be aware of physical limitations. Encourage an older adult to consult with a physician before
making dietary changes or undertaking any new activity that may stress his or her stamina. Respect individual preferences. Because elderly people tend to be less amenable to lifestyle changes, they may be reluctant to adopt new habits or do things that their peers find highly enjoyable. A therapist who specializes in aging issues can help tailor an individualized strategy to combat depression.
Be tactful. An older person with fragile self-esteem may interpret well-intentioned encouragement as further proof of his or her declining condition. Others may resent any attempts at intervention. A therapist can help friends and family members craft positive approaches for dealing with these and other sensitive issues.
Late-life anxiety can often be “silent” missed or difficult to diagnose as older adults tend to somatize psychiatric problems; have multiple psychiatric, medical, and medication issues; and present anxiety differently than do younger patients. Yet late-life anxiety disorders are a “geriatric giant,” being twice as prevalent as dementia among older adults, and four to eight times more prevalent than major depressive disorders, causing significant impact on the quality of life, morbidity, and mortality of older adults. Treatment of late-life anxiety is a challenge given concerns about medication side effects in older, frail, or medically ill patients. Antidepressants are recommended but not always tolerated, and benzodiazepines are generally to be avoided in this population. Effective psychotherapies such as cognitive behavioral
therapy (CBT) are of particular interest for the older adult population, and the combination of CBT and medication is often needed to optimize treatment.