Depression is something that too many individuals will face in their lifetime. In Canada, approximately 8% of people will experience depression at some point in their lives. Although it is believed that depression naturally increases with age, depression is not a natural side effect of aging, even though it happens often due to many reasons including loss of loved ones, isolation, and inadequate care. If you suspect that a loved elder is suffering from depression, it’s important you take steps to get that person the right type of care for their situation.
How do you tell if a loved one is suffering from depression?
The most common answer is to look for signs of sadness or a fixation on death. Our elders will sometimes talk about wanting to die and this can be easy to overlook – we assume it’s just the pain or the loneliness talking and that it “will pass”. Especially with talk of suicide, we should never dismiss what is said, but try view it in context along with the other cues to depression.
What are these signs of depression?
They can include:
- Sleep problems, such as trouble falling asleep, staying asleep, oversleeping, and daytime sleepiness (which can go hand-in-hand with fatigue) (it is also worth noting that the amount of sleep needed in the elderly is statistically less than for younger individuals so “oversleeping” may not look like it from the outset)
- Weight loss or loss of appetite
- Loss of interest in both social and individual (e.g., hobby) activities
- Loss of self-worth, such as believing oneself to be a burden and believing one has nothing to offer anyone
- Unexplained pain and physical ailments
- Memory problems (though notably this can also be a sign of declining memory function)
- Slowed movement or speech problems, such as slurring, shuffling instead of walking without a medical reason, trailing sentences, and so on
- Loss of interest or forgetting about personal care, including missing medications, skipping meals, or neglecting personal hygiene
Sometimes elderly individuals will show symptoms without being depressed and this is why it is critical to look at the entirety of the situation. Unexplained pain and physical ailments do not mean there is no explanation, but perhaps the reason has yet to be identified. However, when these ailments are coupled with reports of sadness, loss of self-worth, or other symptoms, they may be more reflective of depression than something physically wrong.
Additionally, depression does not always come with reports of feeling sadness. Some people simply won’t tell you they feel sad whereas others suffer from depression without sadness. When this happens, it can be even more difficult to think of depression as a possible cause for other symptoms, yet family and caregivers should know that it is possible. When an elderly individual experiences unexplained pain, memory problems, slowed movement, speech problems, lack of interest or personal care, and so on, we should consider that depression may be a cause and seek appropriate help in determining what is wrong.
The process of diagnosis is important, especially distinguishing between depression and dementia as many of the symptoms overlap. It can be that loved ones believe that the changes they see are due to a cognitive decline when in fact the changes are emotional in nature. There are, however, some general differences in the symptoms that are worth knowing. Cognitive changes, such as memory problems or a slowing of language or motor skills, will be often be slower in depression than dementia. Additionally, depression is not associated with confusion and disorientation. If your elder is always aware of the date and time and where s/he is and does not report sadness, but does present with other cognitive symptoms, you may want to look into dementia as a possible cause. As always, getting an appropriate diagnosis is critical to obtaining the right treatment for your loved one so do not assume it is one or the other, but make sure you get a doctor involved who can help identify what is wrong.
How can you help?
The key to helping is to ensure that the elder in question receives appropriate care. This can include psychotherapy, medication, a combination of both, or even just changes to their lifestyle to help improve mood. Finding the right care provider can be difficult, however. In Canada, depending on which province you are in, your elder may be eligible for psychiatric treatment which is covered by provincial health care; however, the wait lists for this can be incredibly long as the need far outstrips the availability. Private care includes psychiatrists, psychologists, and counsellors and the person you select will depend on your circumstances and what is available. Private care can be expensive, but there are programs that can help and some training clinics offer assistance on a sliding scale, enabling high-quality treatment for a fraction of the cost.
In some cases, such as if the depression is triggered by health problems or isolation, in-home care may be a solution. Having regular visits from someone who can help with any medical problems and ensure your loved one gets out to events and appointments may be all your elder needs to regain that sense of purpose. These caregivers can also ensure that your loved one is taking part in regular exercise, eating well, living in a clean environment, and has the opportunity to be social and active in whatever types of activities your loved one enjoys, including learning new activities which have been found to help reduce the risk of other cognitive impairments and improve mood.
Obstacles to Treatment
One of the biggest obstacles to helping an elderly loved one with depression is the temptation or inclination to ignore some of the symptoms. For many of us, hearing a loved one talk about, for example, wanting to die can be extremely difficult and results in us dismissing the comments for fear of what we might discover, often with a comment along the lines of, “Don’t say things like that!” as if we were admonishing a child. Other times people act as though it’s common for older individuals to talk this way and use that reasoning as means to dismiss the comment, but family has to realize is that it is never normal to speak this way.
If family members can move beyond their own fear and discomfort, one of the best ways to elicit more information without shutting down the elder is to simply say, “Tell me more about that”. If the elder feels that s/he can be heard, especially with respect to this vulnerable topic, the family has the opportunity to really learn about the concerns and feelings of their loved one. It may be that it is simply a bad day being voiced in a dramatic way, but it may be a sign that something else is really amiss. Family members also tend to dismiss physical symptoms as well, not out of fear, but out of a misunderstanding of how “normal” they are. Often the physical manifestations of depression are ignored as being natural parts of aging and although some of them are, they are not inherently natural and all loved ones should be aware of the symptoms and when to seek treatment. Again, one symptom may not indicate much, but when there is a cluster of symptoms, it is important for loved ones to get their elder in to see a doctor who can better determine what is going on.
A second obstacle to helping an elderly loved one is when the loved one refuses treatment. Sometimes our loved ones either don’t want to accept that there is a problem or part of the problem is that they lack the motivation or self-worth to see treatment as an avenue worth exploring. Unless you have legal power to force your loved one into treatment, you are left to try and persuade your loved one to get help. In these cases, honest and open conversation can help immensely. As one of the symptoms of depression is to feel that one is a burden, making sure your loved one knows how much you value them and want them around may be enough to get them to at least consider treatment. Remember: You don’t need to get them to agree to a full series of treatments, but just the first one. Taking it one step at a time is essential when faced with a resistant individual.
Depression is hard. It is a disease that affects not only the person afflicted but those around them as well. Unfortunately, there are many reasons our elders may suffer from depression and it is important that we not dismiss the feelings or experiences of our loved ones, but rather help them work through this difficult period.
Is Your Loved One Suffering From Depression?
Mavencare offers high quality and affordable companionship and in-home care services. Give us a call at 1-800-856-2836 to discuss how your family and loved one may benefit from companionship and in-home care. You can also have a care coordinator contact you for a free home care assessment.