Identifying and managing depression in older adults
It may come as a surprise to many that depression is incredibly common in the ageing and elderly adult population, however, depression is not a normal part of ageing.
Many signs and symptoms of depression can be mistaken for other health conditions (and vice versa) or may be considered a natural reaction to a recent event or current situation or, worse still, may be overlooked entirely. For these reasons, it is important to pay close attention to our ageing and elderly loved ones and monitor their mood and behaviour so that we can identify, address and manage changes if or when they occur.
What is depression?
Depression is defined as a feeling of intense sadness. The term may be used to describe a person’s mood, or it may refer to a longer-term mental health condition. A depressed mood may be:
- A perfectly normal reaction to grief or upsetting news.
- A symptom or side effect of another health condition including: Hypothyroidism, Parkinson’s disease, cancer, diabetes, vitamin b12 deficiency, heart disease, stroke, lupus, multiple sclerosis and many forms of dementia.
- A side effect of medication/s – including those used to manage blood pressure and heart conditions, high cholesterol, Parkinson’s disease, gastric/oesophageal ulcers and other gastrointestinal disorders, chronic pain and arthritis, inflammation (steroids), and hormonal imbalances, as well as sleeping tablets and tranquilisers.
- Part of a depressive syndrome, known as ‘major depression’.
To add a layer of difficulty in identifying depression in older adults, many ageing or elderly people with depression report that they do not feel ‘sad’. Instead, their depression often presents as a lack of energy or motivation, or the exacerbation of physical complaints, such as increased pain levels associated with physical conditions such as arthritis, back pain, recurrent or worsening headaches.
Factors that may contribute to or exacerbate depression in an ageing or elderly person
Factors that may contribute to or exacerbate depression include:
- Loneliness / social isolation: This can occur through several means such as living alone, loss of contact with a close friend or loved one, the death of a partner or close friend, decreased mobility (limiting social interactions) or loss of driving privileges.
- Lifestyle changes such as a recent health diagnosis, a change in living arrangements, a reduced sense of purpose (for example, following retirement from either a paid or volunteer position).
- Environmental factors, such as being unable to avoid unwanted stimulation (noise, light, smells) or situations (forced interactions with people the depressed person fears or dislikes).
- Poor health status, such as acute or chronic physical illness, chronic or severe pain, cognitive decline, physical limitations (particularly with regard to loss of mobility and independence).
- Poor diet/nutritional intake from a general decreased intake of food, consumption of foods with insufficient nutritional value, or avoiding prescribed nutritional supplements.
- Fatigue from having sole responsibility to care for one’s own personal needs (hygiene, grooming, shopping, cooking) and own home (cleaning, garden and home maintenance).
Signs and symptoms of depression in an ageing or elderly person
Signs and symptoms that may indicate the presence of depression or a depressive syndrome include:
- Loss of appetite and weight (unrelated to another medical condition).
- Lack of energy and motivation.
- Sleep disturbances.
- Neglect of self-care activities.
- Loss of interest or pleasure in activities.
- Loss of self-worth, feelings of worthlessness, self-loathing, or being a burden.
- Uncharacteristic displays of crying, excessive irritability and/or anger.
- Slowed movement or speech.
- Social withdrawal and self-isolation.
- Increased confusion and impaired thinking.
- Difficulty concentrating.
- Memory problems.
- Expressing feelings of hopelessness, emptiness and despair.
- Preoccupation with or fixation on death.
- Suicidal ideation or attempts.
How is depression diagnosed and the mental state of an ageing or elderly person assessed?
There is no single test to definitively diagnose depression in an older person, because there are so many variables and complicating factors, such as other medical conditions and side effects of, or interactions between, certain medications. Diagnosis requires careful and thorough evaluation by a medical professional.
The mental state and functional capabilities of older people are generally assessed by a screening process that includes:
- A review of personal and family medical history.
- A physical and mental examination.
- General observation.
- An interview with the older person and their family or carers.
- A cognitive test.
Most Australian practitioners use the Mini-Mental State Exam (MMSE), which tests the older person’s orientation, attention, language, and recall, and is considered to be a generally reliable and valid screening tool for assessing cognitive impairment.
What to do if you see signs or symptoms of depression
If you identify any of the signs or symptoms of depression listed above, or notice any other behavioural changes, in the ageing or elderly person you care for, discuss them with the person’s primary doctor and arrange for the older person to be assessed by an Aged Care Assessment Team (ACAT).
If the older person receives in-home care or assistance, it can help to speak with any carers who have regular interaction with the older person, prior to speaking with the person’s doctor. These people will be able to provide more information on the older person’s daily activities and, possibly, greater insight into their mental state.
It may also be helpful to ask the older person’s doctor for a referral to a geriatric psychiatrist, who specialises in diagnosing and treating depression in older adults.
Treatment of depression in older adults
Optimal treatment of depression in ageing and elderly people generally includes a combination of strategies, including medication, counselling and a concerted effort by caregivers to gradually reconnect the older person with activities, hobbies and people that increase their happiness.
Medication is an option that may be discussed between the older person, their carer or loved one and their doctor. You should discuss side effects, risks, benefits and need for monitoring and follow-up. Counselling is also a possibility, but may or may not be useful, depending on the older person’s cognitive capabilities and the presence and/or severity of dementia.
As a loved one or caregiver to the older person, perhaps the most important areas of their life you can help with are:
- Routine: Identify the older person’s physical and psychological rhythm and implement a daily routine to accommodate this. For example, schedule difficult tasks (those that require more energy, effort or motivation, such as attending to personal hygiene and grooming) for the person’s “best” time of day.
- Exercise: Assist the older person to undertake regular exercise, within the person’s capability, particularly in the morning.
- Nutrition: Ensure the person is eating regular and nutrient-dense meals – if the person lives alone you could arrange for a home care service that can provide domestic assistance, including assistance with grocery shopping and meal preparation
- Happiness: Identify activities that the person particularly enjoys or finds soothing, such as playing games, watching a certain TV show, reading a book, listening to music or playing an instrument, or visiting favourite places or people. Then, schedule these things more frequently.
- Socialisation: If the person lives alone, encourage them to connect with other people. They could perhaps join a seniors “Friendship Club”, where they can meet and interact with new people. If their mobility is limited, you could assist them to access transport services to take them on outings or to go shopping.
- Self-esteem: Assist the person to find a purpose and feel useful. Depending on their cognitive abilities and level of mobility, they may gain a sense of purpose and self-satisfaction from volunteering, joining an organisation or club, tending a community garden or looking after a pet.
- Your empathy: Acknowledge the person’s feelings without judging them, express and encourage hope for the future and reassure the person that they have your support and are loved, respected, and appreciated.
Help for caregivers of depressed elderly people
If you are the depressed older person’s main caregiver, and caring for them is becoming a strain, contact a support service that can assist you to access respite care, provide advice on finding or choosing a residential aged care facility, access in-home care and assistance.
You may also want to consider finding a support group (for both yourself and the depressed older person), as it can be helpful to connect with other people who are in similar situations and dealing with similar issues.
Access Aged Care Support Services through ConnectAbility
ConnectAbility Australia provides all the aged care advice and support services you need, helping you to find and access appropriate in-home care services or Supported Independent Living services that are perfectly matched to your own and your loved one’s needs.
If you would like more information on how ConnectAbility can help an older person suffering from depression to feel more supported, connect with other seniors, and regain a sense of purpose, please call us on 02 4962 1000 (Newcastle) or 02 4349 3700 (Central Coast). Alternatively, you can email us at firstname.lastname@example.org or complete our contact form to have a ConnectAbility representative contact you.