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How to Recognize Depression in Elderly Clients - Tips for Caregivers

Mental health is just as important as physical health, but sometimes it gets overlooked. Depression is one of the most common mental health issues that affect older adults.

It is not a normal part of old age, but it is still very common in older people. In the US alone, almost 6 percent of adults over the age of 65 suffer from some form of depression.

Sometimes it can be difficult for older people to recognize it, and sometimes they are reluctant to ask for help even when they do. From the point of view of a caregiver, sometimes, depression is mislabeled as the challenging behavior of a client.

It is, therefore, of great importance that a caregiver keeps an eye out for symptoms of depression in their clients, and encourage them to get proper help if necessary.

Is It Really Depression?

It's important to differentiate between depression and normal bad moods and feelings of sadness.

Depression is characterized by sadness, despair, and discouragement. What differentiates it from just a regular bad mood is that it has to be a departure from the way the person is normally, and it has to last more than two weeks. It also usually interferes with their daily activities and normal functioning.

Depression in Older Adults

It's important to understand that depression is not a guaranteed part of the aging process. Older people experience sadness and grief, but this should be temporary. And most importantly, it shouldn't significantly interfere with their daily living.

Depression is serious especially when it lasts a long time and interferes significantly with daily activities. Older adults should be screened regularly for depression, and it should be treated as soon as possible once diagnosed. If left untreated, depression may lead to all kinds of other illnesses and medical conditions.

It seems to be a common myth that lots of old people are grumpy, sad, and miserable, and that this is just a part of getting old. This is not true. While some people may be a little grumpy by nature, being sad or irritable all the time should not be expected as we grow older.

People who have led satisfying lives have reached most of their lifetime goals and who have a strong support system can expect to be relatively happy and content in old age.

However, older adults are in some ways more susceptible to depression, due to life events or situations that could contribute to becoming depressed.

Depression Symptoms to Look out For

Symptoms of depression can differ for every individual, and depression in older adults can look very different than it does in younger people. However, there are some common behavioral and physical symptoms that are typical of depression.

A Depressed Mood

When we refer to a depressed mood, we are talking about a state that is present almost every day for most of the day for at least two weeks. The depressed person's ability to smile or laugh diminishes greatly, and it is very difficult for them to work up a different kind of mood.

They take very little interest or pleasure in any kind of activity, including activities that they usually enjoy.

Significant Weight Loss or Gain

Changes in weight are a common sign of depression. This is because depression often affects the appetite. Some people lose interest in food and even struggle with digestive problems, and that results in weight loss.

Other people turn to comfort foods when they feel depressed and eat more to find comfort. Combined with decreased movement and exercise, that results in weight gain.

Sleep Disturbances

Mental illness can greatly affect our quality of sleep and sleeping habits. A lot of depressed people experience either insomnia or hypersomnia.

Hypersomnia is excessive sleep. It is one of the most common symptoms of major depression. A lot of people who suffer from clinical depression sleep ten to fourteen hours a day.

On the other hand, insomnia is difficulty sleeping. It can be characterized by the inability to fall asleep or the inability to stay asleep. Insomnia and depression together can be especially difficult because lack of sleep can cause depression to get worse.

Nervous Anxiety

Anxiety and depression are mood disorders which often go hand in hand.

Anxiety usually consists of excessive and sometimes irrational feelings of worry, fear, and nervousness.

When these two mental disorders combine, they often present as helplessness, irritability, or even rage. Sometimes people who suffer from anxiety, or depression, or both, seem more angry than sad.

The anxiety state can cause negative thoughts to repeat over and over, making it more difficult for the person to change behavior patterns or take actions to improve their situation, leading to anger and frustration that others can see.

Living in Slow Motion

Sometimes people who suffer from depression appear as if they're living in slow motion. Their responses and actions are all slowed down. They seem overly calm and like they have lost interest in everything around them.

Guilt and Shame

People experiencing depression often blame themselves for it. Low self-esteem is common, and sometimes they even think that they don't deserve happiness or wellbeing. These feelings are sometimes so overwhelming that they feel incapable of making even simple decisions, like what clothes they want to wear in a day.

Suicidal Thoughts

Suicidal thoughts are not always present in depression, but some people experience them. For some people they might be just unpleasant, intrusive thoughts that come and go without a real intention to take their own life, but for others, these thoughts can persist for a long time and get more intense over time, leading them to think about and plan it out.

Causes and Risk Factors

Mental health is complex. There are many factors that can cause or lead to an increased risk of depression for some people.

Genetics and Brain Chemistry

Family history of depression is a significant risk factor. Research suggests that in around 40 percent of the cases, depression is hereditary.

There are also chemicals in the brain called neurotransmitters that are linked to mental health conditions like depression. Serotonin is one of these that you may have heard of.

Serotonin helps the brain regulate sleep cycles, mood and emotions, appetite, digestion, concentration and other factors. When serotonin levels are low, all of those functions and more can be negatively impacted.

Dopamine is another neurotransmitter that can be involved with depression and other mental conditions. Dopamine is a “feel good” chemical that affects the brain’s pleasure and reward system and influences mood, sleep cycles, concentration, and body movement.

Low levels of dopamine can lead some to develop addictive behaviors toward activities and substances that increase dopamine levels short term. It can also cause increased appetite and affect digestion and metabolism.

Decreased levels of either or both of these chemicals can therefore lead to symptoms associated with depression and affect many aspects of how the body functions.

There are many other neurotransmitters that all work together in the brain, but these two are more commonly involved with depression symptoms.

Treatment for depression can include medications that target different aspects of this condition that change levels of neurotransmitters in the brain, as well as dietary and other lifestyle changes.

Hormonal Changes

Depression tends to run in families and women are twice as likely as men to experience depression at some point in their lives.

No one knows why, but it is suspected that the hormonal changes that occur in women in different life stages cause a higher risk. Many women find themselves feeling depressed after having a baby or during menopause, for example.

Physical, Emotional and Life Changes

Physical changes may make it harder to maintain a social support system. Health conditions and physical problems such as cancer, heart disease, thyroid problems, chronic pain, and many others increase your risk of becoming depressed.

Trauma and grief associated with violence or physical and emotional abuse can also trigger depression at any time in a person’s life.

Grief after the death of a friend or a family member is in itself a normal emotion, but like all forms of loss, it can sometimes lead to depression if it persists and worsens over time.

It's not surprising that people might become depressed during stressful times, such as during a divorce or while caring for a sick relative, yet even positive changes like getting married or starting a new job can sometimes trigger depression.

Certain medications and substances can cause symptoms of depression. Alcohol or substance abuse is common in depressed people which often makes their condition worse because the body starts to depend on those substances to feel good.

Some people have a clear sense of why they are depressed and others don't. The most important thing to remember is that a person is not at fault for depression.

It's not a character flaw. It's one of many health problems that can affect anyone. And regardless of the cause, there are many different ways to treat this condition to find relief.

Age as a Factor for Depression

Older adults may be more susceptible to depression than younger adults, for many reasons. Older people usually suffer from more medical illnesses.

The physical symptoms of those conditions may affect their quality of life. Even treatment or other medications can cause new physical complaints if side effects are significant.

Older adults also experience more loss at this phase of life - spouses, friends and family members may not be around anymore. Health or mobility issues frequently make the older person housebound, unable to leave the house independently.

An elderly person can sometimes no longer drive, making it difficult to stay connected with friends and family. This can lead to social isolation, which is one of the major risk factors for mental health issues in older people.

Economic and Financial Factors

For some older adults, one of the greatest fears is that they will lose their financial independence, and become a burden to their children or other younger people in their life.

Running out of money before you die is a true and legitimate concern. Life expectancy has risen significantly and income tends to be fixed after retirement. This can be a source of great anxiety in older adults, and also lead to depression.

Support and Treatment Options for Depression

There is no one magical cure for depression. However, there are several treatment options that can help. If you suspect a client has depression, the best course of action is to get them to consult a mental health expert so that they can come up with a treatment plan.

Talk Therapy

Talk therapy is a general term for all kinds of counseling, which is very effective in treating depression. Other terms you might have heard are psychotherapy, psychoanalysis, cognitive behavioral therapy, interpersonal therapy, and group therapy.

Regardless of the type of therapy, it usually involves a qualified counselor and the client together, exploring reasons behind the depression, methods for living with the symptoms and ways to cope with situations that could make the depression worse.

Individual counseling is always confidential. This is important to note, otherwise the client will not be relaxed enough to share personal and frequently painful experiences or thoughts.

The counselor is usually a licensed therapist with experience working with depressed clients, but other counselors may be doctors, nurses, social workers, psychiatrists, psychologists, ministers, or other clergy members.

Support groups are another option who prefer safety in numbers or could benefit from a shared discussion with others. If a client is not mobile or can't physically go to see a therapist, nowadays there are plenty of online therapy options.

Lifestyle Changes

What you can do as a caregiver is encourage your client to introduce some positive lifestyle changes and try to help arrange for these activities when they are able.

Lifestyle changes are not always well received when trying to help depressed older adults. Depression can cause a lack of motivation, which makes it hard to get started to try something new.

It is also more difficult for older people to change habits and patterns they have had for a long time even without depression, so gentle encouragement is a great way to start.

If you can help them find small changes in their day-to-day activities that they are willing to try, small steps with good results can help empower them to start making their own changes and managing their symptoms for themselves.

Making changes to their diet and daily movement can be easy first steps. Even people with limited mobility might be able to enjoy light exercise or a short walk. Even a few minutes of regular exercise can significantly reduce depression symptoms and risk.

Other changes can include seeking treatment options explained above. Encouraging them to look for a therapist or support group, keep medical appointments, see a mental health professional, and other self-help techniques can be a great way to support them to find relief and ways to feel better.

Medication for Depression in Older Adults

Medications used to treat depression are called antidepressants. There are several types of these medications.

Each type works in its own unique way, but in general, they all have the outcome of increasing certain brain chemicals that produce positive emotions. There are many different types of drugs to treat depression, just like there are many different factors that lead to depression.

Doctors prescribe medications and hope they will help right away, but sometimes a person will need to try a few different kinds before they find a good fit for their body chemistry.

Older adults might be hesitant to try medication to treat their condition. They might feel that they deserve to feel the way that they do because of past mistakes, or that seeking medication might make them seem weak.

Because depression is an illness in the mind and not one you can see, this can be a common stigma across all age groups. The truth is that depression can be a daily battle that takes a lot of mental strength to endure and everyone deserves to feel good about their life.

Medications can seriously help by working directly with the helpful chemicals in the brain that make symptoms easier to manage.

Antidepressants are designed to increase the amount of neurotransmitters that are in the brain, or help change how the brain uses them for the highest benefit. There are different classes of medications designed to do this in a few different ways.

It can take time for symptoms to improve when starting a new medication, so it’s important to remember it’s not likely that they will feel 100% better right away. Sometimes the first medication will not work and before starting a new one they will need to slowly stop taking it over time.

This is all very normal for people in all age ranges, and once the right treatment is discovered it can be extremely effective to reduce or eliminate symptoms.

This can be a long process which requires patience, and older people often need support while looking for the right treatment. You can help support them through the process, and make sure to help keep track of their medications so they continue taking everything prescribed.

Emotional Support for Depression in Older Adults

People who have experienced depression need a lot of support, emotionally and physically sometimes. Older people can be especially fragile. As a person of trust, you can help them manage symptoms and handle treatment.

It's always good to treat older people with respect, patience, and empathy, and that is especially true when they are dealing with depression.

Every day, treatment options for depression advance as research is developed. Even though older people are at an increased risk, with proper support, the right treatment, and lifestyle modifications, it is totally possible for them to overcome this and live a fulfilled and happy life.

You can learn more about how to support your clients suffering from depression in Cornerstone's course CE304 | Recognizing Depression in Your Older Client.


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