Depression in general is characterised as a psychiatric disorder in which a person has a constant feeling of discouragement, sorrow and self-worth. There has been a widespread distress in elderly people in recent years. An approximate 6 million Americans aged 65 years and older are impacted by an elderly depression (Duckworth, 2009). Available evidence shows that older adults are at risk for depression and have the greatest incidence of depression-related symptoms and depression suicide. The problem is intensified by the reality that the health sector and its clinical aversion neglect the elderly. It is known that just 10 percent of the elderly are screened for the disease (Lovestone and Howard, 2006). This can largely be attributed to different display of depression symptoms among the elderly and therefore delay in treatment. Among many old people, depression is often confused with the effects of other illnesses and the medicines and therapies used in treating them (Blazer, 2002). This choice of elderly depression for this paper was informed by the need to understand the condition since my father has suffered elderly depression severally. This paper will focus on the various dimensions of elderly depression including causes, risk factors, and treatment among others.
When individuals get older, life transitions are major which may place them at risk of depression. Health, psychological, and social research have established many contributing factors that lead to elderly depression. Health issues are the first significant source of elderly depression (Williamson, Shaffer and Parmelee, 2000). Disability and sickness, cognitive impairment, acute or persistent discomfort and body injury induced by cancer or procedure may be a significant source for elderly distress. Many medical problems may trigger distress in the elderly. The medical conditions that may trigger elderly distress, either directly or by psychological reactions to a disease or condition, are essential to recognise (Chew-Graham, Baldwin and Burns, 2008). Both chronic problems, particularly if they are life-threatening, impaired or painful, may contribute to depression or to worse symptoms of depression. The medical conditions that have been identified to cause elderly depression are: stroke, diabetes, lupus, thyroid disorders, Parkinson’s disease, cancer, Alzheimer’s disease and dementia, multiple sclerosis, Vitamin B12 deficiency, and heart disease (Duckworth, 2009).
It is also important to note that isolation and loneliness have been identified as major causes of elderly depression. Many old people are living alone and their social circle is dwindling due to relocation or deaths. This has serious implications on how elderly people live their lives and react to life situations. Also, as people grow beyond 65 years, their mobility decrease due to loss of driving privileges or illnesses (Lovestone and Howard, 2006). This situation further leads to isolation and loneliness and will most likely cause depression. Elderly depression has also been associated with reduced sense of purpose among the elderly. More and more elderly people tend to have feelings of purposelessness, as well as loss of identity because of physical limitations on activities or retirement. Studies have found out that elderly people have multiple fears that contribute to depression (Unutzer, 2007). Many elderly persons fear dying or death and are anxious over health issues or financial problems. Immediate or recent bereavement of family members, pets, spouse or partner and friends also leads to elderly depression. It is worth noting that elderly depression can also be a side effect of certain medications often prescribed to elderly people to treat conditions such as hypertension. Depression in the elderly may be exacerbated and rendered more problematic by opioid misuse and drugs such as alcohol and antidepressants (Blazer, 2002).
Different reports also established contributing factors for elderly depression. The causes that raise the likelihood of depression include: difficult lifestyles, unmarriedness, widowedness, divorce or single, being female, some medications, family background for major depressive diseases; prior history of depression and lack of social support (Duckworth, 2009). Older people appear to be at higher risk than men and women are typically twice more vulnerable to major depressive illness as men. Biological causes including hormone shifts are some of the explanations cited to render women more prone to depression in the elderly. Moreover, the pressures of sustaining marriages or of caring for loved ones usually greatly impact women and thereby lead to higher rates of depression. Widowed and single persons and people with a social network of encouragement seem to have higher rates of depression (Lovestone and Howard, 2006).
While all of the normal signs of depression are observed, elderly depression can be difficult to identify. This is because common symptoms such as appetite loss, trouble sleeping or insomnia, and fatigue can be part of the physical illness or aging process (Blazer, 2002). As a result of this, early depression signs may be ignored or be confused with other conditions that are common among the elderly population. This is the explanation it is important to understand the early and late symptoms of elderly depression. It is equally important to ensure that exams and tests are taken to see whether one is suffering from elderly depression. The nurse or doctor should examine and ask questions to the elderly or his or her caregiver on his or her symptoms and medical history. Also, urine and blood tests may be taken to look for any physical illness (Williamson, Shaffer and Parmelee, 2000). If elderly depression is not established through initial exams and tests, it is important that the elderly person be referred to a mental health specialist to assist in diagnosis and treatment.
So, what are the symptoms of elderly depression? It is not always easy to distinguish between the elderly depression symptoms and symptoms for physical illnesses and other situations such as grief (Chew-Graham, Baldwin and Burns, 2008). However, with depression, it is always easier to identify the constant feelings of despair and emptiness. Elderly depression may also be characterized by slow body movements and speech, as well as hearing and seeing things that are not there. Additionally, elderly depression is characterized by feeling of worthlessness and hopelessness due to factors such as loneliness and isolation. It is also possible to see a depressed elderly person displaying pervasive and intense sense of guilt (Lovestone and Howard, 2006). This symptom may also be accompanied by preoccupation with dying or thoughts of suicide. Elderly depression can also be identified by seeing inability to function at home or work on the part of the elderly person. Elderly depression is often characterized by: social withdrawal, irritability, hallucinations, vague complaints of pain, loss of appetite, delusions, confusion, weight loss, inability to sleep or insomnia, and memory problems (Unutzer, 2007).
It should also be noted that depression in elderly people somewhat differ from depression in other populations in the society. Elderly people with depression often have severe sadness feelings that are frequently not acknowledged or shown openly. Sometimes elderly people do not admit to being depressed (Williamson, Shaffer and Parmelee, 2000). Therefore, it is important for one to be in a position to identify some general clues to know if an old person is experiencing depression. These clues may include: moving in a slower manner, help-seeking, vague and persistent complaints, and demanding behaviour. Depression impacts elderly people differently than other members of society. Elderly depression frequently occurs with other disabilities and medical illnesses and tends to last longer. Elderly depression doubles the risk of cardiac diseases and enhances the risk of death from diseases and illnesses (Blazer, 2002). It also reduces the ability of an elderly person to rehabilitate. It has been found out that elderly depression increases the risk of suicide. It is because of these reasons that elderly depression is considered as a major public health problem. Considering the changes in the circumstances of the elderly people and the perception that elderly people are expected to slowdown, family and doctors may miss the symptoms and signs of elderly depression. Consequently, effective treatment and rehabilitation gets delayed and thereby forcing elderly persons to struggle with depression, unnecessarily (Duckworth, 2009).
Since the cause and results of elderly depression are dire, it is necessary to correctly identify and manage the disease. A clinical examination can decide whether symptoms of elderly depression are related to physical and other medical conditions. Health problems and their care in the elderly are normal (Chew-Graham, Baldwin and Burns, 2008). A review of specific prescriptions is significant, and in many situations a minor dosage adjustment will minimise the severity of the symptoms. A psychiatric and professional interview is an important screening factor. Chat with near friends and family members to create a diagnosis would also be beneficial. Imaging and blood testing have proven beneficial so far because they rule out other medical problems that involve a particular treatment (Unutzer, 2007). There have been concerns over the years regarding the management of depression and elderly depression. The prognosis of care for this disorder is strong. Present research shows that nearly 80 percent of chronically suicidal patients will be successfully handled by electric convulsive therapy (ECT), medicine, psychotherapy or some mixture of these three when diagnosed. The FDA has recently become clear about a potential therapy for transcranial magnetic stimulation (TMS) which will help to relieve moderate depression (Williamson, Shaffer and Parmelee, 2000).
Medicines have been effective in treating the suffering in certain aged citizens. Four separate classes of drugs have been used to combat psychiatric disease effectively: monoamine oxidase inhibitors, tricyclics, norepinephrine and serotonin reuptake inhibitors and specific serotonin reuptake inhibitors (SSRIs). Adherence to prescriptions is of particular significance, as it may cause problems for older people (Lovestone and Howard, 2006). Because all medications have both adverse effects and advantages, the right medication is focused on the tolerability of the side effects. ECT may be very helpful in older people in managing extreme depression. ECT may be a vital lifesaving technique for aged people carefully chosen. Drugs may be particularly helpful for older people in the management of signs of depression. Medicines are also paired with cognitive behavioural or supportive psychotherapy to boost their efficacy. Several reports have shown that certain troubled seniors may need to assess more than one drug to receive an appropriate care (Blazer, 2002).
Considering the fact that elderly depression results to psychosocial consequences, psychosocial treatment plays a very important role in the care of elderly patients who have significant lack coping skills, lack of social support, or life crisis to deal with their life situations (Duckworth, 2009). Since a vast percentage of seniors reside independently, miss communication with a preferred health care provider or insufficient service structures, specific measures need to be taken to recognise and find them for the care they need. Normal assistance can be welcomed, such as bridge mates and churches. While elderly programmes are available, the issue of psychiatric depression must be identified before therapy begins (Chew-Graham, Baldwin and Burns, 2008). Depression is a chronic disease like arthritis or diabetes. Although getting well may seem to be the main challenge, staying well after treatment is the real objective. It is therefore recommended that treatment should be administered for six months to one especially for people who are experiencing their first depression episode. In the case of elderly people who have had two or three episodes during their lifetimes, it is important for treatment to be extended up to two years after remission (Williamson, Shaffer and Parmelee, 2000). Treatment may be life-long for elderly people with more than three depression recurrences.
The first treatment steps for elderly depression are: treating any illness that may cause the symptoms; stopping to take medications that may result to worse symptoms; and avoiding sleep aids and alcohol. In an event that these steps do not assist, medications to treat depression and therapies might be used (Lovestone and Howard, 2006). Medical practitioners and particularly the mental health practitioners prescribe lower antidepressants doses to elderly people, and gradual increase in the doses depending on how elderly people respond to treatment. It has been proved that depression frequently responds to medications and treatment in general. Usually, the outcome is usually better for people who have access to friends, family, and social services who can assist them stay engaged and active (Unutzer, 2007). However, there are worrisome complications, the most worrisome being suicide. Therefore, families should pay closer attention to elderly persons who live alone and are depressed. It is important for elderly individuals and particularly persons close to them such as family, friends and caregivers to call health care provider if elderly person feel persistently hopeless, worthless, or sad. Also, when elderly person is having trouble to cope with life stresses, it is important for them to be referred to therapy options (Chew-Graham, Baldwin and Burns, 2008).
Apart from medications, overcoming depression often involves other options such as self-help for elderly people. Elderly people can learn to adapt to change, be socially active, and staying physically active, as well as feeling connected to loved ones and to the community. The more active an individual is socially, mentally, and physically, the better he or she will feel (Blazer, 2002). Therefore, exercise will be important; physical activity is powerful in boosting the moods of elderly persons. Analysis has actually indicated that exercise may just be as effective as antidepressants to relieve depression. Its biggest value is that there are no side effects. One may not be required to hit the gym to exercise, doing light housework, taking a short walk, and taking stares are example of safe exercises that can help boost the mood and build strength of the elderly person. Also, connecting with others is the other alternative way of addressing elderly depression (Duckworth, 2009).
Getting the support of others can help elderly people lift the depression fog and keeping it away. It can be hard for an individual to maintain perspective and sustain efforts required in beating depression. While an elderly person may not feel like reaching out, one can make an effort of connecting to others and limiting the time they are alone (Williamson, Shaffer and Parmelee, 2000). If an elderly person cannot get out socializing, he or she can invite friends and family members to visit, or keep in touch through email or over the phone. It will also be important for an elderly person to bring his or her life into balance (Blazer, 2002). Learning emotional intelligence skills and new emotional management skills is critical especially when one is feeling overwhelmed by pressures and stress of daily life. The other self-help tips of combating and preventing elderly depression include: getting enough sleep; maintaining healthy diet, participating in activities they enjoy; taking care of a pet; creating opportunities to laugh; volunteering time to help others and expanding social network; and learning new skills(Lovestone and Howard, 2006).
The above discussion describes various aspects of elderly depression in details. As has been noted, there is a widespread depression among the elderly. Available data indicate that older people are at risk for depression and have the highest rates of complications associated with depression, as well as suicide caused by depression. Several causes of elderly depression have been identified, as well as the symptoms of this condition. It is critical to understand the causes and symptoms so as to help address this condition and assist the elderly people to live a normal life. There are various treatment options for elderly depression; depression can be treated through medications and various therapy options and this can be important in assisting them recover and avoid the complications of elderly depression. In addition to medications and therapies, it is important that elderly people suffering from depression engage in self-help activities that can help combat depression such as exercises and connecting with others.
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