Signs to look for
Here are some warning signs of depression in adults over 65, according to the United States Administration on Aging and www.helpguide.org:¢ Persistent, vague or unexplained physical complaints ¢ Memory problems; difficulty concentrating ¢ Social withdrawal ¢ Decreased appetite and weight loss or weight gain ¢ Sleep disturbances: daytime sleepiness, difficulty falling asleep, multiple mid-night awakenings, early morning awakening ¢ Irritability or demanding behavior ¢ Lack of attention to personal care ¢ Feelings of discouragement or hopelessness ¢ Loss of interest in normally pleasurable activities; inability to feel pleasure ¢ Prolonged grief after a loss ¢ Reduced energy, fatigue ¢ Abnormal thoughts; excessive or inappropriate guilt ¢ Suicidal thoughts or attemptsSigns of depression are often difficult to detect in older adults, so attentiveness is key. Look for a change from what is normal behavior for an individual. If you are concerned about an older adult who may be suffering from depression, suggest help. The Administration on Aging says some of the best help you can provide is to be "patient and understanding" and to "talk with the older adult and support the prescribed treatment."
People might expect to lose hearing or sight as they age. In fact, they're likely to accept and adapt to the change.
But losing happiness?
That's one change many experts say the elderly don't have to accept.
Ruth Shadel, aging specialist at Bert Nash Community Mental Health Center, says depression is the most common condition she treats in older adults.
"But it's not an aging thing," she says. "It is just that a lot of older people are depressed."
The assumption that sadness or depression is to be expected in older adults often leads to absence of diagnosis. Sometimes symptoms go undetected because they're overshadowed by other serious physical ailments - or simply a lack of interaction with those who otherwise might have noticed a behavior change.
Concern about depression in older adults prevails in elderly care facilities, especially as the elderly population increases rapidly. Depression affects more than 6.5 million of the 35 million Americans who are 65 years or older, according to the National Alliance on Mental Illness, and the United States Administration on Aging estimates the population of Americans over 65 will reach 40 million by 2010.
Many of those people will end up in long-term care facilities.
But Steffany Brosa, director of social work at Brandon Woods Retirement Community, 1501 Inverness Drive, says alterations are being made to help long-term care residents cope as their lives change.
"I think (depression) is pretty widespread in a long-term care setting because of the number of older people that have experienced loss," Brosa says. "They could have the loss of a spouse, loss of a social-support system, families moving away - and that often coexists with other medical conditions. Sometimes there is still that stigma for getting treatment, so they are more reluctant to seek help because of that stigma."
Losing, regaining power
Cole Ridley, a Baker University student, witnessed a person dealing with loss while working as a student volunteer at a nursing home. There he met a woman who had been diagnosed with depression after the recent death of her husband. Although she had a support system in place, it didn't take long to notice the lack of excitement and expression on her face.
"One of the very last times I spoke to her one-on-one, we worked our way into conversation about her being able to feel motherly," Ridley recalls. "Now her husband was gone and her children were grown and she didn't know what she was here for anymore."
Ridley says the woman's loss of independence seemed to contribute to her depression.
"She had no power over her own life," he says.
This woman's behavior is typical of a person, at any age, suffering from depression. Warning signs include changes in sleeping habits, eating and expressing emotions. Older adults with the condition may also exhibit memory problems, confusion and social withdrawal.
Brosa says that even though depression can occur in a nursing home or retirement community, there are strategies to try and prevent it.
"For most people, a nursing home doesn't conjure up happy thoughts," she says. "They think, 'Oh, it is smelly and everybody is confined.' If they came and spent some time, they'd realize the person-centered concept is the way (nursing homes) should be going."
This approach centers on the idea of allowing a person to continue life as normally as possible, despite having entered a living situation with more care.
"Before a person becomes a resident, we ask, 'How do they spend their day?'" Brosa says. "If they were a person who likes to sleep in until 10 a.m. or enjoy watching their morning shows, we can do that. Whatever they are used to at home, that is what we want to do. We want it to be as if we are working in their home, not they are living where we work."
'Not looking forward to it'
Jean Woolard, resident at Pioneer Ridge Retirement Community, 4851 Harvard Road, says the person-centered philosophy has helped her mood. When she "didn't have a choice" about entering a retirement community, she thought her future might be grim.
"All I knew about rest homes was all you had was a cot and a lamp, and I was not looking forward to it," Woolard says. "But then I saw it, and it was beautiful. I have an apartment; I have my own bed. And that was just the beginning of it."
In addition to her own apartment-style living quarters, Woolard has a full calendar of activities planned by workers at Pioneer Ridge, which are presented as options, not requirements.
Shadel says when it comes to treating older adults diagnosed with depression, it's important to remember the situation is not hopeless.
"I would say the therapy is similar to the way younger people are treated, but it might take longer to address certain issues," she says. "I think you have more issues to consider with older adults - which can be a positive. They have a whole history to draw upon, so you have more rich information to work with."
Taking baby steps
Sometimes it's difficult to make an older adult comfortable with receiving therapy, overcoming a "pull myself up by the bootstraps" attitude, Shadel says. But she suggests asking more questions.
"There's help out there for them. Let them know depression is very treatable - even for older adults," Shadel says. "I usually try asking them, 'How long have you been trying to do that?' or 'How about giving this a shot?'
"Older people are much more accepting than people think. If you help them understand the benefits and let them know they don't have to stick with it if it is not working, most are willing to give it a chance."
Myra Hyatt, a social worker for the Landon Center on Aging at the University of Kansas Medical Center, says therapy for depression in older adults is very often about replacing disordered thinking.
"It is very challenging," she says. "Many have core beliefs they have held for decades and (continue to) hold onto. I think it's just a matter of visiting that at every session and asking a patient to take baby steps."
For family and friends of those coping with depression, Hyatt says there are ways to help.
"I think accompanying an adult to a doctor visit or just being aware of the symptoms of depression (can be helpful)," she says. "The family can help point things out gently.
"I think people can educate themselves on aging. There are a hundred thousand books on aging. Take it seriously, and demonstrate you are concerned."