UNDERSTANDING DEPRESSION IN LATER LIFE

1. UNDERSTANDING DEPRESSION IN LATER LIFE Sean Brotherson, Ph.D. Extension Family Science Specialist

2. Lesson Objectives • Understand key issues relating to depression in later life • Learn about signs of depression in later life • Explore specific strategies for managing depression in later life • Gain knowledge of specific resources to deal with depression in later life

3. True or False? Depression only develops when someone has had a major traumatic experience in life, such as the death of a spouse or a heart attack.

4. Answer - False • Myth – Depression occurs only when people experience major trauma in life. • Reality – Depression is a commonly occurring mental health condition that may arise due to a variety of factors, including genetic influences, body changes, life stress or other influences.

5. True or False? Individuals dealing with depression usually can overcome it if they just work to cheer themselves up or pull themselves up by their bootstraps.

6. Answer - False • Myth – Depression can be overcome simply by telling yourself to feel better or pulling yourself up alone. • Reality – Depression is a complex medical and mental health condition that typically improves with a variety of approaches, which may include therapeutic support, social support, exercise, diet, rest and medication.

7. True or False? Seeking assistance from a doctor or mental health professional for depression is a sign of inability to handle your problems or personal weakness.

8. Answer - False • Myth – Individuals dealing with depression are emotionally weak or unstable and seeking help is a sign of weakness. • Reality – Depression is a condition that anyone can experience. Seeking assistance from competent professionals often is necessary and signals wisdom, understanding and strength.

9. Depression in Later Life • Can cause problems with thoughts, feelings and behavior • Causes physical difficulty, emotional fatigue and mental anxiety • Can be treated effectively when diagnosed • Is everyone’s responsibility

10. Who is at risk for depression? Aging community members who: • Live alone • Are economically disadvantaged • Have no relatives or friends nearby • Have experienced recent losses (job, pets, friends, family members, moves, etc.) • Have been ill or have a progressive or chronic illness • Have personal experience or a family history of anxiety or depression • Have undergone significant challenges with family stress, economic stress or other concerns

11. What is depression? Definition: A mental health condition characterized by an inability to concentrate; insomnia; loss of appetite; physical tiredness or fatigue; feelings of extreme sadness, guilt, helplessness and hopelessness; and thoughts of despair, discouragement and death. Also called clinical depression. Prevalence: 3.8% of people over age 55 residing independently in the community suffer from major depression in any given year. (www.surgeongeneral.gov)

12. Difficulty falling asleep Sleep more than usual Feel tired all of the time Feel less energetic than usual Feel nervous or unable to sit still Experience an increase or decrease in appetite or weight Feel sad or blue most of the day nearly every day Have trouble making decisions Think about suicide Have problems concentrating Be irritable Lack motivation Lose his or her temper more easily than usual Lose interest in things that he or she used to enjoy Symptoms of Depression

13. Personal history of: Chronic medical illnesses Chronic pain Loss of physical functioning Prior depressive episodes Recent significant loss Multiple recent stressors Social isolation Family history of: Recurrent depression Bipolar disorder Alcohol abuse or dependence (www.positiveaging.org) Risk Factors for Depression

14. Anxiety Issues Definition: Anxiety issues represent a mental health condition involving the presence of anxiety so intense or frequently present that it causes difficulty or distress for the individual. Prevalence: 11.4% of the population over age 55 suffers from an anxiety disorder in any given year. (U.S. Department of Health and Human Services)

15. Excess or undue worry or fear Fatigue Disturbed sleep Jumpiness, jitteriness, trembling Muscle aches, tension Dizziness, lightheadedness Gastrointestinal upset Racing heartbeat, chest discomfort Shortness of breath or the feeling of being smothered Numbness or tingling of hands, mouth or feet Dry mouth, sensation of a lump in the throat, choking sensation, clammy hands, sweating Symptoms of Anxiety

16. Personal history of: Depression Anxiety disorder Chronic medical illness Loss of significant person during childhood Cognitive impairment Alcohol abuse/dependence Social isolation Family history of: Alcohol abuse Anxiety disorders Mood disorders Other factors: Female gender Exposure to traumatic event (www.positiveaging.org) Risk Factors for Anxiety

17. How can I help? • Knowing the signs of depression can help you understand when someone may need a kind word, a referral to a mental health professional or encouragement to seek help. • Consider the suggestions in the following material to understand what to watch for and how you might help.

18. What should I look for? Physical Appearance • Dirty clothing, skin or hair • Body odor, unshaven, hair uncombed • Little attention to clothing to wear, appearance • Significant weight loss or weight gain • Fatigue or exhaustion from lack of sleep, despair, etc. www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

19. What should I look for? Emotional State • Anxious, nervous, fidgety • Lack trust, suspiciousness, blaming • Angry, hostile, irritable • Rapid mood changes • Statements such as “no one cares” or “I’m all alone” • Sense of discouragement, lack of hope, helplessness www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

20. What should I look for? Personality Change The person’s usual character or personality may seem different than in earlier years. ▪ Decreased social contacts, isolation from others ▪ Sloppy appearance, lack of care for surroundings ▪ Lack of eye contact, limited social engagement ▪ Preoccupation with health concerns, losses, life challenges or sadness ▪ Lack of interest in hobbies, friends, or things the person formerly enjoyed ▪ Difficulty making decisions www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

21. What should I look for? Living Conditions ▪ Walks not shoveled, lawn not mowed ▪ Neglect of pets, farm animals or family members ▪ Little or no food ▪ Old newspapers or dirty dishes lying around – limited care of surroundings ▪ Calendar on wrong month – little attention to time ▪ Shades drawn, garden/flowers neglected – signs of isolation www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

22. What can I do to help? • Express sincere concern • Demonstrate kindness • Listen; be supportive and gentle • Use calm tone of voice and manner • Exhibit a nonjudgmental attitude • Refer the person for help or contact a family member www.nursing.uiowa.edu/hartford/nurse/Gatekeeper1.pdf

23. Protective Factors in Managing Depression • Effective clinical care for ongoing depression or anxiety, including medication if needed • Easy access to a variety of clinical interventions and support for help seeking • Family and community support • Support from ongoing medical and mental health-care relationships • Healthy living practices that include sufficient sleep, healthy diet and regular exercise • Skills in problem solving, stress management and conflict resolution • Cultural and religious beliefs that encourage hope, optimism and personal support efforts

24. Seeking Treatment and Support for Depression • Social stigma associated with mental health problems prevent many people, especially the aging, from seeking professional help. • For many people, the initial entry point for assessment of mental health concerns is their primary physician or general practitioner • Begin by seeking an opportunity for a medical screening about anxiety or depression. Or talk to a trusted counselor, pastor or friend.

25. Barriers to Diagnosis and Treatment • Age-related changes • Illness • Attitudes of others • Denial • Alcohol or drug use • Health complaints • Stigma

26. Sharing Your Concerns • Avoid talking to the person if he/she is upset or under the influence of drugs or alcohol. • Be gentle and kind. • Avoid a confrontational style. • Avoid using labels because they may carry a heavy stigma. • Take into consideration the person’s age and ability to understand.

27. Sharing Your Concerns • Be consistent and patient in your expression of concern without exerting undue pressure. • Be direct; treat the individual as an adult. • Give specific examples of behaviors that concern you. • Use statements such as “I am concerned about you.”

28. Sharing Your Concerns • Be prepared with referral information. • Don’t be discouraged if the person is not ready to accept your assistance. • Don’t worry if you don’t say things perfectly. What is important is your message of concern is conveyed and your willingness to help is expressed. • Encourage a person to get proper professional assistance from a primary care doctor, mental health professional or other trusted professional source.

29. Resources • Visit the North Dakota Mental Health and Aging Education Project at: www.ndsu.nodak.edu/ndsu/aging/mentalhealth/index.html Mental Health • Mental Health America of North Dakota at: www.mhand.org • Positive Aging Resource Center at: www.positiveaging.org