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Alzheimer's, Dementia & Mental Health
Depression in Senior Citizens Found to Diminish
Ability to Plan and Control
Late-Onset Depression emerges in people aged 60 and
older
 June 23, 2006 The ability of senior citizens to
plan and control their thoughts and actions can suffer a noted decline
if they suffer from late-onset depression. This form of depression first
emerges in people aged 60 and over, is linked to a decline in the
brain's executive functions of planning and control that leads to
repetitive, negative thought patterns a new study reveals.
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More About Depression in Elderly |
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"Suicide is more
common in older people than in any other age group. The
population over age 65 accounts for more than 25 percent of the
nation's suicides." - Read more about depression in
elderly by the American Association for Geriatric Psychiatry
below this news report.
"Some people have
the mistaken idea that it is normal for the elderly to feel
depressed." - Read more about depression in elderly
by National Institute of Mental Health below this news report. |
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Published in the current issue of Cognitive Therapy
and Research, the finding is based on a survey of 44 people suffering
from depressive symptoms. Aged 6692 years, the study's participants
came from retirement communities in Sydney, Australia. The study's lead
author, Bill von Hippel, says evidence for the conclusion is based on
three findings.
"First, the people with late-onset depressive
symptoms showed poorer performance on executive function tests than
those with early onset depression." "Executive decline" is a normal part
of ageing linked to decreased efficiency in the brain's frontal lobes.
Typical signs of executive decline include disinhibition, rigid
thinking, inattention and a decline in working memory.
"Second, we saw that executive decline was
associated with rumination a tendency for repeated negative thinking
patterns -- among those with late-onset depression," says von Hippel,
who is associate professor of psychology at the University of New South
Wales. "We saw no such link among those who had early-onset depression."
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Feb. 6, 2006 - Previous studies have linked
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April
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will send you through the floor, or increase your anxiety, which is even
worse. A study presented today says people who do not have psychiatric
problems but score very high on a personality test pessimism scale have
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"Third, the link between executive decline and late
onset depression was brought about by their joint association with
rumination. That is, executive decline was only associated with
late-onset depression to the degree that it led people to ruminate. When
executive dysfunction did not lead to rumination, it did not predict
late-onset depression.
"Clinical rumination is like problem-solving gone
awry it's a wrong turn," says Dr von Hippel. "Looking inward and being
reflective is a useful thing to do, especially when negative events
happen in our life. But if we get stuck in a pattern of saying 'why me?'
there's a risk that we can spiral into a pathology. Instead of solving
the problem we just stew in it."
Dr von Hippel says longitudinal research is now
necessary to reveal whether executive decline causes excessive
rumination and late-onset depression, or whether some other related
process underlies these associations. "By measuring mental functioning
before and after late-onset depression develops, we'll get a clearer
idea of the role of executive dysfunction in the development of
excessive rumination and late onset depression. We also hope to get a
clearer idea of when executive dysfunction leads to rumination and when
it does not."
"What we can say is this," he adds. "Executive
decline is a normal part of ageing, but late-onset depression is not.
Feeling sorrow after negative events is also normal, but excessive
rumination is not. Our current research suggests that for some people,
these normal processes spiral out of control. Our goal now is to get a
clearer idea of when and why executive dysfunction leads to these
pathological outcomes, and what we might do to circumvent this process."
About author:
Bill von Hippel, Ph.D., is associate professor in
the school of psychology at the University of New South Wales (Sydney,
Australia). His research interests include social-cognitive ageing and
evolutionary psychology. Homepage:
http://www.psy.unsw.edu.au/Users/BHippel/.
Depression in the Elderly
National Institute of Mental Health
Some people have the mistaken idea that it is
normal for the elderly to feel depressed. On the contrary, most older
people feel satisfied with their lives. Sometimes, though, when
depression develops, it may be dismissed as a normal part of aging.
Depression in the elderly, undiagnosed and untreated, causes needless
suffering for the family and for the individual who could otherwise live
a fruitful life. When he or she does go to the doctor, the symptoms
described are usually physical, for the older person is often reluctant
to discuss feelings of hopelessness, sadness, loss of interest in
normally pleasurable activities, or extremely prolonged grief after a
loss.
Recognizing how depressive symptoms in older people
are often missed, many health care professionals are learning to
identify and treat the underlying depression. They recognize that some
symptoms may be side effects of medication the older person is taking
for a physical problem, or they may be caused by a co-occurring illness.
If a diagnosis of depression is made, treatment with medication and/or
psychotherapy will help the depressed person return to a happier, more
fulfilling life. Recent research suggests that brief psychotherapy (talk
therapies that help a person in day-to-day relationships or in learning
to counter the distorted negative thinking that commonly accompanies
depression) is effective in reducing symptoms in short-term depression
in older persons who are medically ill. Psychotherapy is also useful in
older patients who cannot or will not take medication. Efficacy studies
show that late-life depression can be treated with psychotherapy.
Improved recognition and treatment of depression in
late life will make those years more enjoyable and fulfilling for the
depressed elderly person, the family, and caretakers.
Depression in Women
Women experience depression about twice as often as
men.1
Many hormonal factors may contribute to the increased rate of depression
in women particularly such factors as menstrual cycle changes,
pregnancy, miscarriage, postpartum period, pre-menopause, and menopause.
Many women also face additional stresses such as responsibilities both
at work and home, single parenthood, and caring for children and for
aging parents.
Depression in Men
Although men are less likely to suffer from
depression than women, 6 million men in the United States are affected
by the illness. Men are less likely to admit to depression, and doctors
are less likely to suspect it. The rate of suicide in men is four times
that of women, though more women attempt it. In fact, after age 70, the
rate of men's suicide rises, reaching a peak after age 85.
Depression can also affect the physical health in
men differently from women. A new study shows that, although depression
is associated with an increased risk of coronary heart disease in both
men and women, only men suffer a high death rate.
Men's depression is often masked by alcohol or
drugs, or by the socially acceptable habit of working excessively long
hours. Depression typically shows up in men not as feeling hopeless and
helpless, but as being irritable, angry, and discouraged; hence,
depression may be difficult to recognize as such in men. Even if a man
realizes that he is depressed, he may be less willing than a woman to
seek help. Encouragement and support from concerned family members can
make a difference. In the workplace, employee assistance professionals
or worksite mental health programs can be of assistance in helping men
understand and accept depression as a real illness that needs treatment.
Click for more on depression at NIMH
Depression in Older People is Not Normal Part of
Aging
American Association for Geriatric Psychiatry
Depression is not a normal part of growing older.
It is a treatable medical illness, much like heart disease or diabetes.
Depression is a serious illness affecting
approximately 15 out of every 100 adults over age 65 in the United
States. The disorder affects a much higher percentage of people in
hospitals and nursing homes. When depression occurs in late life, it
sometimes can be a relapse of an earlier depression. But when it occurs
for the first time in older adults, it usually is brought on by another
medical illness. When someone is already ill, depression can be both
more difficult to recognize and more difficult to endure.
Depression is not a passing mood.
Sadness associated with normal grief or everyday
"blues" is different from depression. A sad or grieving person can
continue to carry on with regular activities. The depressed person
suffers from symptoms that interfere with his or her ability to function
normally for a prolonged period of time.
Recognizing depression in the elderly is not always
easy. It often is difficult for the depressed elder to describe how he
or she is feeling. In addition, the current population of older
Americans came of age at a time when depression was not understood to be
a biological disorder and medical illness. Therefore, some elderly fear
being labeled "crazy," or worry that their illness will be seen as a
character weakness.
The depressed person or their family members may
think that a change in mood or behavior is simply "a passing mood," and
the person should just "snap out of it." But someone suffering from
depression can not just "get over it." Depression is a medical illness
that must be diagnosed and treated by trained professionals. Untreated,
depression may last months or even years.
Untreated, depression can:
● lead to disability
● worsen symptoms of other illnesses
● lead to premature death
● result in suicide.
When it is properly diagnosed and treated, more
than 80 percent of those suffering from depression recover and return to
their normal lives.
The most common symptoms of late-life depression
include:
●
persistent sadness (lasting two weeks or more)
● feeling
slowed down
●
excessive worries about finances and health problems
●
frequent tearfulness
● feeling
worthless or helpless
● weight
changes
● pacing
and fidgeting
●
difficulty sleeping
●
difficulty concentrating
●
physical symptoms such as pain or gastrointestinal problems.
One important sign of depression is when people
withdraw from their regular social activities. Rather than explaining
their symptoms as a medical illness, often depressed persons will give
different explanations such as:
● "It's too much trouble,"
● "I don't feel well enough," or
● "I don't have the energy."
For the same reasons, they often neglect their
personal appearance, or may begin cooking and eating less. Like many
illnesses, there are varying levels and types of depression. A person
may not feel "sad" about anything, but may exhibit symptoms such as
difficulty sleeping, weight loss, or physical pain with no apparent
explanation. This person still may be clinically depressed. Those same
symptoms also may be a sign of another problem -- only a doctor can make
the correct diagnosis.
It can happen to anyone.
Sometimes depression will occur for no apparent
reason. In other words, nothing necessarily needs to "happen" in one's
life for depression to occur. This can be because the disease often is
caused by biological changes in the brain. However, in older adults,
there usually are understandable reasons for the depression.
As the brain and body age, a number of natural
bio-chemical changes begin to take place. Changes as the result of
aging, medical illnesses or genetics may put the older adult at a
greater risk for developing depression.
Life changes
Chronic or serious illness is the most common cause
of depression in the elderly. But even when someone is struggling with a
chronic illness such as arthritis, it is not natural to be depressed.
Depression is defined as an illness if it lasts two weeks or more and if
it affects one's ability to lead a normal life.
Many factors can contribute to the development of
depression. Often people describe one specific event that triggered
their depression, such as the death of a partner or loved one, or the
loss of a job through layoff or retirement. What seems like a normal
period of sadness or grief may lead to a prolonged, intense grief that
requires medical attention.
The loss of a life-long partner or a friend is a
frequent occurrence in later life. It is normal to grieve after such a
loss. But it may be depression rather than bereavement if the grief
persists, or is accompanied by any of the following symptoms:
● guilt
unconnected with the loved one's death
●
thoughts of one's own death
●
persistent feelings of worthlessness
●
inability to function at one's usual level
●
difficulty sleeping
● weight
loss.
If any of these symptoms are triggered by a loss, a
physician should be consulted.
Changes in the older adult's sensory abilities or
environment may contribute to the development of depression. Examples of
such changes include:
● changes
in vision and hearing
● changes
in mobility
●
retirement
● moving
from the family home
●
neighborhood changes
Other illnesses
In the older population, medical illnesses are a
common trigger for depression, and often depression will worsen the
symptoms of other illnesses. The following illnesses are common causes
of late-life depression:
● cancer
●
Parkinson's disease
● heart
disease
● stroke
●
Alzheimer's disease.
In addition, certain medical illnesses may hide the
symptoms of depression. When a depressed person is preoccupied with
physical symptoms resulting from a stroke, gastrointestinal problems,
heart disease or arthritis, he or she may attribute the depressive
symptoms to an existing physical illness, or may ignore the symptoms
entirely. For this reason, he or she may not report the depressive
symptoms to his or her doctor, creating a barrier to becoming well.
Depression is treatable
Most depressed elderly people can improve
dramatically from treatment. In fact, there are highly effective
treatments for depression in late life. Common treatments prescribed by
physicians include:
●
psychotherapy
●
antidepressant medications
●
electroconvulsive therapy (ECT).
Psychotherapy can play an important role in the
treatment of depression with, or without, medication. This type of
treatment is most often used alone in mild to moderate depression. There
are many forms of short-term therapy (10-20 weeks) that have proven to
be effective. It is important that the depressed person find a therapist
with whom he or she feels comfortable and who has experience with older
patients.
Antidepressants work by increasing the level of
neurotransmitters in the brain. Neurotransmitters are the brain's
"messengers." Many feelings, including pain and pleasure, are a result
of the neurotransmitters' function. When the supply of neurotransmitters
is imbalanced, depression may result.
A frequent reason some people do not respond to
antidepressant treatment is because they do not take the medication
properly. Missing doses or taking more than the prescribed amount of the
medication compromises the effect of the antidepressant. Similarly,
stopping the medication too soon often results in a relapse of
depression. In fact, most patients who stop taking their medication
before four to six months after recovery will experience a relapse of
depression.
Usually, antidepressant medication is taken for at
least six months to a year. Typically, it takes four to 12 weeks to
begin seeing results from antidepressant medication. If after this
period of time the depression does not subside, the patient should
consult his or her physician. Antidepressant drugs are not habit-forming
or addictive. And because depression is often a recurrent illness, it
usually is necessary to stay on the medication for six months after
recovery to prevent new episodes of depression.
Electroconvulsive therapy (ECT) is a treatment that
unnecessarily evokes fear in many people. In reality, ECT is one of the
most safe, fast-acting and effective treatments for severe depression.
It can be life saving. ECT often is the best choice for the person who
has a life-threatening depression that is not responding to
antidepressant medication or for the person who cannot tolerate the
medication.
After a thorough evaluation, a physician will
determine the treatment best suited for a person's depression. The
treatment of depression demands patience and perseverance for the
patient and the physician. Sometimes several different treatments must
be tried before full recovery. Each person has individual biological and
psychological characteristics that require individualized care.
Suicide
Suicide is more common in older people than in any
other age group. The population over age 65 accounts for more than 25
percent of the nation's suicides. In fact, white men over age 80 are six
times more likely to commit suicide than the general population,
constituting the largest risk group. Suicide attempts or severe thoughts
or wishes by older adults must always be taken seriously.
It is appropriate and important to ask a depressed
person:
● Do they
feel as though life is no longer an option for them?
● Have
they had thoughts about harming themselves?
● Are
they planning to do it?
● Is
there a collection of pills or guns in the house?
● Are
they often alone?
Most depressed people welcome care, concern and
support, but they are frightened and may resist help. In the case of a
potentially suicidal elder, caring friends or family members must be
more than understanding. They must actively intervene by removing pills
and weapons from the home and calling the family physician, mental
health professional or, if necessary, the police.
Caring for a depressed person
The first step in helping an elderly person who may
be depressed is to make sure he or she gets a complete physical checkup.
Depression may be a side effect of a pre-existing medical condition or
of a medication. If the depressed older adult is confused or withdrawn,
it is helpful for a caring family member or friend to accompany the
person to the doctor and provide important information.
The physician may refer the older adult to a
psychiatrist with geriatric training or experience. If a person is
reluctant to see a psychiatrist, he or she may need assurance that an
evaluation is necessary to determine if treatment is needed to reduce
symptoms, improve functioning and enhance well-being.
It is important to remember that depression is a
highly treatable medical condition and is not a normal part of growing
older. Therefore, it is crucial to understand and recognize the symptoms
of the illness. As with any medical condition, the primary care
physician should be consulted if someone has symptoms that interfere
with everyday life. An older person who is diagnosed with depression
also should know that there are trained professionals who specialize in
treating the elderly (called "geriatric psychiatrists") who may be able
to help.
About AAGP
The American Association for Geriatric Psychiatry (AAGP)
is a national professional organization of geriatric psychiatrists.
AAGP's 1,400 members are the leading researchers, educators and clinical
practitioners in the areas of late-life depression, dementia,
schizophrenia, psychosis, anxiety and sleep disorders and other mental
health disorders affecting the elderly.
Click to more on depression in older people at AAGP
More links about depression and older people:
●
Coping with Depression and the Holidays (American Association for
Geriatric Psychiatry)
●
Depression and Older Adults: What It Is and How to Get Help
(American Academy of Family Physicians) Also available in:
Spanish
●
Depression in Late Life: Not a Natural Part of Aging (American
Association for Geriatric Psychiatry) Also available in:
Spanish
●
Depression: Don't Let the Blues Hang Around (National Institute on
Aging) Also available in:
Spanish
●
Older Adults: Depression and Suicide Facts (National Institute of
Mental Health)
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