We hope you have benefited from reading our information about some of the symptoms and risk factors for depression, as well as resources and ways to help. Today, we will delve further in to treatment options and health coordination to successfully manage depression.

Depression is particularly devastating for older adults. It is associated with decreased functioning, poor health status and decreased quality of life. Older adults with depression tend to have lower self-care abilities and recover slower from illness. The very issues that sometimes put elders at risk for depression are also outcomes of the disease, so it can be quite a downward spiral. Too often depression goes untreated, and it puts older adults at greater risk of death from poor health and suicide.

Effective depression treatment can be provided to older adults at a modest cost. For example, Katon and colleagues (2005) found that integrated and collaborative treatment of depression in the primary care setting produces positive clinical outcomes and increases health care costs by less than $150 per older adult per year (SAMHSA, The Treatment of Depression in Older Adults). Due to the negative impacts on health and functioning, treatment can actually reduce overall costs, especially in the long-term.

Once symptoms are identified, quality care and treatment can make a big difference to the elder. Evidence shows that psychotherapy interventions (cognitive-behavioral therapy, problem-solving treatment, interpersonal psychotherapy and others) and antidepressant medications are effective treatments in older adults (and may even offer better success when combined). Additionally, due to the nature of these issues for older adults, integrated physical and mental health care and multidisciplinary outreach (home and community-based approaches) are key.

In our geriatric care management practice, we’ve identified these key steps in the treatment process for depression:

1. Getting a thorough diagnostic and overall health workup (differentiating various symptoms, checking for underlying disease and reviewing overall health status)
2. Identifying appropriate practitioners (with expertise in the disease as well as experience working with older adults, accounting also for issues like insurance coverage and personalities) who prescribe evidence-based methods tailored to the person’s needs and overall health situation
3. Coordinating care (providers working together/coordination via care management to ensure cooperative treatment and lack of negative interactions; continuity between settings; ensuring the person gets to appointments, continues treatment/follow up)
4. Properly managing medications and evaluating treatment (assistance with properly taking medications/resource to help; review for drug interactions or side effects; monitoring and evaluating treatment success and problems)
5. Identifying lifestyle issues and managing supportive care/needs (building a support network; helping the person stay active, eat a healthy diet and exercise; addressing financial, housing, care and safety needs)

The best evidence-based treatments can fail, particularly in older adults, for many “non medical” reasons. When lifestyle issues are not addressed, the person may discontinue treatment or suffer further deterioration in health. For example, if the patient starts taking medication but eats very little or does not remember how to take medications properly, she may begin feeling ill from the medication or experience dizziness/falls. A person who is overwhelmed with challenges in self-care and constant health problems may feel hopeless and give up treatment. Other clients may decide they cannot afford treatment.

So many of these issues can easily be addressed with proper coordination and assistance. Please reach out to us via message or at 727-447-5845 if you or someone you love needs help!

References:

Substance Abuse and Mental Health Services Administration (SAMHSA), Evidence Based Practices Kit, Selecting Evidence-Based Practices For Treatment of Depression in Older Adults

SAMHSA, Depression and Older Adults:Key Issues

Easter has just passed and hurricane season is far from most Floridian’s minds. But, here at Aging Wisely and EasyLiving, we are gearing up for our seasonal preparations to help our clients, colleagues and community members minimize risk. Working with elders, we place special emphasis on careful, customized preparation. We recently attended the local Hurricanes in Healthcare conference to bolster our knowledge and resources. Today we will share some insight about the particular vulnerabilities of elders and tips for caregivers to address those concerns.

For personalized help preparing for Florida’s hurricane season, please contact us at 727-447-5845. You can check out our Hurricane Preparedness Package Flier here. You can also read more about the important process of individualized assessment for disaster planning.

There are many complications faced by seniors and their caregivers when a storm hits. The aftermath is particularly deadly for elders. Whether living at home alone, with caregivers or in a care facility, the disruption of normal care and support systems leave many vulnerable. Take for example this article in Clinical Geriatrics about the lesser known issue of pressure sores developing or worsening when care is disrupted by such disasters. Like this particular medical concern, many other issues can worsen when there is no power, lack of supplies and services, and normal care and routines are impacted by hurricanes, flooding, etc. It is most often these issues and the resulting health and safety issues in the aftermath of a storm that prove deadly for those in poor health.

Now is a great time to read up on these important issues and begin gathering resources and ideas. We suggest you start here (or give us a call to benefit directly from our expertise…we’ve already done the homework for you!):

Five Essential Questions for Senior Care in Disasters

Florida Division of Emergency Management

EasyLiving’s Guide to Hurricane Planning for Seniors and Caregivers

EasyLiving’s Hurricane Checklists and Key Contact Information

Caregivers, please don’t leave your research and preparation until the last minute. Find out about options and resources today and get organized for the season. Many of these same tips will help those who live in other areas of the country, who may be affected by tornadoes, flooding, severe winter weather and more.

Sadly, a local resident, Nancy Yates, recently committed suicide by jumping from her apartment window in St. Pete after apparently suffering from declining health and spirits. The story was a tragic reminder of the risk factors that elders face for depression and their relative high rates of suicide.

Please take some time to read or bookmark our past articles on Signs and Symptoms of Depression in Elders and How to Help a Depressed Elder. We encourage you to share this information to spread the word about this vital but too often overlooked issue.

If you recognize some of these symptoms in someone you know, what can you do? Often, the person will not admit to feeling depressed but instead complains of physical symptoms or specific life problems. Your attempts to talk about possible depression may be rebuffed. Many times the person is worried about the stigma of depression or that admitting to it may mean losing control/independence. Particularly when you are a concerned neighbor or friend, you may not feel like there is much you can do and may hesitate to “interfere”. In the Tampa Bay area, where many elders have retired from somewhere else and families may be physically distant, concerned neighbors, friends and professionals are vital connections for the elder’s well-being.

If you have concerns that an elder may be depressed, here are some tips about how to approach the situation to get the person help:

1. Be supportive (and maybe a little pushy). A depressed person often withdraws from social activities and feels hopeless. Your attempts to be supportive or invite the person to do things may be turned away. Do not let this discourage you. Try to check in on the person and continue offering invitations and expressions that you care. Breaking the pattern of inactivity and isolation can reduce depression and hopelessness.
2. Ask about the lesser known symptoms of depression. When trying to get a handle on what is going on, ask the person if he/she is having difficulty sleeping or new aches and pains. You may notice confusion or changes in attitude and behavior versus expressions of sadness.
3. Encourage the person to make a doctor’s appointment. You may not be able to convince someone to see a psychiatrist or counselor, but they may be more open to explaining the recent physical and other symptoms to their doctor. Elders are much more likely to seek help for physical symptoms. Unfortunately, even when elders sought help from a doctor shortly before committing suicide, signs were often missed (20 percent of elderly people who later commit suicide see a doctor the day they die, 40 percent the week they die and 70 percent in the month they die). At the same time, doctors and other healthcare professionals are working hard to better screen patient for these issues, and geriatric specialists in particular will know the signs to look for and may be a gateway to help. Additionally, if you are actively involved in the person’s medical care, you may be able to alert the doctor to your concerns. You can send a letter, email or fax to the doctor’s office before the appointment, outlining the symptoms/concerns you have seen and asking the doctor to screen and sensitively address these as appropriate.
4. Address the person’s worries (including the unspoken) and offer hope. You may want to share a story about someone you know who was going through similar issues and got help. It may be useful to specifically address underlying concerns that people often have but don’t state, such as a feeling that declining health or cognitive abilities will lead to being forced in to a nursing home or having no quality of life. It can be difficult to convince a depressed person that there is hope; it may be better to demonstrate (by telling the person about specific resources, sharing stories or showing them how you or someone you know has been helped). If the person has financial worries or thinks there is nothing out there to help, you can do some general research to find resources to offer. You may need to encourage the person to make some follow up calls together (or ask if you can do it on their behalf), rather than simply offering a list of numbers. Depression often affects motivation.
5. Call in a professional. Because it may be difficult to convince the person to make an appointment with a mental health professional, you may want to start with talking to someone yourself. You can do this without breaking the person’s confidence, simply by having a consultation with a care manager about your concerns and discussing approaches. Sometimes it is possible to take the next step, as a care manager can often be pitched as offering concrete help with issues the person will admit are of concern. The person might be willing to have an in-home assessment to see what can be done to help with household issues or health concerns. With the gentle, experienced approach a care manager can often open the door to address the wider issues.
6. Know your duty. Under F.S. 415, certain persons are obligated to report suspected elder abuse and neglect. This includes self-neglect when the person may be unable to care for himself and in need of services, or when the person may be harmful to self. Professionals such as medical staff, social workers, care staff and bank employees are mandatory reporters under Florida’s statutes. The Florida abuse hotline is 1-800-96ELDER (35337).

Contact Aging Wisely at 727-447-5845 for questions, concerns or to schedule a consultation. We also offer educational materials on issues like depression which you can share with friends and clients.

As elder advocates, we are always glad to share important educational information. We were recently contacted about an upcoming online event focusing on elder abuse. Please take a look at this important information and consider sharing it with others as well. This vital information does not receive enough attention.

Elder abuse remains a drastically under-reported crime because of factors such as the victim’s fear of losing independence. There are also many challenges to investigation and prosecution, so justice is often thwarted.

Here are some of the top myths that hinder the successful prosecution and investigation of criminal elder abuse:

• Elderly people make terrible witnesses.
• If the elderly victim refuses to provide information, nothing can be done.
• If an elderly victim gives money voluntarily, it is not a crime.
• If the victim is deceased, you cannot prosecute.
• Any case where the elderly victim is involved in a home repair dispute involving money is a civil matter.
• Suspects of elder abuse never call 911.
• Elderly people die from natural causes, without investigation needed.

Get the real story and learn how to protect yourself or your elderly loved ones by attending a free online event April 10th 9am – 4:30pm EST. Be an advocate for elders! Register here and help the National Crime Prevention Council fight these awful crimes.

The Alzheimer’s Association just published their updated Alzheimer’s Facts and Figures Report for 2014. Some of the key statistics to note include:

• Approximately 5 million Americans who are 65+ have Alzheimer’s, while approximately 200,000 who are under 65 have early-onset Alzheimer’s. By 2025, the total should reach 7.1 million who are 65 or older (40% increase); by 2050, the numbers are expected to reach 13.8 million (or almost three times what they are today).
• One-third of all seniors who die each year have been diagnosed with Alzheimer’s disease or another form of dementia.
• Americans devoted $17.7 billion hours worth of unpaid care to individuals with Alzheimer’s last year (family, friends and other informal caregivers). The national cost of care (Medicare, Medicaid, healthcare and program spending) related to the disease was $214 billion this year.

We know this is a disease that has a particularly strong impact on caregivers and families as a whole. Many times, people live with Alzheimer’s for a fairly long period of time and the progressive nature of the disease means that caregiving needs are also progressive. Some of the statistics from this report indicate the impact on caregivers, and the particular impact on women:

• Thirty-nine percent of those who cared for someone with dementia said they were depressed (versus 17 percent for non-caregivers). Caregiving responsibilities often impacted the informal caregiver’s health.
• Almost seven times as many female Alzheimer’s caregivers as male caregivers cut back from full-time to part-time work, with twice as many women as men saying they had to stop working or had lost their job benefits. Women caregivers tend to receive less outside help than their male counterparts.
• Women are more than twice as likely as men to provide the end-stage disease care for an Alzheimer’s loved one (often 24 hour, hands-on care).

Women are also more likely to develop Alzheimer’s (1 in 6 chance, versus 1 in 11 for men). This year’s report includes a special section on the disease’s impact on women. The report goes in to great detail about the impact on caregivers and the types of tasks caregivers are doing. Some important points include: 59% of caregivers rate the emotional stress of caregiving as high or very high and a large percentage indicate a good deal of strain regarding financial issues and family relationships.

This report is important as a guide for policy decisions and hopefully influencing increased funding and programming to assist families dealing with Alzheimer’s disease. It also serves as a reminder to all of us working in eldercare of the great need for assisting families with the caregiving process and identifying resources.

If you are dealing with Alzheimer’s in your family or want to learn more, here are a few resources we offer to get you started in the right direction:

Guide to Memory Loss: An overview of terminology to help you understand the difference between dementia, Alzheimer’s and normal aging as well as the warning signs of dementia.

The Essential Eldercare Checklist: What you need to know and do at various stages of pre-caregiving and caregiving

A Caregiver’s Guide to Dementia: Our EasyLiving caregiving team’s advice and practical tips for dealing with various care concerns and handling the different stages of dementia care.

Under our Eldercare Resources, you can also find a dementia quiz and fact sheet, recommended reading and helpful links.

Some of the key ways our advocates can help Alzheimer’s caregivers include:

• Planning ahead and developing a care plan for different stages/needs
• Providing resources and help to navigate various programs and options
• Assessing the comprehensive situation to assist in smart decision-making (answering questions such as: What are the best options for the family? What are the hidden and opportunity costs?)
• Assisting with financial concerns by creating a care budget, helping to access resources and assisting with program eligibility
• Mediating family conflicts and serving as a liaison between various family members and care providers
• Advocating for the person with dementia and caregivers
• Setting up respite care for the caregiver’s continued well-being

If you have questions about dementia care or need help with any aspect of eldercare, please call us at 727-447-5845. Though these statistics are scary, having the knowledge and resources to help can empower any family facing this difficult disease.