With Robin Williams’ recent suicide, there has been increasing discussion about depression, addiction and suicide. Increased awareness is important for these issues that are too often hidden and stigmatized, or misunderstood.

One great article that was recently posted on Forbes.com is Five Common Myths of Depression, which may help you to gain a better understanding of the disease.

Older adults in particular often face untreated depression, largely because of certain misconceptions. Some of this comes from the myth that depression is a normal part of aging. Additionally, the signs of depression can be a bit trickier to spot in elders and often get confused with other illnesses. You may want to read our article, Signs and Symptoms of Depression in the Elderly.

Many people aren’t aware of the high rate of suicide among older adults (though the rates are also increasing among men in Robin Williams’ “middle aged” group). Others believe the myth that these suicides in elders are generally active choices to end their lives due to disease or pain, but studies have not corroborated this idea. Here are the stats about elder suicide:

• People over 65 make up about 13% of our country’s population, but about 18% of all suicides.
• Elderly white males have the highest rate of suicide of any group (over four times the overall rate of suicide).

How do you help the depressed person? How do you convince him/her to get help? Where can you turn?

The Right Approach: How to Help an Older Adult You Feel May Be Depressed

Tips for Helping a Depressed Senior with Healthy Living (ways you can support the person)

NAMI (National Alliance on Mental Illness): Depression in Older Adults 

National Suicide Prevention Hotline: 1-800-273-TALK (8255)

Our Aging Wisely team has in-depth experience helping clients and families seek diagnosis and treatment for depression and other mental health issues. Our care managers assist in managing conditions, coordinating healthcare, advocating for clients and checking in to ensure follow-up and safety. Call us at 727-447-5845 for a free consultation.

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

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.

When one is depressed, he or she may not wish to do anything or see anyone. But isolation and inactivity only make depression worse. The more active you are—physically, mentally, and socially—the better you’ll feel. Isolation and inactivity can be contributing factors to depression in the elderly. Older adults who are socially connected and engaged in activities demonstrate high levels of life satisfaction.

Depression is not a normal part of aging-visit our article on signs and symptoms of elderly depression and contact us if you are concerned about someone you love.

Here are some suggestions for activities to reduce loneliness and isolation:

• Getting out in to the world – Staying home all the time leads to isolation and contributes to feelings of depression. It is important to be involved in some activities outside the home. For those with limited mobility, a home caregiver can assist with transportation and physical assistance to maintain activities.

• Connecting to others – Connections with other people are vital to mental health–this includes going out to visit, having loved ones and friends over, and keeping in touch via email or phone.

• Participating in activities you enjoy – It is vital to continue enjoying favorite past-times. One can modify activities to changing needs when ill, but many activities can be enjoyed despite any limitations. Families might consider spending time playing favorite games or cooking traditional recipes with loved ones, or can hire a personal companion to assist with hobbies. A computer may be a way to continue playing favorite games if getting out on a regular basis is difficult. Audiobooks (Pinellas County offers a Talking Books program, as do many library systems) can be used for those who enjoy reading but have difficulty with vision or holding a book.

• Volunteering your time – Helping others is one of the best ways to feel better about yourself and regain perspective. In Pinellas County and other counties in Florida, you can contact 211 for local organizations that might need volunteers.

• Taking care of a pet – Pets provide companionship and purpose. If your elderly loved one is moving to assisted living, find out about the facility’s policy on pets since many allow animals (though there may be size/type restrictions).

• Learning a new skill – Pick something that you’ve always wanted to learn, or that sparks your imagination and creativity. Local community and senior centers, such as the Dunedin Hale Center and the Clearwater Aging Well Center, offer a wide variety of courses and activities.

• Enjoying jokes and stories – Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.

• Maintaining a healthy diet – Avoid eating too much sugar and junk food. Choose healthy foods that provide nourishment and energy, and take a daily multivitamin. EasyLiving Pinellas home care provides meal preparation assistance for those needing help shopping, cooking and even having a companion with which to share a meal.

• Exercising – Even if you’re ill, frail, or disabled, there are many safe exercises you can do to build your strength and boost your mood—even from a chair or wheelchair. Your doctor or physical therapist can recommend an exercise program and there are numerous senior-oriented exercise options, at your local senior center, YMCA or gym.

Contact us if we can assist with resources for remaining active, getting help for a depressed senior or to answer your questions about geriatric care management services.