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Depression Among Seniors During the Holidays and Year-round

In any normal year, the holidays bring about stress, depression, and anxiety due to the number of physical and emotional demands placed upon individuals and families. Planning for get-togethers, shopping, buying that just-right gift, memories, and entertaining tax even the most even-tempered people, but the last couple of years have added yet another layer of stress to the mix - the ongoing coronavirus pandemic. This has left more seniors than ever grappling with the challenges of depression and other mental health issues and is a problem that we cannot ignore.

Seniors affected more...

"The pandemic has affected nearly everyone no matter what the age, but numbers that are starting to emerge regarding mental health indicate that seniors have been disproportionately impacted, " stated certified elder law Attorney Connelly. "Because most seniors could not travel or long-term care facilities were on lockdown, isolation and loneliness appear to have affected their mental health more than any other group. This has led to a serious uptick in mental illness, particularly depression, among our older adults." And depression in seniors is indeed a cause for concern as symptoms are usually overlooked and undertreated in health care settings because it co-occurs with other medical problems that they present with.


Depression in seniors not only affects the mood and general functioning of those with the condition but can also exacerbate other physical health problems. Research shows that older adults with depression have poorer outcomes with chronic medical conditions such as lung and heart disease, high blood pressure, diabetes, and more.


Concerning Pandemic Numbers

A National Poll on Healthy Aging, reports that since March 2020, "...nearly one in five adults age 50–80 (19%) reported worse sleep than compared to before the COVID-19 pandemic. Two in three (64%) said they regularly had trouble falling or staying asleep one or more nights in the past week. Additionally, one in five (19%) reported experiencing worse depression or sadness, and 28% reported worse anxiety or worry, since the start of the pandemic. Worse sleep, depression, and anxiety during the pandemic were also more common among women than men, those aged 50–64 compared to age 65–80, and those who rated their physical health as fair or poor compared to those in excellent, very good, or good health. More than one in four older adults said that for several days or more within the past two weeks they had little pleasure in doing things (29%) or felt depressed or hopeless (28%). One in three (34%) reported feeling nervous, anxious, or on edge, and 44% said they felt stressed. More than one in three older adults (37%) reported feeling a lack of companionship and 46% reported feeling isolated from others in the past year."


Besides the pandemic and its continued variants popping up, there are a plethora of other factors that also play into the psychological well-being of seniors as 2021 draws to a close and 2022 appears to be getting off to a very rocky start. With inflation spiraling out of control, less disposable income, difficulty paying high energy bills, and increased food costs, the upcoming year may offer no relief for seniors struggling with their mental health.


Holiday and Pandemic Struggles

Recently, Attorney Connelly met with Carl and Marie, an older couple who wanted to develop an estate plan. As he discussed the options available to them, he noticed that both became somewhat ill at ease, and then they began to fight back tears. The process was halted for a few minutes to allow them to collect their thoughts.

Depression exacerbated by the pandemic

"Marie voiced her concerns, stating that the discussion actually highlighted the fact that their lives were winding down," said Attorney Connelly. "And for Carl, he shared his sadness of the house being empty for the holiday season with their adult children and grandchildren living in the midwest and west coast, and given the travel difficulties due to the pandemic, they would not be seeing them for the third year in a row."


This couple expressed what so many other elderly couples feel at this time of year -- depression, which has been exacerbated by the ongoing pandemic. In fact, issues like depression are magnified at a time when so many are feeling joyous and happy. It is estimated that over 6 million seniors over the age of 65 are clinically depressed at any given time with the holiday season increasing these numbers even more and as previously stated, the pandemic has added significantly to these totals.


"We haven't seen our grandkids in years and my son is so busy with his job in Arizona that even going there doesn't mean we spend all that much time with them," said Marie. "So we sit in the house, especially if it's cold because of Carl's arthritis, and look at pictures on the mantel. It's really depressing, especially when we realize that our own time is limited."


This discussion occurred in our office but is repeated in households, workplaces, and facilities tens of millions of times during the holiday season and at other times as well -- and it should not be ignored.


Depression in Seniors

First and foremost, depression is not a "normal part of aging" as some like to say. Depression is an extremely serious mood disorder that affects our senior population and we must give it the attention it deserves. According to Mental Health America (MHA), more than 2 million of the 34 million Americans over the age of 65 suffer from some type of depression. Given that, just how knowledgeable are seniors about this disorder? Here's a survey that was done by MHA regarding the question:

Depression occurs in every setting
  • 68% (7 out of 10) of adults 65 and older know little or nothing about depression.

  • 38% (4 out of 10) of adults over the age of 65 believe that depression is a serious health issue.

  • If a senior has depression, older adults are more likely to "handle it themselves" than any other age group. Even more concerning, only 42% (4 out of 10) would seek professional help.

  • Symptoms of depression are more likely to be discussed by those under the age of 64 than by those over the age of 65. The symptoms most discussed are “a change in eating habits” (29% vs. 15%), “a change in sleeping habits” (33% vs. 16%), and “sadness” (28% vs. 15%).

  • 58% (6 out of 10) of adults age 65 and older believe that it is normal for people to become depressed as they age.

And before we continue, there are multiple "types" of depression that can affect seniors. They include:

Alcohol induced depression
  • Major Depressive Disorder - This is diagnosed when the symptoms of depression last for more than two weeks and interfere with the senior's normal functioning.

  • Persistent Depressive Disorder or Dysthymia - This is when a depressed mood lasts more than two years but the senior is still able to perform their daily tasks, something someone having a major depressive episode cannot do.

  • Substance/Medication-Induced Depressive Disorder - This is a depression that can be directly related to the use of substances like alcohol and pain medication. But a note of caution, sometimes the use of substances occurs because a major depressive episode was occurring, so it's important to monitor a senior who is abusing a substance and not accept that just stopping access to the drug or substance will cure the depression. Also, don't just take away a senior's access to an abused substance because you could be causing withdrawal, a potentially deadly situation. Always seek medical help.

  • Depressive Disorder Due to A Medical Condition - Depression can "co-occur" along with a medical condition like heart disease, cancer, or stroke.

There are two concerns to be aware of if the depression is substance induced. First, don't assume that stopping the abuse will halt the depressive episode, and second, taking away the drug or alcohol suddenly may lead to withdrawal, which could be potentially fatal. Consult a professional for advice.

Symptoms of Depression

With older adults, depression may be extremely difficult to identify because their symptoms may present much differently than those of younger people. For instance, feeling sad may not be a complaint of depression with a senior, rather a sense of numbness or lack of interest in engaging in physical activities may be the only sign.


Common Symptoms

Some of the most common symptoms of depression in older adults are:

Know the symptoms
  • Feeling hopeless, guilty for no obvious reasons, worthless, and an overall sense of helplessness.

  • An ongoing sadness, anxious feeling, or just feeling "empty" inside.

  • Restlessness and irritability.

  • A general lack of interest, especially in things that were pleasurable.

  • Feeling fatigued.

  • Unable to concentrate, remember, and make decisions.

  • Sleeping issues, such as an inability to sleep or consistently oversleeping.

  • Overeating or undereating.

  • Thoughts of death or suicide, suicide attempts.

If an older adult experiences several of these signs or symptoms over a period of two weeks, professional help may be indicated. "The above symptoms may not include everything," points out Attorney Connelly. "Basically, any significant change you see in a loved one's activities or mood for a prolonged period of time should be considered a red flag and warrant attention. Do not ignore the warning signs."


Risks Associated With Depression

"There is a multitude of risk factors with depression," said Attorney Connelly. "It could be a death of a loved one, anniversary dates of a loss, retirement, and for a few, no real clear reason is present prior to the onset of the depressive episode." When discussing depression among seniors, research and statistics show some correlation between the following events and depression (note: correlation does not denote causality):

Medical events can lead to depression
  • Medical reasons - Having a medical condition such as cancer, a stroke, bypass surgery, etc.

  • Genetic - family history can be an indicator of depression.

  • Stress - social, financial, and caregiver.

  • Sleep - Lack of sleep or sleep disorders.

  • Isolation - social and loneliness.

  • Sedentary lifestyle - lack of exercise or physical activity.

  • Disabilities - any limitation that interferes with engaging in acts of daily living.

  • Addiction and alcoholism.

"The risks mentioned do not need to be present for a senior to experience depression," continued Attorney Connelly. "What's important is knowing the symptoms of depression and being willing to address it with the individual and offer them the appropriate support."


Medication Induced Depression

"Because seniors take so many medications, there exists the possibility that depression could be caused by a drug they are taking," said Attorney Connelly. "Although side effects of medications can occur at any age, in older adults, they are more prone to experience depression as a side effect because their bodies inefficiently metabolize the drugs." If a loved one is experiencing symptoms of depression, make sure you review the medications they are taking with their health care provider. Here are some of the medications taken by older adults that are associated with drug-induced depression:

  • Medications that are taken for Parkinson's disease

  • Blood pressure medications

  • Beta-blockers

  • Calcium-channel blockers

  • ACE inhibitors

  • Sleeping pills

  • Steroids (prednisone)

  • Cholesterol-lowering drugs

Those seniors who are taking several medications in the categories we mentioned above are at greater risk. And a reminder, do not stop any medication without the approval of the health provider.

"Although side effects of medications can occur at any age, in older adults, they are more prone to experience depression as a side effect because of the way their bodies inefficiently metabolize the drugs." --- Attorney RJ Connelly III

Depression and Dementia

There are some interesting notes regarding depression and dementia. For instance, if a person had depression in the past, they are more likely to develop it again if they have dementia. Now, once again, it is a correlation and not causation. It's quite possible someone in the early stages of dementia has developed depression because of the diagnosis and not the result of it. This seems to be borne out by research that shows depression is more likely to develop in those with vascular dementia, whose victims have more insight into their condition than those with Alzheimer's, which may explain why they also have higher rates of depression.

Differences

There are also concerns that early Alzheimer's disease, some other dementias and depression can share similar symptoms. Given that, there are some differences to be aware of when trying to differentiate between the two:

  • Depression tends to develop rather quickly compared to most types of dementia. Depression can present itself over a period of just weeks where dementia takes much longer to develop.

  • Speech problems tend to be present for those with developing dementia whereas depression does not usually have speech affected by the condition.

  • Although depression can cause some memory issues, when prompted, someone with depression will likely recall the event. For someone with dementia, they are not likely to remember recent events even when prompted and they take steps to cover up for the memory loss.

  • Those with serious depression will have problems with reasoning and memory caused by the inability to concentrate. This will clear up after treatment. For those with dementia, reasoning and memory problems will persist and get worse.

And one other thing that is extremely important, suicide attempts may increase in those who have recently been diagnosed with dementia. Let's discuss this further.


Depression and Suicide

"This is a topic we need to pay much more attention to," stated Attorney Connelly. "Although older adults account for 12% of our population, they make up nearly 18% of completed suicides and an unknown number of suicide attempts. We can no longer look the other way." And as Attorney Connelly pointed out, there are other statistics that bear out his concerns. Here are a few:

Chronic health conditions can contribute to suicide
  • In 2017, there were an estimated 47,000 suicides in this country. Of that number, some 8,500 were in the 65 plus age group.

  • Older adults tend to be more successful than younger people because they plan it out more carefully. They also use more lethal means for the attempt, such as guns and overdose of medications (because seniors use so much medicine, they have a lot at their disposal).

  • Among those who attempt suicide, 1 in 4 will succeed compared to 1 in 200 youth. And because of their age, even if they fail, they are less likely to recover from the attempt.

  • Men over the age of 65 have the highest rate of suicide.

So why is this happening? Today's seniors, more than ever, are choosing to age in place. There are many reasons for this, including the high cost of nursing home care, fears brought about as a result of the pandemic, the yearning to remain independent, and the number of home health care companies who can keep them in the home. On this surface, this appears to be a positive development, almost a protective factor against such behaviors, but there is a downside.

"This is a topic we need to pay much more attention to. Although older adults account for 12% of our population, they make up nearly 18% of completed suicides and an unknown number of suicide attempts. We can no longer look the other way." --- Attorney RJ Connelly III

Reasons for Suicidal Thinking

"At some point, many who do remain in the home eventually become homebound, depending on outsiders to come into the home and provide care," said Attorney Connelly. "However, when no one is around to provide companionship, this can lead to an incredibly lonely existence. So it's not surprising to find that loneliness tops the list as a reason for suicidal behavior." But there are other reasons that are also connected to suicidal behavior among older adults. These include:

Financial difficulties is on the list of concerns
  • Grief due to losses - The older a person lives, the more they begin to lose those they loved and depended upon for companionship. For some, these losses mount up and intensify the feelings of loneliness and hopelessness.

  • Chronic pain and illness - Seniors will face illnesses like arthritis, heart disease, diabetes, and more diseases of aging. These conditions bring on constant pain and mobility issues that interfere with independence. Add to this the loss of sight, hearing, and other senses.

  • Cognitive issues - A recent study suggests that seniors who have been diagnosed with mild cognitive impairment and dementia are at a higher risk for suicide. There are a number of theories as to why this may be true, including that a diagnosis of mild impairment does not mean they lack insight, so knowing what they are facing down the road, they choose suicide while they still have some decision-making skills. Another reason put forth is that a decline in cognitive functioning can lead to poor decision-making skills and an increase in impulsivity.

  • Financial difficulties - Older adults living on a fixed income at times struggle to afford food, pay bills and purchase the medications they need. Add this stress to existing health issues and this can trigger suicidal ideation.

Warning Signs of Suicidal Behavior

A first step in possibly preventing suicide is to know the warning signs. "If someone clearly expresses suicidal intent or thoughts of suicide, this must be taken seriously," said Attorney Connelly. "There are also behaviors that, if taken together, can indicate that a senior may be thinking about suicide." These behaviors include:

  • A loss of interest in activities that they once enjoyed.

  • Avoiding friends and social activities.

  • Giving away important keepsakes or changing a will.

  • A lack of hygiene and self-care.

  • Being preoccupied with death.

  • Showing little or no concern for personal safety.

"Most people are afraid to discuss suicide with someone out of fear that they may say or do something wrong -- but saying something is better than saying nothing at all. In fact, study after study shows that discussing the subject does not increase suicidal thoughts or behaviors." --- Attorney RJ Connelly III

Helping a Suicidal Person

Suicide is a complicated issue and not all attempts to prevent them are successful, even among the most seasoned professionals who deal with these behaviors regularly. But here's the good news, many can be prevented and it doesn't take a trained psychologist to do so. "Most people are afraid to discuss suicide with someone out of fear that they may say or do the wrong thing -- but saying something is better than saying nothing at all," stated Attorney Connelly. "In fact, study after study shows that discussing the subject does not increase suicidal thoughts or behaviors. Discussing it shows support and can begin the process of getting that person the help they need." Here are some tips on communicating with a potentially suicidal individual and actions you can take:

  1. Ask: “Are you thinking about killing yourself?” It’s not an easy question, but as stated cited earlier by Attorney Connelly, studies show that asking people if they are suicidal does not increase suicides or suicidal thoughts.

  2. Keep them safe: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. This includes access to firearms or dangerous locations like bridges.

  3. Medication: Talk with their doctor and pharmacist about the lethality of their medications and what can be done to keep them secured.

  4. Be there: Listen carefully and learn what the individual is thinking and feeling. Again, talking about suicide has been shown to be a protective factor.

  5. Help them connect: Connect them with a trusted individual like a family member, friend, clergy, or mental health professional. For additional support, reach out to the National Suicide Prevention Lifeline at 1-800-273- TALK (8255).

  6. Stay connected: Staying in touch after a crisis or after being discharged from care can make a difference. Research shows that follow-up with a person after treatment is another important protective factor.

"The takeaway from this is that depression and suicidal thoughts are not a normal part of aging at any time of the year," said Attorney Connelly. "Depression is very treatable and the best thing that you as a friend, relative or caretaker can do is advocate for the individual because if they are depressed, they are unable to effectively advocate for themselves."



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