COUNSELING DEPRESSED ELDERLY

GERIATRIC COUNSELING

Reporter: Lara Riza R. Sabunod

Notes here
TRIVIA GERIATRIC DEPRESSION
GERIATRICS (GER·I·AT·RICˌJERĒˈATRIK/) is a mental and emotional
disorder affecting older
Adjective 1.relating to old people, especially with regard to their health care. adults. Feelings of sadness
"a geriatric hospital" and occasional “blue” moods
Noun 1.an old person, especially one receiving special care. are normal. However, lasting
"a rest home for geriatrics“ depression is not a typical
part of aging.

DEPRESSION= Depression, otherwise known as major depressive disorder or

clinical depression, is a common and serious mood disorder. Those who suffer from
depression experience persistent feelings of sadness and hopelessness and lose
interest in activities they once enjoyed. Aside from the emotional problems caused
by depression, individuals can also present with a physical symptom such as chronic
pain or digestive issues. To be diagnosed with depression, symptoms must be
present for at least two weeks.

As we grow older, we often face significant life changes that can increase the risk for
depression.
These can include:
Health problems – Illness and disability; chronic or severe pain; cognitive decline;
damage to your body image due to surgery or sickness.
Loneliness and isolation – Living alone; a dwindling social circle due to deaths or
relocation; decreased mobility due to illness or a loss of driving privileges.
Reduced sense of purpose – Feelings of purposelessness or loss of identity due to
retirement or physical limitations on activities you used to enjoy.
Fears – Fear of death or dying; anxiety over financial problems or health issues.
Recent bereavements – The death of friends, family members, and pets; the loss of
a spouse or partner.

How Does Depression In the Elderly Differ From Depression in Younger

Adults?
• In the elderly, depression often occurs with other medical illnesses and
disabilities and lasts longer.
• Depression in the elderly is associated with an increased risk of cardiac
diseases and an increased risk of death from illness.
• At the same time, depression reduces an elderly person's ability to
rehabilitate.
• Older adults are often misdiagnosed and undertreated

Medical conditions that can cause elderly depression

=Any chronic medical condition, particularly if it is painful, disabling, or life-
threatening, can lead to depression or make your depression symptoms worse.
These include:
• Parkinson's disease
• Stroke
• Heart disease
• Cancer
• Diabetes
• Thyroid disorders
• Vitamin B12 deficiency
• Dementia and Alzheimer's disease
• Lupus
• Multiple sclerosis (MS)
Medications that can cause or worsen depression include:
• Blood pressure medication (e.g. clonidine)
• Beta-blockers (e.g. Lopressor, Inderal)
• High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
• Tranquilizers (e.g. Valium, Xanax, Halcion)
• Calcium-channel blockers
• Medication for Parkinson's disease
• Sleeping pills
 • Ulcer medication (e.g. Zantac, Tagamet)
• Heart drugs containing reserpine
• Steroids (e.g. cortisone and prednisone)
• Painkillers and arthritis drugs
• Estrogens (e.g. Premarin, Prempro)
Why aren’t seniors getting the help they need?
• Depression in the elderly can be very difficult to recognize. It can easily be
overlooked as a symptom of another medical condition.
• Family, friends and medical personnel often see depression as a normal part
of the aging process and the inevitable result of the losses of life we all will
experience.
• Many seniors were raised to be self-sufficient and stoic in the face of life’s
challenges making them reluctant to complain about how they are feeling or ask
to for help. They are used to working hard to solve their own problems and feel
ashamed by their inability to cope.
• Some seniors (and possibly even their friends and family) don’t know that
depression is an illness and that treatment is available and works!
• Depression in the elderly can be very difficult to recognize. It can easily be
overlooked as a symptom of another medical condition.
• Family, friends and medical personnel often see depression as a normal part of
the aging process and the inevitable result of the losses of life we all will
experience.
• Many seniors were raised to be self-sufficient and stoic in the face of life’s
challenges making them reluctant to complain about how they are feeling or ask
to for help. They are used to working hard to solve their own problems and feel
ashamed by their inability to cope.
• Some seniors (and possibly even their friends and family) don’t know that
depression is an illness and that treatment is available and works!

HOW DO WE KNOW IT’S DEPRESSION?

-Depression is more than just feeling sad or blue. It is a common but serious mood
disorder that needs treatment. It causes severe symptoms that affect how you feel,
think, and handle daily activities, such as sleeping, eating, and working. It also lasts
a long time. It's important to know what to watch for. Anxiety and slowing of thoughts
are common symptoms. For many seniors depression is often expressed through
many vague complaints of physical aches and pain. The most common symptoms of
depression include:
1. Physical changes
2. Changes in thinking
3. Changes in feeling
4. Changes in behaviour

 Physical changes
1. Changes in appetite - with a resultant weight loss or weight gain.
2. Sleep disturbances- with trouble falling asleep, staying asleep or
sleeping too much.
-Sleep, when it comes, does not restore and
refresh. People often report feeling worse in
the morning with the mood lifting as the day
goes on.
3. Decreased energy, with feelings of weakness and physical fatigue.
- Some people experience agitation with restlessness and
have a need to move constantly.
4. Phantom pains, headaches, muscle aches and pains, with no known physical
cause.
5. Stomach upsets - constipation.

 Changes in thinking
• Thoughts may be confused or slowed down which makes thinking, concentrating
or remembering information difficult.
• Decision-making is difficult and often avoided.
• Obsessive ruminations, a sense of impending doom or disaster.
• Preoccupation with perceived failures or personal inadequacies leading to a loss in
self-confidence.
• Becoming harshly self-critical and unfairly judgmental.
• In extreme cases, there can be a loss of being in touch with reality, perhaps
hearing voices (hallucinations) or having strange ideas (delusions).
• Persistent thoughts of death, suicide or attempts to hurt oneself.

 Changes in feeling
• Loss of interest in activities that were once a source of pleasure. • •Feelings of
worthlessness, hopelessness, and excessive guilt.
• Deadening or an absence of feelings.
• Sense of overwhelming or impending doom.
• Loss of self-esteem.
• Feeling sad, blue and down in the dumps that may be worse in the morning lifting
as the day goes on.
• Crying for no apparent reason.
• Irritability, impatience, anger and aggressive feelings.

 Changes in behaviour
• Withdrawal from social and leisure activities.
• Failure to make important decisions.
•Neglecting duties such as housework, gardening, paying bills.
• Decrease in physical activity and exercise.
• Reduced self-care such as personal grooming, eating.
• Increased use of alcohol or drugs (prescription and non-prescription).

Why is it important to treat depression in the elderly?

 Depression throws a dark cloud over our emotional well-being, draining away
pleasure and robbing people of hope. Depression can lead seniors to further
isolation and despair.
 Depression tends to last much longer in the elderly and can result in
unnecessary or premature placement in institutional care.
 If depression is not managed, it can compromise the treatment of other
conditions and can increase the risk of prolonged disability or early death.
 Untreated depression can also leave seniors more vulnerable to developing
other serious health conditions such as heart disease, infections and immune
disorders.
 Depression can make people feel angry, irritable and anxious. This can rob
families of the pleasure of their loved one’s company and place an additional
burden on care providers.
 The risk of suicide in elderly is high and it is particularly high for depressed
elderly men.

Treatment of depression in older adults

Effective treatment of depression in older adults can require more than one
approach.
 MEDICATION
 PSYCHOTHERAPY
 Electroconvulsive Therapy (ECT)
 LIFESTYLE CHANGE

Medication: Antidepressants can be prescribed to relieve the symptoms of

depression. Antidepressants can have significant side effects, and elderly patients
are sensitive to medications. Medication should be closely monitored.
For older adults who are already taking several medications for other conditions, it is
important to talk with a doctor about any adverse drug interactions that may occur
while taking antidepressants.

Talking treatments OR Psychotherapy

It can help to talk to a good listener. This could be a friend, a relative, a volunteer or
a professional. If this is not enough, professionals can offer special ways of talking
which include:
Psychoanalytic therapy : which helps you to see how your depression may be
connected with what has happened to you in the past.
Cognitive Behavioral Therapy: which helps you to see how some of the ways you
think or behave may be making you depressed. It then helps you to think in more
realistic ways that make you feel better.

Interpersonal Therapy (IPT)

This is a treatment for depression, but it has also been used with other problems. It
aims to help you to understand how your problems may be connected to the way
your relationships work. It then helps you to find out how to strengthen your
relationships and find better ways of coping. Friends and family members
can help by doing the
following:
outings
Problem-Solving Therapy (Pst) PST can improve an individual’s ability  Establish a weekly
to cope with stressful life experiences. It is an effective treatment option, visit
particularly for older adults with depression. Using a step-by-step process, you  Assist with
identify problems and come up with realistic solutions. It is a short-term therapy and transportation to
medical
may be conducted in an individual or group format. appointments
 Cook and freeze
HOW? healthy meals for
1.INDIVIDUAL COUNSELING easy preparation
2. Support groups: Groups designed to connect older adults experiencing similar  Have a pet
 Gardening
issues (depression, medical conditions, bereavement, etc.) are beneficial in  Help create a system
establishing social support and providing a safe space to talk. to ease with taking
medication regularly
Lifestyle change
Daily exercise, healthy eating habits, and increasing social support are all important
in helping elderly patients with depression.
References:
https://mdsc.ca/documents/Consumer%20and%20Family%20Support/Depression%20in%20Elderly%20edited%20Dec16%202010.pdf
https://www.nia.nih.gov/health/depression-and-older-adults
https://www.healthline.com/health/depression/elderly
https://www.cdc.gov/aging/mentalhealth/depression.htm
https://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/depressioninolderadults.aspx