Depression Can Manifest in Later Life, Especially During the Holidays


Depression Can Manifest in Later Life, Especially During the Holidays

By David W. Hart, Ph.D.

 

Autumn is here, folks.  And right around the corner is what Andy Williams described as the most wonderful time of the year.  You know, scary ghost stories, parties for hosting, and marshmallows for toasting – it’s the hap happiest season of all.  Well, maybe not for all.

 

October is National Depression Education and Awareness Month and our column today is dedicated to illuminating an often stigmatized health challenge that is less prevalent in later life than you might think and is also, for most, relatively easy to treat.  Let’s review the roots of depression in older age, how it’s manifested, and most importantly, how to feel better.

 

According to the American Psychiatric Association, depression is a medical illness that negatively affects how an individual feels, thinks, and acts.  Depression may cause feelings of sadness, hopelessness, lack of interest in once pleasurable activities, changes in appetite and sleep hygiene, irritability, and fatigue.  These changes in mood frequently interrupt a person’s ability to perform activities of daily living both at home and in the community.  You may be surprised to read that prevalence rates of major depression in community dwelling older adults is lower than their middle aged peers, with about 15% of the former exhibiting clinically significant symptoms.

 

There is substantial consensus that older adults who experience depression in later life face distinct risk factors and manifest specific symptoms.  About half of older adults diagnosed with major depression experience their first symptom in late life, compared to the other 50% who were diagnosed in young to mid-life.  Some studies have found that patients with later life depression are more likely to have cardiovascular and executive functioning deficits, which may increase their risk for dementia in their 70s and 80s.  Stressful life events also have been shown to affect the onset of depressive symptoms in older adults, including bereavement, caregiving, lack of economic security, and family estrangement.  Common indicators of later life depression include the following:

 

  • Sleep disturbance
  • Fatigue
  • Psychomotor retardation
  • Loss of interest in living
  • Hopelessness about the future
  • Subjective complaints of poor memory and concentration
  • Slower cognitive processing speeds

 

Depression, notwithstanding year of onset, has etiological roots in genetics, concurrent medical conditions, individual psychology/personality, interpersonal relationships, and other environmental factors.  I imagine that it doesn’t take a rocket scientist to recognize that dementia, diabetes, insomnia, obesity, and other cardiovascular factors would increase an individual’s risk for depression.  Physical limitations resulting from arthritis, osteoporosis, glaucoma, and general hearing loss can severely impact a patient’s mental health and subsequent depression.  Psychological factors too, including how we manage stress (making a mountain out of a molehill or turning lemons into lemonade), play a role in the onset of later life depression.  In older adults, a ruminative coping style (repeatedly but passively thinking about one’s distress) has been associated with increased risk for depression in later life.  Importantly, bereavement nearly tripled the risk for depression in older adults, the largest risk factor of any listed above.  Loneliness has been found to be as lethal as smoking 15 cigarettes each day.  That should scare the daylights out of any of us who struggle with finding and maintaining meaningful relationships, yours truly included.

 

Now, let’s talk hope.  Noting the majority of older adults experience medical challenges, social stressors, and bereavement, only a small fraction of the population develops later life depression.  As I’ve previously written, the Positive Psychological movement has transitioning the study of depression from examining patients to investigating individuals who have somehow buffered the onset of depression in later life.  Factors that have been shown to be most protective against later life depression include social support to manage health related stressors and meaningful engagement in social activities, volunteer work, or religion.  Wisdom also appears to be a protective factor as older adults are better able to regulate negative emotions (i.e., don’t sweat the small stuff) and have a more positive self-concept. Satisfactory replacement of lost activities due to disability, exercise, mindfulness, and religious involvement have also been shown to be protective.

 

Psychopharmacological interventions, individual psychotherapy, and life review have all demonstrated high rates of success in treating later life depression.  The challenge is the stigma.  Often older adults report psychosomatic and cognitive symptoms to their physicians who may inadvertently neglect to evaluate patients for depression and further psychotherapeutic follow up. This phenomenon can be attributed to the difficulty of detecting depression in older adults due to age related difference is presentation.  It’s incumbent on all of us as good medical consumers to advocate on our own behalves.  If we exhibit symptoms described herein, there’s no hurt in broaching the subject of depression with our healthcare professionals. Asking for help is the first step in addressing a likely solvable problem.  As always, I’m an email away.  You are invited to be in touch if you need further direction and support.

 

 

 

 

 

 

 

 

 

 

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