2008/01/21 00:00:00
The hectic holiday season is over and a new year has begun. While spending time with your loved ones, did you notice any changes in your parents' demeanors or moods? Were your usually pleasant conversations and reminiscences marred by a litany of complaints or angry blustering? If so, it could be that one or both of your parents is depressed.
Depression occurs in 3 percent of older people who live in their own homes and in 25 percent of those in senior-living and skilled-nursing facilities, according to the American Geriatric Psychiatric Association. Situations that can trigger depression include the obvious - loss of a spouse or friend, loss of independence, or admission to a nursing home. Less obvious triggers include chronic pain, caregiving for a spouse or family member, moving, health problems, memory loss, or hospitalization.
Depressed individuals often are described as sad, isolated, or lonely, but among older adults that is not always the case. Instead, indicators might include weight loss, sleep disturbances, restlessness, memory problems, fatigue, and apathy. Anger and somatization - turning feelings into physical complaints - also frequently are observed.
Because these signs also can be symptoms of a physical illness, the best way to obtain a diagnosis is to have your loved one undergo a thorough physical examination. Laboratory testing should be a part of it and should include a complete blood count and assessments of electrolytes, vitamin B12 levels, and thyroid function.
When making the appointment, it's helpful to mention that you suspect depression in your family member. Health care providers have a tool called the Geriatric Depression Scale (a series of yes or no questions about feelings and thoughts) that can help confirm the presence of depressive symptoms, and it should be included in the exam.
Getting your loved one's cooperation might be tricky. The current generation of seniors was raised in a culture that stigmatized all forms of mental illness, including depression. Their solution was to pull themselves up by their bootstraps and tough it out. If this is the case with your loved one, focusing on the physical symptoms of depression as the need for an exam might be a more effective approach.
Depression in older individuals most commonly is treated with antidepressant medication. The correct drug and the starting dose vary depending on the person's age, other medications prescribed, and any physical symptoms that might respond to a particular drug, such as loss of appetite or insomnia.
It can take up to 30 days for an antidepressant to achieve a therapeutic level in the body - so don't expect immediate results. Regular follow-up will be needed to monitor the appropriate dose and need for the medication, because the length of treatment will depend on the type of depression.
As a family member, you can show your love and support by offering assistance with chores and appointments, staying in touch with phone calls and visits, and not forcing social situations and activities.
Depression never should be viewed as a normal part of aging. It also should not become the "elephant in the corner" during family visits. A practical, caring approach should be taken with regard to the early identification of depressive symptoms, seeking treatment, and assisting with recovery.
Nanette Lavoie-Vaughan is an adult nurse practitioner and professional consultant. She is a featured speaker at national professional conferences and writes about geriatrics for multiple publications. If you'd like to send Nanette a comment, question, or suggestion for a future column, please e-mail rolereversal@moaa.org.
