DEPRESSION IN THE ELDERLY: OFTEN ASSOCIATED
WITH FEELING INVISIBLE.
When a person is repeatedly ignored, negative feelings about the self can emerge and result in depression. This is especially true for the elderly. Walk into most social or professional gatherings filled with young, attractive, energetic people and you will usually find clusters arranged by age group.
Imagine you are an older person and unexpectedly find yourself in a room full of people fifteen or twenty years younger. As a senior person, you may be surprised if someone starts a conversation with you. And if they begin one, it will probably be short. The other person will soon find an excuse to get away from you, the pariah. Instead of younger people valuing your experience as a senior citizens, in our culture, you’re likely to be discounted. You may be bright, funny, interesting to your friends and family, but in many social situations, you will feel invisible.
When retired individuals lose a sense of worth or purpose (previously associated with their work), it is crucial they search and find new meaning in their life. Otherwise, situations, such as I’ve described above, may trigger a clinical depression. Social isolation and a lack of life purpose are key triggers for depression. Some elderly individuals are emotionally resilient and can overcome the potentially significant and negative impact of feeling socially invisible. They’ve usually developed strong coping strategies over their lifetime and have adopted an optimistic attitude. For others, who are highly vulnerable, these situations may contribute to a full-blown depressive episode, especially when coupled with poor self-esteem. Older individuals who have experienced an unhappy childhood followed by a long series of rejections and disappointments throughout life, chronic illness, loss of loved ones and financial instability during retirement, are more likely to plummet into a serious depression as they age.
In general, depressed people are usually easy to spot. They actually look down-in-the-dumps. They are apathetic and withdrawn. They are often tearful, agitated, angry, and cranky. They express feelings of guilt, worthlessness and hopelessness, are tired, have a poor appetite, and may suffer from difficulty sleeping. Their hygiene and grooming may be poor since they no longer care how they look.
But sometimes, depressive illness is difficult to recognize, especially among the elderly. Seniors may not exhibit these classic symptoms. Instead, they may complain of vague aches and pains and/or express fear that these problems are a sign of a severe or debilitating illness. Unfortunately, they may consult a variety of physicians who don’t recognize their struggle with depression. Some may be diagnosed as hypochondriacal and avoided by the doctor in the future. Many times, the elderly person’s visit to the doctor represents a natural desire to seek human contact with someone who will simply pay attention to them. In the past, physicians often recognized this need in the elderly, but today, with the demands of managed care, doctors have little more than an average of seven minutes to spend with each patient! The human touch has been lost in the rush.
It is important for loved ones to recognize that vague, physical complaints with no physical basis in their aging parents may signal a depression. These physical complaints may be an unconscious attempt to obtain attention that is otherwise unavailable. Once emotional needs are addressed and met, physical complaints may greatly diminish.
Depression may also accompany a physical condition, especially when the condition does not respond to treatment. When depression is handled appropriately, the person can cope better with the actual physical problem.
Age related illnesses are often treated with medication or a combination of medications that can negatively affect one’s mood. Physicians must be alerted to any changes or decline in a patient’s mood. Drugs affect people differently and the usual adult dose for medication is often too strong for many seniors. Over-medication can cause serious problems in the elderly and should be re-evaluated periodically. The abuse of alcohol is another over-looked problem that can contribute to a depressed mood. When alcohol and medications are mixed in seniors, problems can escalate quickly and loved ones may be unaware of what is making the elderly person’s condition worsen.
Depression that goes untreated can cause physical problems, such as malnourishment, thus weakening the immune system. Dehydration, disorientation, mental confusion, and psychotic behavior can result from inadequate medication management. Loved ones should carefully monitor medication in their elderly parents and keep a list in their possession at all times. Seniors who are alone should keep a list of current medications in their wallet for emergencies.
Many social agencies provide services geared toward seniors. They provide meals and social programs that can help with social isolation and loss of meaning. Family, friends and neighbors can offer support and encouragement. It is vital for the depressed person to have significant involvement with others. When you walk down the street and see an elderly person walking toward you, say hello. Your simple hello can help relieve the feeling of being invisible in society.
Individual, family and group therapy can help the elderly recover from a bout of depression. We cannot predict if the depression will return especially if the person has had an earlier history of a mood disturbance. However, if there is no history of depression, there is a better chance that it will not return, especially if the person develops new skills for coping with the vicissitudes of life and if family or social supports are anchored and consistent.
Remember, depression is treatable through a combination of psychotherapy, appropriate medication, and consistent social supports.
© Copyright, 2003, Ginger E. Blume, Ph.D.