Helping the Depressed Older Person

Depression in the elderly is often manifested by memory problems, confusion, social withdrawal, loss of appetite, inability to sleep, irritability, and, in some cases, delusions and hallucinations. Feelings of sadness may or may not be acknowledged or shown. Thus, depression is often mistaken for dementia or the normal aging process and goes untreated.

Regardless of the cause of the depression-and there are many reasons why an elderly person can be depressed-appropriate treatment can alleviate symptoms and suffering. Even Alzheimer’s patients, who are often severely depressed during the early stages of the disease, can gain extra years of function ing and pleasure with treatment for depression.

The first step in helping the older person who appears to have symptoms of depression is a complete physical checkup. Depression can be a side effect of a physical illness or of a medication to treat an illness. If patients are confused or withdrawn, it is important that they be accompanied by a per son who can give the doctor essential information about their medical history and receive instructions and recommendations. It is particularly important that the examining physician be told of all drugs used by the patient, including over-the-counter, prescribed, and borrowed drugs.

If the cause of the symptoms is not uncovered, the next step is an evaluation by a mental health specialist-preferably one with a geriatric specialty or experience in dealing with older people. Seeking consultations with specialists is a relatively common experience for older patients, who often have multiple clinical problems. Therefore, the need for referral to a expert to gain further diagnostic information can be readily understood by the older patient, particularly if care is taken to explain the interrelationship between physical health and emotional well-being.

A major issue for the older person wh3 has limited energy and financial resources is the length and t) e of treatment. Patients often believe that all mental health treatments involve many years of analysis, so they need to be told about the medications and relatively short-term psychosocial treatments now used successfully to help depressed adults of all ages. In fact, all aspects of the recommended treatment should be carefully explained by the mental health specialist.

If antidepressant medication is prescribed, the prescribing physician should be fully informed of all o’ her drugs the patient is taking. Since drugs are metabolized more slowly in older people, antidepressants must be carefully prescribed and monitored.

If older depressed people refuse to see a mental health specialist, they may need assurances that treatment will reduce symptoms, improve functioning, and enhance well-being. This message may have to be repeated more than once by several different people. Sometimes close friends, siblings, or a religious leader can have more success in convincing the older depressed person to get help than a spouse or child.

In some cases, the older person who will not or cannot make an office visit may accept a phone call from a mental health specialist, who then might arrange to visit the patient at home, if the patient is willing. Phone contact can introduce and enhance patient/therapist interaction; however, it is not an appropriate substitute for the person-to-person contact needed by a therapist to properly evaluate and treat a patient.

The following vignette illustrates how a phone call from a geriatric psychiatrist laid the groundwork for the treatment that helped Kai overcome his depression.

Kai

Kai had been a devoted family man and a hard worker. He hadn’t had time for hobbies or other interests, but he was satisfied with his life. He possessed everything important a man could need-a good job, good health, and a loving family.

Then the first blow came: retirement .He was not ready to stop working when the company vice president suggested, not too subtlety that he should make room for a younger man who needed his job.

The next blow was the heart attack. Fun and relaxation were not what Kai had been used tot and he had tried to avoid his overwhelming feelings of uselessness by compulsively working around the house and yard. His heart attack took that option away. The damage to his heart made him a poor candidate for surgical repair, according to several cardiologists. His life became dependent on the miracle of drugs-many kinds, many times a day. Good health and worthwhile activity once taken for granted, were replaced by exhaustion, pain, fear, depression and inactivity.

While still recuperating in the hospital, Kai was told by his doctor about a psychotherapy group organized for heart patients, but Kai did not join. There was nothing wrong with his head, he thought at the time. Later, realizing that he was forgetful and sometimes outright confused, he began to wonder. He knew, however, that he wasn’t crazy!

Nevertheless, Kai’s bad mood was “driving his wife crazy” or so she said. She begged him to see another doctor, but he couldn’t be bothered. Doctors just make you sicker, he proclaimed.