Why all the depression? Rafi Kevorkian, M.D. calls them the five D's: disability, decline, diminished quality of life, demand on caregivers, and dementia. To combat senior depression, then, requires coming up with creative methods to counter the five D's. Here are 12 strategies to do just that, to help people break free from the prison of depression and anxiety in their senior years.
1. Separate the illness from depression.
Depression in seniors is more complicated to identify and treat than that of younger folks because of all the other illnesses involved. For example, Parkinson's disease directly effects brain chemistry and can exacerbate depressive symptoms. Estimates show that 25 percent of cancer patients are depressed and as many as 50 percent of stroke patients suffer from depression.
Karen Swartz, M.D., Director of Clinical Programs at Johns Hopkins, maintains that patients with co-existing depression and chronic illnesses tend to focus more on the physical ailment, and therefore delay or impede full recovery from a mood disorder. Her advise? "Treat both the depression and the chronic illness simultaneously, setting aggressive treatment goals for both.... Do not settle for substandard treatment results--if one or both conditions is/are not responding to treatment, intensify or switch approaches." Also be sure there is cooperation and clear communication between your doctor and your mental health provider.
2. Watch the drinks.
Did you think teenagers were most at risk for substance abuse? Actually, alcohol and drug abuse are very prevalent among people over age 60, affecting 17 percent of older adults. It's not uncommon for seniors to self-medicate with alcohol and drugs as a way of coping with their loneliness or dealing with chronic pain. Hell, I can't say I blame them.
But it's bad, bad news. For one, alcohol is a depressive and is going to depress you even more (once you come down from the buzz of course). Popping sedatives can be lethal, especially when taken in combination with alcohol. Alcohol and drugs can also interfere with the effects of medications taken for diabetes, heart disease, and other common conditions among seniors. And finally, substance abuse increases the risk of suicide, especially in older men.
In other words, pour with caution.
3. Try Tai Chi.
Because disability and diminished quality of life are two of the D's of senior depression, older people would be smart to invest in some fall insurance--to do whatever they can to prevent falls. The fear of falling is legitimate among the elderly because approximately 33 percent of Americans ages 65 or older fall at least once a year. And when you consider the rates of osteoporosis, arthritis, and weak cardiopulmonary systems among elderly, healing from a fracture isn't so easy.
Therefore, take up an exercise program like Tai Chi, a martial art that teaches agility, slow movement, and coordination between body and mind. Tai Chi has been proven to prevent falls among seniors because it builds balance, core strength, and confidence. Strength training with either free weights or resistance rubber bands is also beneficial. And yoga, too.
4. Treat any insomnia.
Here's an interesting trivia fact from David N. Neubauer, M.D., author of "Understanding Sleeplessness: Perspectives on Insomnia": "As we age, we typically spend less time in the deepest levels of non-REM sleep (Stage 3 and Stage 4) and more time in the lighter levels. Consequently, older people often suffer from fragmented sleep, waking up more often during the night and early in the morning. In response to these changing sleep patterns, many [older] people develop poor sleep habits that compound the problem."
Dr. Neubauer reports that 80 percent of people who are depressed experience sleeplessness, and that the more depressed someone is, the more likely it is that he or she will have sleep problems. And vice versa! So absolutely essential to a senior's depression treatment is addressing any sleep problems and to practice good sleep hygiene: like going to bed at the same time every night, waking at the same time in the morning, and cutting down on or eliminating caffeine.
5. Distinguish grief from depression.
By the age of 65, half of American women will be widows. And in 10 to 15 percent of spouses, the loss of their loved one leads to chronic depression. The questions is: what's normal grief and what's depression? Kay Redfield Jamison, Ph.D., Professor of Psychiatry at the Johns Hopkins University School of Medicine, distinguishes the two in this way: "The sadness of grief usually comes in waves, with varying degrees of intensity and bouts of crying, and feelings of intense sadness, guilt, anger, irritability, or loneliness. A person experiencing grief, however, can enjoy some of life's activities. Grief is generally time limited and resolves on its own. Depression is a more persistent and unremitting sadness."
In other words, a depressed person is unable to enjoy life activities, merely slogging through life. She may also start to abuse alcohol or other drugs, experience difficulty eating (or overeating), and suffer from sleep disturbances.
6. Carry some photos.
Here's a simple way you can buffer yourself from the beast of depression: carry photos of your loved ones and friends in your wallet. Yep! A new study by UCLA psychologists found that by simply looking at a photograph of their significant others, a group of women reported less pain to the heat stimuli to their forearms than when they looked at pictures of an object or a stranger. Says study co-author Naomi Eisenberger: "The mere reminder of one's partner through a simple photograph was capable of reducing pain. The study fits with other work emphasizing the importance of social support for physical and mental health."
7. Make new friends.
Even better than photos are actual people! Countless studies have demonstrated that people with strong social networks are more resilient to depression and anxiety, especially in their senior years. And since losing friends and family is part of growing older, it is especially important for seniors to make an effort to meet new people. In my piece "13 Ways to Make Friends," I offer a few suggestions: trying out a book club, volunteering, taking a night class, and connecting with your alumni association. Pysch Central's John Grohol proposes 10 more in his "10 More Ways to Make Friends," such as joining a bowling league, getting involved in your church, or making a local restaurant or coffee shop your place to hang out.