Darkest Hours: Shedding Light on Depression in Older Adults

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The longest night and shortest day of the year is coming soon on December 21. With longer dark hours throughout winter, health concerns including sleep quality, fatigue and depression can often worsen due to lack of sunlight for everyone. Yet these symptoms are most harmful to adults age 65 and older.

For these older adults, symptoms of depression are often mistakenly attributed to normal aging. Seniors are at an increased risk for depression because risk factors such as physical illness and life transitions, including widowhood and retirement, are more common in this age group.

Those with dementia are particularly vulnerable to having depression symptoms overlooked by those around them because they have difficulty voicing their symptoms, leaving depression unrecognized, not assessed, and not treated.

For both of us, through our individual work in physical therapy specializing in elder care and also in neuroscience focusing on Alzheimer’s and dementia, we each have worked with hundreds of older adults with memory impairments.

With 10,000 people turning 65 years old every day, ensuring appropriate mental health care for our aging society should be a public health priority. That includes healthy older adults to those with dementia and other terminal conditions.

Unfortunately, few elders have their mental health needs addressed routinely and when they do, care is often insufficient to meet their needs. Depression in older populations frequently goes unrecognized because the symptoms of geriatric depression present differently compared to those symptoms in younger adults.

Older persons are less likely to report a sad or depressed mood and more likely to complain of symptoms such as fatigue, memory changes, and slowed physical performance.

Still, the stigma of receiving mental health services is pervasive across generations and contributes to the misconception that symptoms of depression are normal age-related changes.

For some with dementia, symptoms including agitation, confusion and/or restlessness may worsen toward the end of the day due to sundowning, when lack of sunlight affects behaviors and mood. While the causes of sundowning are not known, depression and poor sleep cycles may play a role.

It’s not just a lack of sunlight during this time of year that adversely affects older adults. The fear of falling is greater due to cold weather, snow, and ice restricting community mobility. This restriction worsens social isolation and loneliness contributing to increased depression.

While the days will lengthen and the nights shorten beginning December 22, be sure to continue to monitor your older loved ones and ask about depressive symptoms.

Look for indications of hopelessness such as a lack of interest in personal care, and other symptoms such as weight loss, fatigue or unexplained pain.

Consider behavioral changes such as stopping normal activities they previously found meaningful. Ask if these changes are due to specific life events such as the loss of a spouse, illness, or mobility restrictions. Particularly, ask about medication changes since some medications can result in unintended side effects that interfere with motivation and mood.

Going with a loved one to health care appointments or seeking permission to talk with a loved one’s physician helps you gather a more complete picture of an elder’s health. Take time to create a personal family history to assess health risks, so that you can implement preventative health strategies.

Finally, be vigilant in reminding older adults that depressive symptoms are not a normal part of aging.

To access successful treatment for the symptoms of depression, the first step is symptom recognition. Families and caregivers are the most important partners in the diagnostic process, particularly for those with dementia.

One of the most important ways that family members can advocate for their loved ones is by monitoring and providing information on changes in health status over time to health care providers, including mental health concerns.

While each one of us will hopefully grow older, with sufficient advocacy, evaluation, and treatment, we can each age with optimal mental health. That way none of us are left in the dark.

This piece was co-authored by Emily Rogalski, a translational neuroscientist and Associate Professor at Northwestern Medicine’s Cognitive Neurology and Alzheimer’s Disease Center.

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