Depression in the elderly
Many of us have probably often encountered such manifestations from elderly relatives, such as: bad moods, dissatisfaction and other negativity. At such moments communication with the elderly becomes extremely difficult, but at the same time to such a condition of the elderly person should be treated with understanding and sympathy. Elderly people are very often faced with such a disease as senile depression, and in fact it is a mental disorder of the neurotic sphere against the background of changes in the functioning of the processes of the vegetative and consequently the nervous system.
Nevertheless, even depression in older people is treatable, and it can and should be treated. Treatment is possible! Moreover, in most cases it brings tangible results. In this article we will tell you about the symptoms of depression and the causes of depression in older people and also what methods of prevention and treatment exist.
Causes of depression in the elderly.
According to the statistics of the world psychiatric community, from 15% to 30% of older people (from 65 years old) have symptoms of depression. The range of causes can be extremely diverse. In an active period of life, when everyone has millions of worries and tasks, including a favorite job, opportunities to take care of children and loved ones, physical activity to think about worries just no time. A person feels needed by family and society, is aware of their life goals and objectives. From the moments of retirement and the end of labor activity, especially if the children have grown up and left, there is a huge amount of free time, which it becomes very difficult for an elderly person to use, feeling self-fulfillment. The level of social importance and the number of contacts is sharply reduced, which leads to the manifestation of decadent moods and depressive states. Another significant reason is a decrease in physical activity and limited opportunities to spend time in the usual way.
All of the above causes lead to the development of neurotic symptoms, such as feelings of fear and anxiety, panic attacks, decreased appetite and autonomic symptoms, which we will discuss below.
Depression in Older People: Who’s First at Risk?
Gender is also worth considering. Women after the age of 80, for example, are susceptible to senile depression more often than men of similar age. And middle-aged people may be more symptomatic than the deeply elderly. Also, as noted earlier, the presence of family and a caring environment, people who can support, create the appearance of significance and distract the elderly person from gloomy thoughts, plays a significant role.
Thus, conventionally speaking, the causes and preconditions for the development of depression in the elderly may depend on the factors listed below.
But at the same time, do not underestimate the overall mental component of the personality. In addition to such psychological causes, in many older people, depression is caused by the initial psychotype (genetic predisposition), previous experience and propensity for neurotic diseases, abuse of alcohol or medications, as well as the environment in which the person is, physical health.
Symptoms of depression
As for the symptoms of depression, the main and most common signs are:
- Frequent mood swings,
- a general energy-related mental decline,
- as well as decreased interest in life.
At the same time, many elderly people who used to be easygoing and cheerful, suddenly become aggressive for no apparent reason, or, on the contrary, fall into apathy and apathy, completely losing interest in life and any motivation whatsoever.
In medical practice, the most common symptoms include: The elderly person’s overestimation of his or her current physical condition. Complaints about health that do not correspond to reality. Increased anxiety, apathy, unwillingness to communicate with anyone, physical stagnation, negative vision of reality, including thoughts of death, anhedonia, potential for panic attacks, loss of interest in social duties (unwillingness to solve even simple everyday tasks), memory impairment, hysteria and demand for increased attention, unreasonable nagging at relatives and strangers.
Thus, in a more structured way, the symptoms of depression can be manifested in the form of:
- decreased activity and increased anxiety about the slightest activities outside the home,
- sudden and constant mood swings, manifestation of aggression,
- High levels of anxiety and unreasonable fear,
- Increased attention deficit from loved ones,
- increased attention deficit from loved ones.
It is logical to assume that the listed symptoms worsen not only the mental state, but also directly affect the physical health of the elderly person. Because of constant gloomy thoughts, anxiety, fear and dissatisfaction chronic diseases and age-related illnesses develop.
According to WHO statistics, the physical consequences of depressive disorders in older people can lead to diseases such as impaired blood circulation in the cerebral vessels, including atherosclerosis, which increases the risks of ischemia, heart attacks and strokes, and can also provoke the development of diabetes or even cancer.
It is worth understanding that the development of chronic and dangerous diseases require constant medication therapy, and taking drugs, as we know, can aggravate mental condition, in connection with this to the taking of drugs elderly people should treat with caution.
Prevention of depression in the elderly
The most effective way to prevent depression in elderly relatives is participation and care, as well as understanding the emotions and feelings that one experiences with the arrival of old age.
Help and participation are needed for anyone in old age, even if they do not openly declare it and do not demand attention to themselves. To help the elderly person and prevent the development of depressive syndrome, it is worth showing him/her that he/she is important and still in demand. Ideally, delegate important responsibilities to grandmothers or grandfathers: taking care of grandchildren, finding important information, cooking and so on. It is excellent if an elderly relative can do something with his hands: knitting, small repairs, sewing, construction – any work with his hands can not only distract the elderly from gloomy thoughts, but once again remind about his importance and role in the family. Unfortunately, in a state of depression, older people often begin to limit themselves in communication with other people, so the task of loved ones to gently and tactfully provoke an elderly person to action. Another powerful trigger for the development of depressive disorder in old age is the loss of a spouse or friend. As well as the development and exacerbation of chronic diseases, loss of former activity and performance. To avoid the consequences of these factors, it is very important not to give up physical activity: it’s great if the family has a dacha, where older people could tinker with the garden something to build or care for flowers. Regular walks, hydrotherapy, therapeutic exercises – all these simple methods are an excellent prevention of the development of neurotic conditions. Another effective method in a number of cases is medication therapy. Properly developed specialist course will help to eliminate the aggravation of many symptoms.
How to get an elderly person out of depression at home
The first thing to do in case of suspicion of a mood disorder is to talk gently and carefully with your relative, trying to identify the specific reasons that are causing him anxiety. Particular attention should also be paid to the physical condition. Further in the conversation, it is necessary to explain to the elderly person the need to go to a psychologist or even a psychiatrist, since the treatment of depressive disorders is possible only under the supervision of a specialist. Also, as noted, it is very important to organize the proper level of physical activity: water procedures, fresh air, sunbathing, communicating with nature and animals. Finally, try to organize your leisure time in such a way as to improve your mood. Any slight, but pleasant for a loved one of the elderly person can distract him from his worries and direct his thoughts in the right direction. Statistically, attacks of bad moods and slumber overtake people in the evening before bedtime. To smooth these periods you can resort to the methods of traditional medicine: tea with chamomile or rosehip infusion, a warm bath, body-oriented practices if possible (massage sessions, for example) – all these simple methods will help an elderly person to sleep easier and reduce anxiety.
But the most important thing, of course, is attention and care, sincere participation and friendly communication from relatives.
How depression is diagnosed in the elderly
Diagnosing age-related depression is a time-consuming and complex process, depending on many factors, because, above all, the symptoms of depression can get lost in the background of other general symptomatology accompanying disorders of the physical spectrum in the elderly. Moreover, the patient is likely to be more concerned about somatic manifestations (lack of appetite, poor sleep, blood pressure), and meanwhile, all the above somatics may be a direct manifestation of a depressive mental disorder.
Another important factor is the decreased interest on the part of relatives in the depressive manifestations of the elderly. Grumbling and health complaints are taken for granted by others in old age and are associated by them with the natural state of aging of the body. It is also worth noting that old people themselves are not willing to seek help from a specialist for fear of ending up in a madhouse or nursing home, which also makes the process of diagnosing a pathological condition much more difficult.
Peculiarities of treating depression in the elderly
Due to the fact that in our modern society the diagnosis of “senile depression” is not common, the treatment itself is presented in a rather limited range, nevertheless, it exists and is able to bring very positive results.
In fact, comprehensive therapy is represented by two areas of treatment: medication and psychotherapy.
Unfortunately, most elderly people, while agreeing to medication therapy, completely refuse psychotherapy and communication with a specialist. In this aspect, it is very important that relatives are able to explain the necessity and effectiveness of this treatment and convince the elderly person to undergo therapy with a professional. In most cases, comprehensive treatment shows excellent results and is able to bring the patient to the level of stable remission.
So, let’s look at each of the treatment areas in more detail.
Treatment of depression in old age, as we mentioned above, the complex consists of two stages: medication and psychotherapy.
It is logical to note that drug therapy involves taking medications.
Experts recommend the following medications for depression in the elderly:
- Melipramine . Assigned to the category of antidepressants of stimulating effect. It has a sedative effect, affecting the calming of the nervous system and improving the mood of the patient. It is essentially suitable for the treatment of any kind of depression, normalizes sleep, stimulates motor function.
- Attarax . Has a strong and fast action, effectively relieves anxiety, dulls feelings of fear. It is recommended to relieve irritability and aggression on the part of the patient.
- Leviron . Also used for all types of depressive disorders. Characterized by the strongest sedative effect, aimed at the general calming of the nervous system. It is recommended for the treatment of just the same elderly people, because it has a reduced spectrum of side effects.
- Cipramil . Excellent treatment for psychosomatic manifestations, Recommended for a course of treatment. The main range of action is sedative.
Be that as it may, psychotherapeutic treatment, even for the elderly, is still the most effective method for dealing with all types of depressive disorders. Moreover, in the case of mild and moderate depressive forms, a psychotherapeutic approach can be sufficient, that is, it allows to do without medication. Medications can be applied only for the purpose of consolidating the effect and longterm stabilization of the condition.
As we know, the psychotherapeutic method is the safest, besides, even in the case of taking medications, you cannot do without the intervention of a specialist. Neutralization of depressive states and its consequences is possible only with personal psycho-emotional contact with the patient. Medications themselves have an effect only on the work of the CNS and the brain, and it is the work with a psychotherapist that changes the way of life and thoughts.
As noted above, very important in therapy are aspects such as keeping a daily routine, establishing a proper lifestyle, including walks, activities, proper diet, adequate timely sleep, etc. The patient may be enrolled in a special club for the elderly. It is worth noting that even in Russia, especially in psychotherapy centers, there are special clubs for the elderly, where they can not only get skilled help. But also to find like-minded people.
Depression in older people and its types
According to the causes that provoke the development of depressive disorder in old age, this neurotic disorder can be divided into types:
- Organic depression . It is the most common disorder, based on destructures of the nervous system, which can be genetic (congenital) or acquired in the course of life.
- Psychogenic depression . A traumatic factor most often serves as a trigger for its development. Any acute negative event that occurred to the patient. For example, the departure of a loved one, family problems, difficulties in society, or even a change of residence.
- Somatogenic depression. This type is especially characteristic of the elderly, as well as patients who have been in an institution for a long time. This type is based basically on the physical health problems that in most cases accompany people of age (heart disease, brain disease, musculoskeletal system, respiratory and vegetative vascular system). In other words, physical suffering and performance limitations act as a powerful trigger for the development of neurotic disorders.
- Bipolar Monopolar depression is expressed in endogenous and affective illnesses: sudden bouts of aggression or irritability, sudden and frequent mood swings, provoked by internal destructive aspects, combined with a genetic factor.
- Iatrogenic depression . The predominant trigger is long-term medication of any spectrum.
As for elderly depression, as such, the main motive for its pathogenesis is the negative emotions most often experienced by the elderly person. They are associated with a variety of factors, including physical abnormalities. On the second place goes the social environment: disappointment in life and people, loneliness, absence of support from relatives.
Effective treatment of an elderly person from depression
As we have repeatedly noted, the first possible help for an elderly person facing depression can and should be provided by immediate family members. If there are none, then friends or acquaintances, even neighbors on the stairway. Medical therapy – this is certainly the destiny of specialists, but the main thing to do is sincerely attentive and heart-to-heart talk. Listen, cheer up, do something pleasant, at least just walk down the street together.
How to treat depression in an elderly relative at home
Below we give some simple but effective recommendations for what you can do in the case discussed.
- Listen carefully and patiently . Allow the elderly person to nostalgically reminisce about the past and loved ones, and if necessary, let them cry.
- Contact the attending physician, even a general practitioner, and elaborate on all symptoms, some of which may be preconditions for a worsening of the condition.
- Make up different tasks and encourage them to be done. Tasks can be absolutely simple, the main thing is to make the relative feel their importance: take part in cooking or setting the table, advise on interior novelties.
- Do not be stingy with praise and encouragement. Note any, even if in your opinion, and insignificant detail. Independent walk, a good mood, household chores.
- Learn and help to realize the strengths of your relative. If grandpa is good at handicrafts – involve him in building a craft for your grandson or making a birdhouse. Grandma likes to bake pies – ask him to make something for friends.
- It is very important to monitor the serviceability and availability of additional accessories for the elderly person’s senses, whether it is glasses or a hearing aid. These things should always be in constant reach, because it is thanks to them the elderly person does not lose contact with the outside world.
- If the relative has problems with his or her musculoskeletal system, show sympathy, demonstrate full understanding of his or her painful condition. Ask if there is anything you can do to help.
I hate to think about sad things, but a person’s suicidal tendencies are often completely invisible. Carry out a number of preventive measures to secure the environment, such as: careful cleaning of sharp objects, ensuring timely and regular warm meals, control of taking medications prescribed by a doctor.
We understand that when there is an elderly person in the family in a state of apathy and irritation, it is very difficult for relatives. Many lack patience and acceptance, which in principle is understandable, because the ability to empathize and have compassion, especially against the worries of the modern world, is a great art. Don’t forget that we are all human, and if someone needs our help – we have to give it. And the experts are always there for us.
In medicine, apathetic depression, which requires obligatory treatment, is understood to be a mental condition that proceeds with the oppression of the volitional and emotional spheres of the person.
- An excessively lowered background of mood;
- Passivity of volitional activity;
- thoughts of futility and their own unimportance;
- sharp depression of the general tone of the body.
Apathetic depression can occur:
- Against the background of diseases of internal organs – somatic;
- against the background of mental pathology in schizophrenia, epilepsy, manic-depressive psychosis, etc. – endogenous;
- against the background of neuroses, personality accentuations (extreme types of behavior), psychopathies – psychogenic.
The classification of depressions is very voluminous. We will touch upon only one variant of its course – development and apathetic depression, which is sometimes difficult to treat.
In everyday parlance, depression is most often understood as apathy – a lowered background of mood.
Apathetic psychopathy is a rather common condition. The basic difference from other types of this disorder is the arising indifference to doing anything, and absence of desires. At the same time, the awareness of the need to do something (“I want to want to do something”) remains. But apathy restrains the person, gives rise to depression, and at the same time the patient plunges into his own inner state, in which the state of anxiety grows.
Gradually an excruciating sense of hopelessness develops, reaching the point of despair. Outwardly sullen and self-absorbed, the person continues to lead a habitual life in which few people pay attention to his changed state.
Many patients with apathetic psychopathy successfully hide their problems under a mask of indifference. Treatment of apathetic depression is long and complicated.
The main signs of apathetic depression
In this condition is observed:
Diagnostic criteria for apathetic depression
If a person draws attention to the fact that excruciating feelings no longer allow him to live normally, he seeks help from specialists. Most often he goes straight to a psychologist or psychiatrist.
The doctor carefully examines the patient’s complaints, conducts an interview and assesses his physical and mental condition.
He has to take into account everything to the smallest detail, including the presence of similar conditions in the family environment of close relatives.
The psychiatrist’s main task is to identify the main cause that triggered the development of apathetic depression, which significantly simplifies the treatment of the pathology.
Complications of depression
Prolonged and untreated apathetic depression can lead to severe complications and even diseases that threaten the health of the patient and even his life.
Among the most common complications are:
- The development of chronic alcoholism.. The desire to escape from the rush of apathy and hopelessness often leads the patient to alcohol. It is in people suffering from depression that alcoholism develops according to a “shortened scenario”. Sometimes a few months are enough to form a mental addiction.
- Drug addiction and polytoxic addiction. For the reasons mentioned above, the patient resorts to drugs….. The destructive effect sets in very quickly.
- Drug addiction .. Independent attempts to get rid of apathetic depression, self-medication and advice from people who have a remote relation to medicine lead to the fact that the patient begins uncontrolled treatment of apathetic depression by using medications that have psychotropic effects. Improper selection of the drug and the dose, ignorance of the side effects lead to the formation of drug toxicity, which aggravates the course of depression.
- The development of internal diseases – To depression, after a certain period of time can join diseases of the heart, gastrointestinal tract, nervous system. They are caused by direct cortico-visceral connections (brain-organ). That is, the direct impact of a negatively working psyche on the organs.
- Suicidal thoughts– Being constantly under the pressure of hopelessness can push the patient to want to give up on life. Such thoughts and attempts especially occur while taking alcohol, drugs and medications that have an effect on the psyche.
Apathetic Depression: Treatment
Treatment of apathetic depression is aimed at all the links of the development of this condition.
First of all, it is necessary to determine and eliminate the cause of the beginning of the disease. To do this, individual psychotherapy is used.
For stabilization of the mental state, it is indicated:
- individual rational psychotherapy;
- group psychotherapy with the formation of health motivation and goals;
- Hypnotherapy, including narcohypnotherapy (suggestion with the use of nitrous oxide);
- Methods of stress therapy.
Medications are of great importance.
Of the medications used:
- Antidepressants .. There is a very large number of medications in this group. An experienced psychiatrist, based on his experience and intuition, selects the right one. The selection of a drug sometimes takes months. Unfortunately, many patients try to take antidepressants for apathetic depression (or as it is often mistakenly said – for “apathetic depression treatment”), which often leads to undesirable effects.
- Tranquilizers. Drugs in this group are used very cautiously in apathetic depression, usually in combination with antidepressants. Inept and unnecessary use can have the opposite effect.
- Symptomatic medications .. Prescribed to correct abnormalities of internal organs.
Acupuncture is successfully used in the treatment of apathetic depression.
A separate and effective way to return the patient’s psyche to normal functioning is estherapy – the impact on the psyche with music, poems, prose. For all their apparent mediocrity, these methods are very effective.
A special role should be given to physical training and sports. Skillfully directed exercise can work wonders and sometimes helps “pull” from apathetic depression people with very serious mental disorders.
The text is checked by doctors-experts: the head of social-psychological service of the AlkoClinic center, the doctor psychiatrist-drug specialist Serova L.A.
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