Roughly a quarter of people age 65 or older suffer from depression. More than half of doctor’s visits by the elderly involve complaints of emotional distress. Twenty percent of suicides in this country are committed by seniors, with the highest success rate belonging to older, white men. According to a recent report in the “Journal of the American Geriatrics Society,” depression is one of the major causes of decline in the health-related quality of life for senior citizens.
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 effect 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.
8. Get online.
According to a new report issued by the Phoenix Report, spending time online reduced depression by 20 percent in senior citizens. The study’s co-author, Sherry G. Ford, makes an excellent point: “Maintaining relationships with friends and family at a time in life when mobility becomes increasingly limited is challenging for the elderly. Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult.”
Let’s say you’re 84 years old and have never worn a pair of tennis shoes. You don’t like to move fast. Let’s say you eat steak and fries every night, the fries being the only vegetable to go near your mouth. Are you really going to benefit from exercise at this point in your life? Had I not read the September 14 issue of “Archives of Internal Medicine,” I would have said, “hell no.” Alas, I stand corrected. Senior citizens who exercise–EVEN if they take it up at age 85–live longer, healthier, and happier lives. The seniors who exercised regularly experienced fewer declines in their quality of life, were less lonely, and were more likely to stay independent.
10. Review your options.
I can imagine how I’d feel if a well-intentioned family member stole my car keys, said the stove was off limits anymore, and dropped off a friendly “guest” (or spy) who would be staying with me for the rest of my life. NOT happy.
It’s no wonder why those seniors who lose their independence and mobility end up depressed. In fact, the “Journal of Leisure Research” just published a study by four researchers that confirmed a very basic theory: humans thrive when they have choices and feel in control. When they don’t? They become helpless and lose the will to live.
So a good exercise is to take inventory of our options: the brand of toothpaste we brush our teeth (or dentures) with, the websites we visit, the novels we read, the cereals we eat, the tv shows we watch, the people we talk to, the coffee we drink, the activities we pursue, the crossword puzzles we attempt. Okay, you get the point. Even in the midst of limited options, we always have some control, a plethora of possibilities. Simply take note of them.
11. Get a purpose.
According to author and life coach Richard Leider, “Purpose is the glue that holds the good life together.” Met Life, the insurance company, wanted to find out if that was really true, so they asked 1000 people between the ages 45 and 74 the big question: “Hey guys, why do you get up in the morning? What really matters in the end?” Contrary to the message we get blasted everyday in the media, folks reported that a sense of purpose was what was truly important. Even more so than money or health. And as people age, a sense of purpose becomes even more important.
So get a purpose, no matter how big or small: recycling the plastic bags of everyone in your apartment complex, providing free babysitting for your daughter so she can have a date night with her husband, spoiling your grandchildren with ice-cream, or visiting a lonely neighbor once a week. It doesn’t have to require lots of time, energy, money, or brain power. All you need is a little motivation and a touch of kindness.
12. Go with the pain.
Look. There is no escaping all the pain of growing older. When you consider all the physical ailments and chronic conditions experienced by seniors, it is understandable that so many are depressed and anxious. Not to mention the agonizing process of losing loved ones to death. When experiencing acute loneliness, I like to remember these words by spiritual author Henri Nouwen: “It is the absence itself, the emptiness within you, that you have to be willing to experience, not the one who could temporarily take it away. You have to own your loneliness and trust that it will not always be there. The pain you suffer now is meant to put you in touch with the place where you most need healing, your heart.” In other words, sometimes the best the thing to do with our pain is simply to surrender to it, and go with it.