Know the warning signs of an older adult’s depression

By Stephanie Trelogan, caring.com

Older adults often face stressful situations, including chronic illness, financial problems, and loss of independence. Add that to physical and emotional isolation, and you’ve got a recipe for depression.

But there’s a big difference between situational unhappiness and clinical depression. Feelings of sadness and anger are natural after a catastrophic event like a heart attack or the death of a loved one, but when those feelings linger for months on end and prevent an older adult from enjoying life at all, it’s more than a normal reaction to grief.
Sometimes it’s hard to tell the difference between depression and just a case of the blues. Depression is more than just feeling sad or “down.” Depression affects a person’s thinking, emotions, behavior, and physical health. A depressed person may feel empty inside, or may no longer enjoy activities she once loved. She may complain of aches and pains that can’t be explained or treated. When someone has several of these symptoms for weeks or months, it’s likely that she’s clinically depressed.

Here are 11 different warning signs of depression. Keep in mind that depressed people don’t all experience the same symptoms, and the severity of symptoms may vary. But if someone exhibits several of these symptoms for more than two weeks, he may need help.

1. Persistent sad, anxious, or “empty” feelings

2. Feelings of hopelessness, worthlessness, or helplessness

3. Frequent crying episodes

4. Increased agitation and restlessness

5. Fatigue and decreased energy

6. Loss of interest in activities or hobbies that once were pleasurable

7. Difficulty concentrating, remembering details, and making decisions

8. Sleeping too much or not enough

9. Poor appetite or overeating

10. Expressing thoughts of dying or suicide

11. Persistent aches or pains, headaches, cramps, or digestive problems that don’t ease with treatment

And it’s also helpful to know what specific indicators to look for:

  • Lack of interest in personal appearance. One of the most obvious signs of depression in older adults is when they stop caring about their personal appearance. If the person you’re caring for used to take great pride in her looks but no longer bothers with makeup, she may be feeling depressed.
  • Increased complaints about aches and pains. Depression can actually amplify physical pain, turning minor irritations into severe discomfort. If your once-stoic friend or relative won’t stop complaining about her sore feet, she may be suffering from more than just bunions.
  • Social withdrawal. Depressed older adults tend to push other people away — especially those they love the most. If the person you’re caring for suddenly starts making excuses not to see you or other family members or friends, it’s worth checking into what’s really going on.
  • Break the taboo. Depression is a taboo subject for many older adults, and they may have an especially tough time thinking of it as an actual illness. But the first step toward helping someone who’s depressed is letting her know you care about her and support her.
  • Broach the subject carefully. Instead of plunging directly into a tough discussion about therapy or treatment, try asking what’s going on. “I’ve noticed you haven’t been sleeping well and you’ve been so irritable lately. You just don’t seem like yourself. Are you okay?” Of course, there’s no guarantee that your tactful, gentle probing will open the floodgates, but it’s worth a shot.

If she agrees to see the doctor: In the best-case scenario, you’ve had a great heart-to-heart with the person in your care and she’s agreed to talk to a psychotherapist or psychiatrist about her mood. In the worst case, she’s repeatedly brushed off your attempts at discussion and doesn’t want to hear another word about it. In that case, you might want to try another approach: Suggest a checkup with her primary care doctor. An older adult may be less resistant to this idea, and she may be more willing to listen to a doctor who urges her to get help.
If she resists: If she’s resistant to the idea of seeing a doctor because she’s embarrassed or afraid, help her understand that a diagnosis of depression isn’t the shameful secret it once was. It doesn’t mean she’s “crazy” or is going to be taken away to a nursing home. What’s more, her test results are private, so no one but she and her doctor needs to know.
If she refuses: If she refuses to see a doctor, there’s not a whole lot you can do. You can’t force the issue unless she’s psychotic or suicidal, or her depression has progressed to the point where she can no longer take care of herself. If none of those circumstances apply, your best bet is to enlist other family members and friends to try to persuade her to seek help.

Provide practical daily help. When someone is diagnosed with depression, the doctor may prescribe antidepressant medications and/or psychotherapy. The doctor may also recommend lifestyle changes. You may need to drive her to appointments, remind her to take new medications, help her get out more, or help her make other lifestyle changes.
Get her to a professional. Even if a primary care doctor diagnosed the depression, the person may still benefit from seeing a mental health professional. Not all primary care physicians are comfortable treating depression.
Provide reassurance. Older adults are often anxious about taking antidepressants, either because of the stigma they associate with such medications or because they’re afraid of potential side effects. Assure the person in your care that the doctor can work with her to find the medication that’s most effective with the least-severe side effects.

Here are some other things you can do to support her:
*Help her stay as physically active as possible. Make sure you talk to her doctor about what activities are appropriate before beginning any exercise program. Find activities you can do together, such as a morning walk around the neighborhood. Exposure to sunlight can help break the cycle of sleeping during the day that many depressed people fall into.

*Structure the day around activities that give her pleasure and a sense of purpose. For example, meet friends for lunch or enjoy a leisurely walk through the mall.

*Join a support group — for either or both of you. Talking to other people who’re struggling with similar issues can be enormously comforting and helpful. It’s also a great way to connect with other people her age and caregivers.

If you’ve tried everything you can and nothing seems to help, remember it’s not all up to you. In the end, it’s really the responsibility of the person suffering from depression to get help for herself. If she won’t talk to her doctor or comply with treatment, you can’t make her do it. Keep offering support and provide positive reinforcement when she takes those difficult steps toward recovery.
If feelings of guilt or sadness about the situation overwhelm you, you may need help coming to terms with the fact that your loved one isn’t going to get help. Ask your own doctor for information about support groups and other resources to help you manage your own feelings.

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