Recognize and treat depression in the elderly

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Extract from the article: Depression is a mental disorder that manifests itself primarily in moral pain (intense sadness), a loss of desire to carry out life activities (anhedonia). When this condition lasts for more than two weeks or is chronic, it is called depression. It o

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Depression is a mental disorder that manifests itself primarily in moral pain (intense sadness), a loss of desire to carry out life activities (anhedonia). When this condition lasts for more than two weeks or is chronic, it is called depression. It occurs when the person is subjected to external and internal factors that become increasingly recurrent such as overwork, lack of rest at home, certain diseases, chronic stress, family problems, etc. The particularity of elderly people is that they cumulate several factors favoring its occurrence. How can this be remedied?  

Depression is an important condition in the elderly due to its frequency, but also its consequences from the individual, family and societal point of view.  According to the WHO, depression affects 4.4% of people worldwide, or about 300 million people. And the prevalence increases with age, reaching its peak around the age of 60-65 at retirement.  

What is an elderly person’s depression?

According to the DSM-5 (reference book in psychiatry), depression is expressed by a very low depressive mood (which is not systematic in the elderly person), a loss of interest and pleasure, a decrease in self-esteem, a feeling of guilt, indecision and recurring morbid thoughts, sleep disturbances, eating disorders (which most often result in weight loss and anorexia in the elderly), intense fatigue (asthenia) as well as decreased cognitive abilities (which should not be confused with signs of senility) are associated with the disease.

What are the causes?

Research has shown that many biological factors are involved, including the imbalance of several neurotransmitters, because as we age, the cells of the body also suffer from the impact of aging.
The main neurotransmitters identified are serotonin and noradrenaline. Research shows that a person whose parents are or have been depressed has an increased (2 to 4 times higher) risk of developing depression in their own lifetime.

Environmental factors include social isolation, interpersonal conflicts, retirement, loss of loved ones, widowhood, financial problems, placement in a retirement home, taking depressive medication. Some diseases can also lead to depression such as stroke, Parkinson’s disease, dementia, heart failure, chronic pain (HIV/AIDS, hypertension, diabetes), loss of autonomy due to senility. An elderly person who has accumulated several painful experiences during his life, isolation, withdrawal, morbid thoughts disturb his daily life. All of these are additional causes that older people accumulate and cause them to become depressed more often than adults.

Can we cure her?

In order to avoid any deterioration of health or suicide (very common among the elderly) of patients, management is essential. But it must take into account the specificities related to the age of patients. Depression is a disease that can be treated. There are two main groups of treatment: medication and psychological care. In geriatrics, we always start with the psychological treatment because it works best with no side effects, because it is done without medication.

Let us take as an example the case of bereavement which elderly people experience very often. A couple who have lived together for several years and one spouse dies, the other survivor will experience a period of mourning that is quite normal. But beyond a year, if the person is still closed, depressed and no longer tastes anything, it must be considered that it is more a depression than a grief and at this time it needs to be treated.

What will help the person most is not medication, but being able to talk with someone to express their sadness. The ideal treatment is psychotherapy. In some cases, medications can be added when there is severe depression, but drugs alone are not sufficient and should be used sparingly.

Advice to the elderly  

Learn to be resilient. Know how to put things into perspective. Use the experiences gained throughout this life and put them into practice. When your own resilience capacity is over, don’t hesitate to open your mouth for help.  

To prevent symptoms of depression in the elderly or relapses, ensure respect for a healthy lifestyle: practice of appropriate physical activity, balanced diet, regular sleep schedules, etc. Try to multiply activities (volunteering, hobbies) and communicate with the entourage as much as possible. Indeed, you must try to be surrounded as much as possible to avoid feeling abandoned. Strengthen family ties by engaging in activities with children and grandchildren, for example. Through their involvement with the younger generations, seniors play a role in society, pass on their knowledge and feel useful. In short, we must escape idleness.

In addition, raising awareness among relatives is also essential to prevent the onset of a depressive state in an elderly person. The entourage must also accompany and support the elderly person: know how to be present and show themselves present for the elderly person, bring love and especially time to our seniors. Be aware that any change in an elderly person’s behaviour can be the first signs of depression, and don’t hesitate to seek advice from health care staff. To better help them, try as much as possible to put yourself in their shoes to understand them and not judge them.

Anxiety and depression are measurable parameters that affect quality of life. They can also lead to chronic diseases, to impairment of brain functions. The quality of life can be significantly improved by better multidisciplinary management.

 Abel OZIH

Article validated by Dr Zinsou Selom Degboe, Clinical psychologist and psychotherapist at CHU Campus-Lomé