|Understanding Geriatric Depression|
ElderCare Online is dedicated to bringing you educational materials that help you to enhance the quality of life your elderly loved one. We have begun working closely with RSI, a leader in the development of health assessments, care plans and training materials for frail elderly people and their caregivers.
RSI pioneered the idea of care management for the "whole person" for elderly residents of assisted living facilities. In the course of years of research, they developed a comprehensive training and care management program that helps the elderly person stay active physically and mentally.
Together, ElderCare Online and RSI have tailored key components of the Caring Community program to meet the needs of family caregivers. Over the next several months, we will be presenting a new series of Skill Builders that focus on how caregivers at home and in residential facilities can learn more about chronic conditions and improve quality of care to their loved ones.
Depression greatly diminishes a persons quality of life, personal joy and productivity. Frail elderly persons, the residents in assisted living facilities, too often experience depression. Their declining health and functioning, multiple life changes and diminished personal resources are factors predisposing the frail elderly to depression. Depression is a medical condition, which affects the whole person; body, mind and spirit. Societal stigma and misunderstandings continually affect detection, treatment and prevention of depression. Depression can be managed and treated so that the persons quality of life, personal joy and productivity can return.
Because depression is a common and personally devastating condition for frail elderly
people, it is essential that appropriate training and education be provided to caregivers.
This Skill Builder equips the caregiver with the knowledge, skills, attitudes and
competencies to prevent, improve and manage depression in the people you care for.
Depression is more than sadness and low mood, more than the "low feeling" we all experience now and then but goes away when we take a walk or have coffee with a friend. Depression is more than the grieving that occurs after the death of a loved one. Depression is the darkest of moods, an empty feeling, many things and people are no longer interesting, aches and pains that keep coming back and go on and on for weeks, months or years. Depression is a whole body disorder that affects the way you think, the way you feel, both physically and emotionally. It isnt normal to feel depressed all the time when you get olderin fact, most older people feel satisfied with their lives.
Depression is difficult to recognize in the elderly because other changes are also occurring and these can mask real depression. Physical conditions, grieving and dementia are common changes that can mask depression. The way depression is expressed is also different in the elderly than in other populations. Instead of looking sad, elderly with depression will more often have physical ailments, headaches and stomach pain, with no medical cause and be tired or irritable.
Signs and Symptoms of Depression in Frail Elderly Persons
1. Behavioral Changes
2. Thinking Changes
3. Mood changes
4. Physical Changes
Is it Depression or Dementia?
Several of the symptoms related to changes in thinking or cognition. Knowing whether the main problem is depression or dementia is often difficult. Depression can imitate dementia and both depression and dementia can have depressive symptoms. Depression can also be superimposed on dementia. In the early stages of dementia, the person knows his/her memory is declining and this loss can lead to depression.
Distinguishing Depression and Dementia
Depression: A Medical Condition
Depression is a biological condition in which there are real physical changes occurring. The brain is a powerful organ that controls body, mind and emotions. Brain chemical, neurotransmitters, are involved. The main neurotransmitters are norephinephrine and serotonoin. They send messages by traveling within the brain and body along nerve fibers. Brain chemicals out of balance can lead to depression.
What tips the balance?
Depression is misunderstood
Management of Depression
Depression can be dangerous for a lot of reasons. And its all unnecessary because depression responds extremely well to treatment. People dont have to be depressed. But they do have to know that, and they do have to seek help.
The first course of action is to prescribe the right antidepressant drug. Pharmaceutical companies have developed a long list of antidepressants, as well as stimulants. Doctors decide which ones to use based on the severity of the depression and on the patients other conditions; then they make adjustments in the prescription as they monitor its effect.
Medications have become the most effective treatment for depression with 65-75% clinical improvement. There are several categories of medications to treat depression but Selective Serotonin Inhibitors (SSRIs) are effective, relatively safe to use and most commonly prescribed for elderly persons.
It is important to know that it can take 4-8 weeks before there is any relief from depression. For any long-term benefit, SSRIs must be taken for 6-9 months. When depression has occurred more than once, the duration of treatment is 1-5 years. Antidepressant medications are helpful in 60% of cases, and take 6-12 weeks to work. But they have numerous side effects in elderly people.
Side effects from taking antidepressant drugs often are more noticeable during the first few weeks but usually diminish after that. They include:
If your loved one has pain, chills, rash, fever, blurred vision or other troublesome symptoms, call your doctor.
There are a few rules for managing depression medication well:
While antidepressant drugs can work wonders in most cases, they nevertheless may have varied and surprising effects, or toxic accumulation, and so must be closely monitored by a physician.
Selective Serotonin Inhibitors
Once a person is started on medications, counseling can help. Sadness due to loss or the worry that goes with being sick can trigger depression, so we also need to deal with those feelings and not just the chemical imbalance.
"Cognition" means knowing or perceiving. Basically, thats thinking. Cognitive-behavioral therapy tries to identify and correct errors in thinking, where the person is seeing things as bad, when really they arent so bad.
Some of those thinking errors are:
The counseling that works on those problems can be either in individual sessions with a doctor or other professional or in a group. A key factor is restoration of the sense of control and autonomy in every possible aspect of a persons life. Depressed people must be helped to see that they have choices, that they are in control of their own lives.
Its much better if the person can talk about his/her symptoms and be involved in assessing his/her own problems, rather than having professionals confer and issue orders without the persons involvement.
For the same reasons that counseling helps, increased contact with friends and family will help lift depression, too. People need people. Although its very hard when you are depressed to make yourself move and do things, it is important to try. Remember what you used to like to do, and get it started again.
And finally, spiritual renewal and rediscovery of meaning in your life are powerful tools for overcoming the fear and the sadness that go along with depression.
While some people seem to think that there is something wrong with talking about the past, in fact, there is a lot of evidence that reminiscing has strong therapeutic potential for people of all ages, and especially for elderly people. The people who criticize reminiscing call it "living in the past," when it isnt that at all. People who reminisce are living their present lives but learning from the past. The past helps all of us understand the present.
By reminiscing, people can resolve old conflicts, disappointments and guilts, and also strengthen their self-esteem and celebrate the good in their lives. It has even been found that people who do life review -- that is, think back over their entire life -- experience less death anxiety and a stronger sense of satisfaction with who they are.
Medical science knows that the ability to tolerate bouts of depression is one important
basis for a satisfactory old age. As we get older we have to weather many storms. Those of
us who ride them out and get back safely to a calm harbor are the ones who know to ask for
help. Good medicine, good friends, and good philosophy can dispel the gloom of depression
and bring back the light of life.
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