Nov 12

Seniors with Depression

by Dillon Kato

While depression can affect us at any age, there are special approaches taken when dealing with depression in seniors.

Dr. Amy Schuett, a psychiatrist with the Billings Clinic, said when she sees patients, the depression is the same, but how she goes about talking with older people about depression is different.

I might say something like, ‘How are your spirits lately?’ and talk less about physical issues,” Schuett said.

She said there is a useful tool that can be found online for family members called the short form geriatric depression scale that can help them judge depression help ask the right questions.

“Often, elderly people may be more resilient to mental health issues. There’s that attitude of go it alone, go tough, not admit to problems, a more stoic type of heritage,” she said.

When a patient with depression issues comes in, Schuett said she will look for underlying medical issues like a thyroid condition, diabetes, or infections that could be causing the person not to feel well. Then, she uses questions from the scale to gauge their mood.

“I’ll talk to them about whether they’ve dropped any of their interests or activities. Do you feel like your life is empty, are you enjoying things that you used to?” Schuett said.

A section of a person’s life she focuses on is the family. Is the person declining to go out as much or show up to family events. Often with older people, she said grandchildren are a subject that she finds most people will normally become more talkative and interested in.

“One thing that complicates elderly depression is they can look very demented, something like Alzheimer’s that is actually depression,” Schuett said.

When tested, she will find that their memory is actually pretty good, but when she asks them questions they respond with noncommittal answers.

“Some of the problem with geriatric population is staying inside much longer. Their vitamin D goes down, which is already a problem for Montana people,” she said.

For someone with an older family member, Schuett said just getting them out into the sunlight and walking around is one of the best things that can be done to prevent depression.

“Definitely light will make a difference. if you can’t get the person out of the house, open their blinds and turn on the lights. Being available just for some casual activities can be very helpful too,” he said.

This can be particularly important if they are living alone, for example after the death of a spouse.

“Say the spouse is the one that drove, had the friends, took them places. The risk goes up,” Schuett said.

The doctor said that for older patients being treated for depression, she also takes a different approach in how she talks to them about antidepressant medication, especially with men.

“I think men see it as a weakness more than women, feeling like they need to rely on a medication for depression,” Schuett said.

Her solution is to rephrase how she introduces them to the pills, taking a tone of what things they will help with. Schuett said she’ll tell them about how it will help them rest better at night, or decrease their worrying, addressing some of the patients target symptoms.

The most effective way to combat depression can be a combination of these medications with lifestyle changes, Schuett said.

“Sometimes, the medications can help them get to the points where they can make the changes,” she said.

Deb Matteucci, mental health bureau services chief with the Montana Department of Health and Human Services, said while her office is not a direct service provider, they do partner with health agencies and assisted living facilities, providing outreach and training to make them more aware of the behavioral health needs of an aging population.

One thing to look at is an older person’s general living condition in their home. If they have historically maintained flower beds, or kept their home very tidy but that has changed, Matteucci said, that could be physical discomfort, or it could be a symptom of depression.

Similarly, if they are staying in more, not engaging in their normal social groups, like a bridge or bingo night. Social supports are an important part of a healthy mind for all age ranges. Side effects of medication are also a potential cause of depression, she said.

“We just want them to really be looking at those things, not to be afraid to reach out to primary care doctors, ask questions. I think there’s a longstanding myth that depression comes along with aging, that’s just not the truth. Reach out and get help,” Matteucci said.

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