Depression in the Elderly: Spot the 10 Warning Signs - MalaysiaChronic Conditions

Depression in the Elderly: Spot the 10 Warning Signs

Depression in the elderly is not something to be ignored. Learn the 10 warning signs of depression in the elderly and what you can do to help.

What is Depression in the Elderly?

Depression is a serious mental health condition that silently affects many people worldwide. In Malaysia, an estimated2.3%of adults live with depression – and that number may possibly increase in the future. Other statistics indicate thatone in six women, and one in eight men, will also experience depression at any point in their life.

Depression is a recurring and persistent condition that has adverse physical, mental and even social consequences. A person with depression may constantly feel sad, moody or low for long periods of time, sometimes spanning months to even years. There are a number ofdifferent typesof depression, including postpartum (postnatal, or immediately after childbirth) depression and seasonal affective disorder.

Depression is not a natural part of ageing. While it is perfectly normal to experience some sadness or grief in your life, prolonged periods of sadness and moodiness can be a sign of underlying problems that are not addressed. Spending one’s years may not necessarily be like a walk in the countryside. Events and experiences shape us, and sometimes they have a more negative impact on our lives than we initially anticipated.

The elderly are at higher risk of developing mental health conditions due to numerous risk factors. Depression often goes undiagnosed and untreated, and in some cases, its symptoms can be underreported, if at all reported.

The Risks of Depression in the Elderly

The risk factors of depression in the elderly (also known asgeriatric depression) are numerous, and thus requires a comprehensive medical plan to accurately treat. Some risk factors include, but are not limited to:

• Significant chronic health conditions that impair their independence
• Chronic pain due to advancing age, poor health and/or illness
• Side effects from treatment/specific medications
• Major changes to lifestyle and/or living arrangements
• Significant loss, e.g. loss of loved ones; loss of self-worth
• Lack of a strong support system/network
• Previous history of depression
• Substance abuse (e.g. drugs)
• Past memories that may evoke unpleasant feelings (e.g. guilt)

Depression may be missed during diagnosis because of a variety of causes. For one, elderly persons may feel afraid to admit that they are dealing with depression. Despite advances in understanding depression, society continues to persecute and alienate depressed persons for being “crazy” or “unwell”. Fear of reprisal, shame, or being shunned can prevent depressed people from getting help for what is actually a treatable mental health condition.

On top of this, there is still a great deal of misunderstanding about what causes depression. Most people think they are not depressed because they view struggle and sadness as a part of life, and so they continue to deny being depressed despite having the symptoms. They do not believe they are depressed because they firmly believe they are perfectly happy with how their life is going.

Misdiagnosis by a medical professional is also another cause, stemming from confusion between depression and medical conditions such as dementia. There is still a significant knowledge/understanding gap between health care and mental health settings. This leads to misattributing symptoms to other conditions instead of depression. Depressed persons may also inaccurately report their symptoms, instead of dismissing them as a part of the ageing process, which also complicates the diagnosis.

These can be motivating reasons that people find it difficult to talk about their depression and get the treatment they deserve.

Looking Out for Warning Signs

The similarities of symptoms between depression and other mental health conditions, like dementia, can seem rather confusing at first, so this article aims to help you stay informed with additional information to help you spot the warning signs.

Because of how depression can happen at any time without warning, you will either be able to notice telltale signs of depression very early or find difficulty in knowing whether it is the case. If you have doubts, be sure to speak to a professional psychiatrist or counsellor who is trained to treat depression.

Early detection is thus the key factor in determining if it is indeed depression. However, if you or your loved one experiences any of the following warning signs, be sure to take notes of everything you can observe and then share the information with the medical team. Do not be shy or embarrassed to ask for help when you need it.

It is very important to reiterate that depressionisa treatable medical condition if detected. Early intervention can save you or your loved one’s life.

Sudden Changes in Mood

A change in mood, usually a shift towards sadness, apathy, or anger, is one warning sign to watch out for. As mood swings can also be seen in persons with dementia, many have made the mistake of misdiagnosing it as a sign of developing dementia.

The key difference is that you or your loved one can be made aware of behavioural changes (or are immediately aware of them), while those with dementia may not realize it even if it was pointed out to them. Mood swings in persons with dementia also happen without any specific reason; you could be telling them a joke, and they may end up crying or scolding you without warning.

It should be noted that you should avoid making assumptions about your or your loved one’s condition if you observe any mood changes. Singular symptoms should not be taken at face value as being a particular medical condition. Seek medical attention immediately to accurately ascertain what it may be.

Cognitive Difficulties

Unlike persons with dementia, those with depression may see a rapid decline in mental functioning when compared to other types of dementia. Cognitive impairments, such as memory lapses, will happen from time to time; you or your loved one may become aware of this. They are a few occasions where you may feel disoriented and lose track of time. However, depression can mean you will forget tasks or thoughts more often, or find it hard to concentrate.

Cognitive impairments in those with depression do not cause them to become unable to speak coherently or have difficulty understanding others. However, persisting cognitive difficulties can become a part of anegative feedback cyclethat worsens depressive symptoms

One studyhas noted that those with depression who go through cognitive deficits are at higher risk ofdeveloping dementia. Immediate treatment of depression can eventually lead to a significant improvement in memory and a reduction in said risk.

Onset of Insomnia

The constant worrying and sadness a depressed person goes through will gradually affect their health. The sudden onset of insomnia in you or your loved one, especially if either of you has never hadsleeping difficultiesbefore, can be a warning sign to take note of. In fact, some studies have found thatpeople with insomniaare at high risk of developing depression.

Changesthat might happen to sleep in depressed persons are similar to changes that also occur as a person ages. This can manifest in shorter sleeping times or a decline in restful sleep quality. The after-effects can include irritability, difficulty in concentrating on tasks, and even memory lapses. All of these can negatively influence their depression, which could eventually cause more concerning issues.

Constant Fatigue

A majority of persons with depression also exhibit symptoms of fatigue. Fatigue is said to be thesecond most common symptomseen in a majority of persons with major depression. Moreover, being depressed makes youfour times more likelyto develop fatigue. Both can prevent you or your loved one from getting a good night’s rest, thus draining you of energy and motivation to do things you enjoy.

Fatigue can last for weeks to months. The physical, mental and emotional aspects of fatigue can influence other symptoms and in some cases, worsen other symptoms. However, you should be aware that it is still possible to be fatigued and not depressed, and vice versa.

Social Isolation

Depression can lead some to gradually withdraw from all manner of social interactions, including those with family members. A major part of depression causes people to feel extremely uncomfortable with being part of social activities. Some reasons cited by depression survivors include a feeling of worthlessness, guilt and/or resentment in comparison to others. Some feel like they are being a hindrance to others, and choose to remain quiet and/or avoid eye contact. Given a choice, they may even choose to leave if their discomfort grows.

A common misunderstanding is that shyness or a lack of confidence is what causes persons with depression to withdraw from social activities. However, depression forces people to pull away from others and go into a complete shutdown. In some cases, it is actively reinforced whenever they pull away from social activities, reinforcing ideas that they are “nobody” in the eyes of their friends and family.

Loss of Interest

Depressed people slowly withdraw into themselves as time goes on. This can be seen when they withdraw not only from people but from hobbies and other activities they used to enjoy. As they withdraw further and further from life, they begin to exhibit a lack of energy to even think about favourite pastimes. This is also known asanhedonia.

This can differ from person to person, however. Some may continue to do what they do, but may no longer have any passion for it, or take no pleasure from it. It is believed that it may be a case where the braincannot sustain good feelingsover a long period of time, making depressed persons feel like they cannot enjoy the good things in life.

Persistent Aches and Pains

If you or your loved one were in good health prior to this, the onset of sudden aches and pains that last a long time could be another warning sign. Pain is not only a physical symptom but is also an emotional one. Pain has the potential to modify your thoughts, moods, and behaviours. This can result in a cycle where pain worsens depression and vice versa.

Sometimes, these aches and pains may appear without any reason, even if you were in good health. If the pain goes to a point that it interferes with your daily routines, this can also lead to a decline in your mental health. Studies have also found that depressed persons in pain experience more severe cases of pain that lastssignificantlylongerthan other people in pain.

Changes in Appetite

You may suddenly find yourself, or your loved one, having an increase or decrease in your appetite. It may also be a specific change in your dietary preferences, such as an increased desire for sweet foods like chocolates and custards. One study found thatspecific brain activitycould actually influence an increase or decrease in appetite.

You or your loved one might be eating more than usual. Sometimes, you might eat certain foods like ice cream or fast food as a source of temporary comfort (comfort foods), which could lead to weight gain and other health concerns. Conversely, you or your loved one may be eating less. The unintentional weight loss can put you at risk and deprive you of much-needed energy to do things. Either of these contributes to further depressive symptoms.

Other changes may also include digestive problems such as frequent diarrhoea or constipation.

Lingering Anxiety and Worries

You or your loved one may also find worrying a lot more than usual. Some level of anxiety and worry is normal, but when it gets out of control that you cannot stop dwelling on these negative thoughts, you should think about seeking help as soon as possible. Falling into this endless cycle of worrying, without any semblance of control over these thoughts, will only make the depression harder to overcome.

When worrying goes overboard, you may find yourself drowning in so many negative thoughts that you cannot think clearly to find a solution. This is what makes depression a difficult challenge to overcome, simply because you are unable to keep your worries to a limit. Dwelling on negativity will also eventually negatively affect your physical health and contribute further to your depression.

Suicidal Tendencies

Possibly the most worrying sign of all, suicidal tendencies may either be in the form of verbal statements of intent, or actual declarations of intent. Suicide is still a taboo topic in many societies, but mental health issues are becoming more and more important to focus on as our understanding of it grows. When you or your loved one exhibit any signs or make it known of any suicidal tendencies, regardless of actual intent, an immediate intervention must be taken before it gets out of hand.

The danger of suicidal tendencies is how often people do not notice the telltale signs, as in some cases the depressed person hides their true feelings from others around them. It is therefore critical to identify possible signs as quickly as possible before any suicidal tendencies manifest.

Getting Help

The sooner you spot the warning signs of depression, the sooner you can take action and get the help you or your loved one needs to treat it. It will seem daunting to even consider it, and you might find negative thoughts creeping in and making you second guess whether this is the right course of action.

Depression is not a sign of “craziness” or “instability.” It is a treatable mental health condition, one that affects millions all over the world. Mental health awareness has been gaining significant traction over the years, and medical professionals in theWorld Health Organizationand other bodies are emphasizing the importance of detecting and treating depression early, especially in the elderly.

Talking about your feelings is a small step forward to helping you or your loved one move on from depression. Having a support system that can lend a helping hand or a shoulder to cry on can do wonders to one’s self-esteem, and make them feel like they are loved and cherished for who they are. Being able to externalize these inner thoughts to trusted, empathetic listeners at any time can be beneficial to treating depression.

Seeing a medical professional is also an important part of overcoming depression. A thorough diagnosis of depressive symptoms will be the first step in treating depression. Following that, a treatment plan will be formulated to help you get back on your feet. This may include talk therapy sessions, taking prescribed antidepressants, or other treatment options. Treatment is meant to help your mental health recovery, while also addressing other side effects that affect your overall health. As your mental health improves, you may also find that your physical health also gets better.

An important axiom to know when tackling depression is that “depression feeds on withdrawal and inactivity.” In conjunction with treatments you receive, you or your loved one should slowly get back to doing activities you once enjoyed. On top of that, frequent exercise can also keep you fit and help to improve your mood. Joining a support group can also be a good way to socialize with others who share similar experiences of depression; some groups even organize various fun-filled activities to get their members moving and mingling with one another.

Depression Can Be Overcome

It is important to remember that you are not alone and help is available to help you through difficult times. While medication and therapy are available, support from family and friends are equally vital in overcoming depression. Check on your friends and family if you have not been in touch for some time and ask them how they are doing. If you learn they are battling depression, let them know that they are loved and you are there to support them while they overcome depression.

If you think it is best, considerhome careas an option for cases where advanced depression affects someone to such an extent that they need assistance with daily chores and other activities.

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