Thoughts on Depression in Older Adults

Writer’s Note: This post is written to to connect with people over the age of 65. It is intended to bring them together as not just a group, but as the human beings they are. To that purpose “we” and “our” is used extensively.

Depression can be experienced at any time. Although it may feel or appear to be “just you,” the reality is that nearly 25% of all people aged 65 to 75 will suffer from depression at some point. In fact, more than half of doctor’s visits by the elderly involve complaints of physical impairment or limitation that can actually be traced to emotional distress. As people continue to celebrate birthdays, there are many times when they will see themselves as “growing old” or just “aging”. What they do not see is a “continued maturation.”

Of course, that difference may seem insignificant or a muddle. But the fact is, the difference is significant. When you, personally, view yourself are “growing old” or “aging”, those are negative approaches to life. The positive approach is one that looks for continued opportunity and benefit in your life. The one seeking “continued maturation” is positive because it looks for growth; it looks for the continued application of previously known skills along with the growth of new skills, the knowledge, and overall activity. While you may not be able to physically do some things like play football for the New York Giants or compete in the Dinah Shore Classic, you can still be active, both mentally and physically.

According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens. So why all the depression? Many doctors will refer to the problems as “The Five Ds”. These are:

  • disability,
  • decline,
  • diminished quality of life,
  • demand on caregivers, and
  • dementia.

To combat senior depression there need to be creative methods to counter The Five D’s. Many of these are quite obvious, but hidden to the sufferer. Let’s take each one at a time.

1. Understand each of the “Ds” and the “As” you can make them into.

Let’s start with what they can be made into:

  • Disability becomes Ability,
  • Decline becomes Action,
  • Diminished quality of life becomes Adjustment of quality of life,
  • Demand on caregivers becomes Assistance with caregivers,
  • Dementia becomes Alignment.

Consider how each of these work out in the long run of our lives.

Disability becomes Ability. We all have levels of skills throughout our lives. One of the mistakes made far too often in our Society is that we apply standards to everyone as if they will always and forever remain the same. Yet we all know that humans change over time. We will each reach our peek in our own time and slowly change as time goes on. What we need to do is to identify our abilities at each part of our lives. We need to recognize those abilities that remain sharp and continue to use them to our benefit. Similarly, we need to identify those abilities that may have dulled over time to determine if we are able to sharpen them once more or if we need to look for alternative methods to attain what those abilities provided to us in the past.

Decline becomes Action. As we continue our lives, there will always be that point at which our senses may dull slightly or our ability in doing some action is not as sharp. We can either just give up on our efforts to live or we can seek ways to remain active in our lives. That activity is described below in a number of creative and successful ways.

Diminished quality of life becomes Adjustment of quality of life. We all know there are any number of limitations that occur as people continue their lives. We know that even our quality of life we experienced while we were working changed. In fact, there are many things that have changed while we were working that we have had to adjust to. But those prior adjustments help us to prepare for now. They help us to recognize what is of value to us. Now we have the opportunity to use that knowledge to our advantage. That information is what helps us to determine what what is valuable and essential for our lives now. Recall this as you read further to see just how this works out.

Demand on caregivers becomes Assistance with caregivers. Many times when we hear that we will need a caregiver, we are apprehensive. Sometimes we have a level of distrust because the person is a “stranger” to us. Even when the caregiver is a family member there will be a bit of anxiety. That anxiety stems from having a significant change in relationship occur. But the anxiety and distrust is also found when we think about what needs to be done to help us. There are many times where we find ourselves overwhelmed by what our situation is requiring of our caregiver. This is where we can enter into dialog with the caregiver and ask how we may be of help and let the caregiver know what our limitations are. It is also the point at which we can learn about what our caregiver is doing to help us. In doing this, we can provide the reassurance we need that what is being done is “best practice” or determine that a change is needed.

Dementia becomes Alignment. Yes, it is understood we “slow down” over time. But as we change mentally, we can still take the time to align ourselves in what we are capable. That alignment begins with a simple inventory of what we can do each year and what we are comfortable in doing. While our brain shrinks each year we are still able to conduct our lives in different and varying ways. It is how to willingly align our abilities with what needs to be done that we can remain connected with our family and our caregiver(s). That alignment ultimately helps everyone to support one another in our care year after year.

2. Separate the illness from depression… But treat both concurrently.

The most difficult problem facing any senior is going to be illness. As we grow older, our immune system “ain’t what it used to be.” This results in more complicated and challenging illnesses to resolve. This can lead to more trips to more doctors and more types of treatments that can drain time from us, the patient, our family, and our caregiver. Over time, this can all lead to greater stress, frustration, and emotional upset. Each of these emotions has the potential to debilitate us, our family, and our caregiver in various forms.

In some instances, diseases can actually have an effect in the bodily chemistry which can, in turn, exacerbate the mental outlook of a person. This is also true in the types of chemicals, otherwise known as medicines, that may be proscribed to address the symptoms being experienced. Likewise, the interactions among the drugs may also effect a change in the mental outlook of us as a patient.

For these reasons, it is critical for us to be able to recognize the differences and nuances among which we are experiencing. These differences are between what it being thought vis a vis what is being felt. While we may be experiencing “pain”, the differentiation is between the physical (location, limitation) and the thinking. That is, are we, as the patient, disabled because of the pain in our lower back or because we are thinking about the pain in our lower back? While it may seem like a nuance, it is significant. What is causing actual pain in the lower back can be treated in several ways while your thinking about the pain is treated in a number of other ways.

A number of doctors encourage patients to recognize what is impacting them most. That is because many patients will have co-existing depression and a chronic illness they do not see in themselves. As a result, the full recovery from both is delayed because only one is being addressed at a time. Instead, it is best for doctors – those conducting management of the physical ailment and the psychologist or psychiatrist aiding the patient with his/her depression – to work collaboratively. This interactive effort allows for a discussion of treatment options, where the patient is at any given time, and identification of how each option is helping or limiting the advance of the patient to health.

Within the collaborative treatment should be an agreement among the doctors, us, the patient, and the caregiver that all will work together for the good of us. Secondly, aggressive treatment goals need to be established for our value as a patient. In this manner, we will be able to “see” and experience physical improvement that can be positive reinforcement used to eradicate the thoughts that drag down the mental health and outlook of the patient.

Throughout the treatment process, be sure there is cooperation and clear communication between and among doctors and you.

3. Treat all insomnia.

With each succeeding year of life, our sleep patterns will change. Those changes usually involve less time in Stage 3 and 4 of non-REM or Rapid Eye Movement sleep patterning. This means the patterns can become fragmented and unorganized. Many times older people will find themselves “wandering” in their sleep. That does NOT mean sleep-walking. Rather, it refers to instances throughout a 24-hour period in which the person will take many naps throughout the period. This leads to an all-too-common situation in which the person winds up developing sleep habits that actually enhance the situation.

One of the most common conditions found in this situation is how we prepare to sleep. For decades we have done the same thing: finish watching or reading something, go to the bedroom to prepare for the night, go to the bathroom to bathe or complete a toilette, return to the bedroom and climb into bed. But it is at this point that routines have changed over time. Over the course of time working, we pick up “bad habits” that affect how we “collect” our hours of sleep. Certainly there were times in our younger years – 20-30s – when we might just collapse in bed from exhaustion. But as we began our careers, we would continue to “work”. While it may not have been setting up a desk and reading through reports or editing some document, we would still “work” by thinking about things. Many people did not discipline themselves to shut down their working minds with a sense of trust and belief that they would be able to manage and address what they were thinking of in the morning… with the knowledge that a solid eight hours of sleep would refresh and recharge our minds and bodies. So the person thinks as they would go to sleep, never letting go the thoughts and ideas that kept them awake, usually with emotions of worry, anxiety, concern, even fear. In turn, that led to an inability to actually slip into the deep, restful sleep in Stage 3 and 4.

In the same manner, many older people find themselves overthinking the Five D’s of disability, decline, diminished quality of life, demands placed on caregivers, and dementia. These thoughts can exacerbate the emotions and stressors already being experienced with the experience of an illness. In many instances, the person experiencing depression will also have sleep problems and vice versa. Thus it is essential for anyone over the age of 65 who is receiving care for senior depression to be up-front and honest with their caregiver and their doctors if they are also experiencing any form of insomnia. This could include

  • using electronic devices or reading for a period of greater than a half hour before finally going to sleep,
  • recurring instances of two or more nights on a regular basis where it takes longer than 15 to 20 minutes to actually fall asleep,
  • frequent dreaming or being aware of thinking while sleeping during the night,
  • waking up either regularly or frequently, including having to void or evacuate more than twice at night.

One way to address these issues is to discipline yourself to practice quality sleep hygiene. This is a series of steps that will provide calming influences to your mind while also guiding your self to actually want to fall asleep on a regular schedule. It will also provide you a discipline for when you want to wake up. It is rather straight-forward discipline:

  • Set a time when you want to go to sleep and wake up that will be a span of eight hours,
  • Reduce your intake of stimulants as you near the time you want to got to bed,
  • Give yourself two hours before the time you want to go to sleep so you can relax and separate yourself from the events and thoughts of the day.

Most critical in this process is to set a time when you will go to sleep and wake up each evening and morning. In doing this, you are preparing yourself to be “ready” to sleep for a full seven to eight hours while also being ready when the alarm sounds to actually have something to do to wake yourself up. For example, if you know you will be getting up each morning at 6 AM so you can prep yourself to be out the door for a brisk walk by 7 AM, that means you need to be asleep no later than 10 PM the evening before to get the full eight hours of sleep. If that means you will miss your favorite TV show or sports event, take the time to learn how your cable or satellite service offers you the opportunity to digitally save the program for future viewing. Or adjust the time when you get up to make certain you are getting a full eight hours of sleep.

Next, you want to reduce the intake of products that will stimulate your body and your mind. This may seem fairly logical, but it needs to be stated because many times people are not aware or alert of what can be stimulants. We know about sugar that can be found in chocolate, sodas and many manufactured beverages. We are also generally aware of coffee and sodas that have caffeine as well. But what we may be less aware of are the drugs proscribed for what ails us. Many times the drugs proscribed are with the best of intentions. They are meant to do the very thing we should be doing naturally.

But some of the drugs are intended to address bodily functions we experience while we sleep. In essence, they are intended to give our bodies a “booster shot” of chemicals. Unfortunately, they may also act as stimulants that cause us to stay awake or give us difficulty in getting a full night’s sleep. Similarly, if they are taken during the day, we need to be alert to whether they can also be depressants that will make us groggy or sleepy. Thus, it is critical to make certain there are no side-effects that can affect sleep patterns. Also, make certain to discuss with each doctor the best time to take medicines that are being proscribed.

Lastly, be sure you have completed all exercises and eating at least two hours in advance of when you are turning in for the evening. In the case of this example, that means you should be sitting and resting by 8 PM. Coupled with that is another critical consideration of what you will be doing for the two hours between 8 PM and 10 PM. Obviously this activity needs to be calming, soothing, something that is going to reduce, not increase, the amount of adrenaline coursing through your system. Thus, no rock’em, sock’em football games or reading any murder mysteries or sci-fi thrillers. Likewise, no reading up on your favorite political candidate or watching overly exciting YouTube videos. While they may be great activities during the height of the day as a retiree, now is the time to be looking to “get sleepy”.

The goal, ultimately, is to bring yourself to the point where you look forward to rest and sleep for an extended period of time each night for a full eight hours with limited interruptions to relieve yourself.

4. Distinguish grief from depression.

“Grief” is defined by “keen mental suffering or distress over affliction or loss; sharp sorrow; painful regret.” All of this references experiences, emotions, and the inevitable feelings that are short-term. They are experienced at a point in time when something tragic or upsetting occurs. “Depression” is far different. Within the psychological and psychiatric fields, the condition of depression is defined as “a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason.” The difference is stark and realistic when the mindset is looked at through objective review.

What needs to be recognized, first and foremost, is the length of time of the emotional state. Someone who has just lost a loved one or has just been informed of very upsetting news will likely experience grief. The sadness of the situation that causes grief usually has a variety of degrees of intensity of emotions. The emotions experienced will run the gamut from intense sadness to a sense of guilt of not being able to stop or address the situation to anger that the situation occurred to a sense of loneliness or irritability that may be expressed to others. But the most critical element of the range of emotions is that the person experiencing grief will still be able to take part in the daily activities of life which includes interacting with other people, other family, friends, or new acquaintances. Ultimately, grief is for a limited period of time. It will resolve itself because the person is able to put it in perspective of the larger world.

The person experiencing depression, however, closes in on him or herself. The focus of the mind is not on doing activities or interacting with others. Instead, the focus is on the negative aspects of the person’s life. In essence, the person looks only at the problems being experienced. Those problems may include

  • the physical pain or limitations being experienced,
  • worries, fears, doubts, or dwelling on “what could have been”,
  • upset or anger within him or herself as not being able to do something over the course of years,
  • inward focus on not being able to do specific activities,
  • recurring anger or resentment about a specific topic that transcends years.

Depression is more persistent that is usually coupled with an unremitting sadness. The depressed person is so consumed with their personal thoughts, they are unable to look at the outside world and see opportunities to enjoy activities. In essence, they find themselves just slogging through life because they have gotten up each morning. Any sense of happiness in being alive or seeing opportunities to take advantage of are ignored or lost.

5. Develop a new reason for life.

“Giving up” always seems to be the easy way out. You just throw up your hands and say, “I can’t do this anymore.” But that is at odds with the purpose of life. It is at odds with living.

For decades, you have lived life for yourself and for your family. Life has been the catalyst to do something in which you have an interest on a regular basis. As you continue to mature, look for new opportunities that are of interest to you. Pursue opportunities which involve some types of activity. To do this, ask yourself these two questions each morning:

  • “Why am I getting up this morning?”
  • “What do I want to do today?”

In both questions you are giving yourself a sense of purpose to fulfill. Many times the goals may be simple such as:

  • calling an old friend and talking with them about nothing for ten minutes,
  • rereading a favorite book,
  • listening to an album of fun, toe-tapping songs from when you were younger,
  • looking at photos of vacations past or events that you took part in.

As you strengthen your mind and your focus on interests, you can begin to pursue more physical activities. These may include:

  • stretching your arms over your head several times during the day,
  • standing up in front of different windows in your home to see what is around your home,
  • making a commitment and then fulfilling it to write down five positive thoughts each hour from the time you get up until you go to sleep,
  • reread each of those thoughts each day and then add to them.

Continue your efforts by actually going outside at least twice each week and doing something active. Ideas for these activities are:

  • walking from your front door to your driveway and back,
  • expanding that walk to a walk around your neighborhood,
  • asking your caregiver to take you to a park for a walk,
  • walk over to a local park and sit in the sun for a half hour,
  • invite your grandchildren over for a playdate so your child and his or her spouse can go out for a date night,
  • if you are able, pick up your grandchildren at school and spoil them with a trip to an ice creamery.

When you first start, you may need help from your caregiver. That is to be expected. Make it a collaborative effort once more where you can seek out the support of your caregiver while presenting to yourself a goal to strengthen yourself to different points where you do not require your caregiver to help, but rather to be a cheerleader for you.

The key to each of these efforts is self-motivation to be active. That drive changes the focus from dwelling on negative thoughts to wanting to do something that is positive and valuable for yourself and others.

6. Carry photos with you.

Many times people who are suffering from depression have closed themselves off from happy times or people who have held value in their lives. Those times and people have been “forgotten”. One of the best ways to combat the thoughts that lead to depression: carry photos of your loved ones, friends and happy experiences in your wallet. For anyone who owns a smart phones or other types of technology that allow for digital photos, this is a perfect opportunity to hold many albums of photos that will allow you to reminisce on the fun times you have had in the past. It is also a great way to reconnect with family and friends and share those times when you are meeting with them.

In addition to combating depression, the photos also fire the imagination to offer ideas of what can be done again or funny experiences that help to suppress the “near negatives” you may be experiencing at that moment.

7. Make new friends.

As useful as photos may be, being able to connect with real, live people is far better. This is because each person can interact and relate with you as a person. One of the most important elements that make up the emotional and personal strength of each person is a strong social network. Regardless of age, being able to connect with people whom you know and who know you benefit each person. But this is even more important for people as they live through their 60s, 70s, 80s and beyond. As we continue to mature, the strength of our social networks is valuable in helping us to be resilient to depression and anxiety in our lives.

We may have the need of our caregiver to be there to talk to and to be near our side from time to time. That presence is valuable for us because they are someone with whom we have built and continue to build a trusting relationship. Yet we also need to recognize they are not a crutch either.

This relationship is critical for us because it refreshes in our minds what it means to have help. It also provides us the opportunity to identify where the caregiver’s life is their own to live and cultivate. In no way does this mean that he or she is not interested in us or does not love us – especially if they are a family member. What it does mean is that we have a responsibility to give them their own freedom. We know they will be there for us when we are in need. It is through their contact and efforts to support and assist us that we come to trust and believe that they will put their lives aside from time to time when we need them. Thus, we need other people in our lives as well.

That is where the value and importance come into play in meeting new people and developing new relationships with age-equal and people near us. It does not mean we just blindly start up friendships. What is does mean is that we think about who the people are we want to meet. It means we consider their personalities, what their interests are, how they act, what their backgrounds are, and just how we connect. Ways of doing this include:

  • becoming involved with your church,
  • connecting with organizations that you have a mutual interest in,
  • attending the book club at your local library,
  • volunteering with a local charity,
  • developing relationships with people who have similar interests,
  • connecting with the alumni organization of your college in your local area,
  • reconnecting and keeping in touch with those with whom we have worked.

What is most important in all of this is that you look for opportunities that are fascinating and interesting to you as a person. Seek what is beneficial and fulfilling to you as positive and valuable.

8. Follow the guide of the song to “Hold On Loosely” when it comes to caregivers.

Our husband or wife will always be Number 1 in our lives. But let’s face it: caregivers become the single most important person in our life as we continue to celebrate each new year of life. That’s because the caregiver becomes the person whom we rely on for just about everything. From simple things like making our meals to keeping our homes, the caregiver is critical to our lives. But remember that even if the caregiver is a family member, we are maintaining a relationship with a person. It is that relationship that is so critical to keep healthy.

In 1980, the band .38 Special gave us all a clear guide of how to handle relationships, whether romantic or personal. That guidance was with the title and lyrics of the song Hold On Loosely. Huh, you may say. What does that mean? But when you take a few moments to think about the refrain, it makes a lot of sense:

Just hold on loosely
But don’t let go
If you cling to tightly
You’re gonna lose control
Your baby needs someone to believe in
And a whole lot of space to breathe in

Indeed, the value of your caregiver is that he or she will be there for you when you need them, but only when they know they have their own time when they need or want that time. So as the title of the song goes, Hold On Loosely and watch how dedicated and careful they will be in caring for you.

9. Get online.

As much as you will want to connect with people locally, there are also opportunities to connect with people – with family and friends from your past and the present – through the Internet. This is not just about idly browsing pictures or reading some series of comments on articles. This is actually about talking with individuals. But this is not about getting on dating sites. To make this work, you need to work at it. That work involves learning about what you are interested in. Learn about the positive and beneficial topics you want to learn more about. Learn about the websites that provide information about those topics. It may mean taking some time to become “conversant” in the language that is used today when talking about research. But even doing that is a positive way to use your time and separate yourself from debilitating thoughts.

Some of the most important steps start with you asking yourself,

  • “What do I want to learn about?”,
  • “What am I interested in?”

But remember: you are looking for thoughts and ideas that will help with your “continued maturation.” This is all about positive, beneficial, and useful learning. The fun part is when you begin your search for information on the topics. That is because it allow you to open your mind and expand your horizons beyond what you currently know. It is at that time you utilize the 5Ws&1H Questions:

  • Who,
  • What,
  • Where,
  • When,
  • How,
  • Why.

As you pursue the answers to these questions, you give yourself the opportunity to develop new knowledge and understanding that you can put into practice. Such use of the Internet and the access available is valuable for anyone, but especially for people as they grow older. That is because it will allow for connection with sources of social support wth other people in the same age range. It also provides continued to access to people, regardless of age, who have similar interests. In both cases, this offers access to other opportunities when face-to-face interaction may become more difficult.

10. Exercise.

Up front, one of the immediate responses to this effort is, “I’m too old.” In response, we need to remember that age is only in the mind of the person.

Even if you have never even set foot in a gym in your life, there is no better time to start exercising than right now. You may have never even worn a pair of sneakers, you still have the opportunity every day to make your health even healthier. It starts with that stretching and walking described in Number 4. We are not training for anything; we are not looking to lose weight or do bodybuilding. What you are seeking to do is to live longer, healthier, happier lives. In order to do this, you need to begin by wanting to be active. Wanting activity in your life has a built in value. It provides your mind positive goals to pursue such as:

  • walking a certain distance,
  • riding a stationary bike for 10 minutes,
  • working out with friends,
  • lifting light (1-10 pounds) weights.

The options and opportunities are almost endless that can be used for exercise. Some other examples include:

  • walking up and down the stairs of your home,
  • using the first step of the stairs to lift yourself up using your legs,
  • taking a book, holding it by the spine and lifting it with your arms several times.

In each case, you are taking a positive action to do something that involves activity. Even if you begin by doing these actions with the help of your caregiver, the fact is, you are improving your quality of life by being active. The next step is to move into the broader world where you can connect and interact with other people your own age. This helps to reduce sensations and feelings of loneliness. At the same time, by reinforcing within yourself the recognition that you are able to “do for yourself”, you improve your ability to stay independent.

11. Review your options.

Inevitably, there is a need to think about how you are doing on a yearly basis. This review is intended to aid you in identifying where your strengths and weaknesses are. There is a distinctive reality in everybody’s life, no matter the person’s age: human beings will thrive when they find within their lives freedom and choices that allow them to manage and maintain their life without interference. That is done best when the person is able to

  • step back from participating in life,
  • objectively look at what they are doing, and
  • identify how comfortable they are in doing what they are doing.

One of the best ways to do this is to target the decisions we are making from time to time. Evaluate such things as

  • What are the toiletries that we use?
  • Do we like what we are eating, when, how often?
  • What about the websites we are visiting?
  • How about the books we are reading?
  • Which TV shows are we watching?
  • Who are we friends with?
  • Do we find enjoyment in the exercises we are performing?
  • What are we satisfied with?
  • Are there other options that may be better?

All of these questions and the responses, along with the research we may be conducting to find additional information, give us that important sense of freedom. We are taking responsibility for our lives and the way we live them. But of even greater importance are some of the questions we can and should ask ourselves about our health and welfare. For instance,

  • Where are our aches and pains?
  • Do they stop us from being able to live easily?
  • Based on where those physical incapacities are, which of our doctors should be consulted?
  • What can we do to give ourselves better health beyond just “popping a pill”?

Even when we find ourselves slowing down, or with a limited variety of options to choose from, it becomes obvious that we, as humans, have freedom in our lives. But it is up to us to take note of them and make decisions of which ones we want to follow and why.

12. Go with the pain.

Wait, what? What does this mean? No matter how hard we try, there is no Fountain of Youth; there is no way to escape the process of aging. There is no escaping all the pain of growing older.

But when we think about the sundry physical ailments and chronic conditions experienced by seniors, everyone who actually thinks can come to an understanding of why and how so many over the age of 65 can be depressed and anxious. But beyond that is the inevitable loss of friends and family to death. Not to mention the agonizing process of losing loved ones to death. Yet that pain is fleeting when you consider all of the foregoing opportunities to continue to live.

We will experience grief, including acute loneliness. But this is short-term; it is only for a brief period time that we mourn their passing or adjust to the condition. We still have all of the methods described above to put the happiness and health of our lives in perspective. When we live, we value and cherish the healthy, happy, beneficial times we have had with people. When we live, we appreciate the abilities and activities we are able to actively take part in. In many instances, we also seek ways to recover the abilities or find alternative methods to remain active.

In all cases, the healthy older adult will seek “continued maturation” for our benefit. Let’s do that together!

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