Caregivers: Lending support to a depressed senior

Long face. No energy. Loss of appetite. Trouble sleeping.

When do the signs become a cause for concern? When is it really depression?

We often refer to depression in the singular form, but there are several types:

• Clinical depression
• Persistent depressive disorder (lasting more than two years)
• Prolonged grief disorder (triggered by a specific event unlike clinical depression)
• Seasonal affective disorder

For the purposes of this article, we will focus on clinical depression. We will also propose solutions to help you be the best caregiver you can be.

What are the signs of depression?

No one is immune to sadness, exhaustion and despondency. We all have good and bad days—life is cyclical.

It’s only when the dark thoughts persist that depression can be suspected. The signs don’t lie:

• Refusing to get dressed or neglecting one’s personal hygien
• Not answering the phone or door
• Having mood swings (sadness, restlessness, anger or no emotions at all)
• Not talking or giving vague answers
• Being quick to complain (often of pain) or making unreasonable demands
• Experiencing memory loss and a lack of concentration
• Rarely doing what is asked

These behaviours are telltale signs of depression. An official diagnosis requires that at least five of the symptoms below manifest themselves nearly every day over a two-week period. The symptoms must include a feeling of sadness or a loss of interest or pleasure.

The symptoms cannot be attributed to the side effects of taking medication or another disease.

Case study

For several weeks now, Julie has had trouble sleeping, waking up several times a night. She feels exhausted and overwhelmed.

Despite forcing herself to eat, she has lost weight.

Once very active, she has trouble getting out of bed and going about her day.

She is overcome with sadness. She thinks about killing herself but has yet to plan it out.

She doesn’t feel like herself.

Unable to explain her despondency, she consults a doctor. She is diagnosed with clinical depression and starts taking antidepressants. The doctor recommends attending group therapy sessions.

Julie is now on the mend.

What are the risk factors?

What causes depression? One specific trigger is very unlikely. It’s more likely a combination of factors like:

• It runs in the family
• The person suffered from depression in the past
• An illness (cancer, stroke, arthritis, Parkinson’s disease, anxiety, etc.)
• Chronic stress
• Isolation, solitude and lack of a social network
• Repeated grief (loss of a loved one, loss of autonomy, etc.)
• Nutritional deficiencies (lack of vitamin B12 in seniors)
• Financial insecurity
• Drug, alcohol or prescription drug abuse

One thing’s for certain: depression doesn’t discriminate when it comes to age.

Statistically, 20-25% of people affected are hospitalized and 10-40% are LTC residents. Those who live at home seem to be better protected.

When to consult?

A healthcare professional should be consulted when both these conditions arise:

• The symptoms of depression affect the person on a daily basis
• The person is in distress  (This hyperlink will open in a new tab).

Depressed seniors rarely seek help on their own. It will be up to you to insist and schedule a consultation, if you deem it necessary.

Caution!

When it comes to a diagnosis and treatment, refer to a healthcare professional.

How to accompany a depressed senior?

Seniors suffering from depression harbour feelings of guilt and shame that compel them to hide their true state and feelings. It stems from a fear of being judged. This keeps them from seeing people they used to spend time with.

Don’t simply focus on emotions and mental distress. Sometimes, a variety of physical symptoms will mask depression.

You might have to get the person to open up.

Trust is the magic word when it comes to getting a depressed senior to share their feelings.

As the caregiver, you have to be patient and caring. As for the senior, this person has to summon up their courage to ask for help.

Plan regular visits to break the isolation and solitude. Do something together like gardening or go on a special outing.

Set aside times to talk one-to-one. Ask open-ended questions. Listen without judging. Avoid comparing this person’s situation to others.

Try to find a balance between optimism and realism. Yes, this is a difficult situation, but solutions are out there. Focus on the person’s improvements and successes. Things seem dark now, but the sun will rise again.

How is depression treated?

The sooner the diagnosis, the quicker you can take action and get a treatment plan.

Depression that goes untreated can last months, even years.

One thing’s for sure, depression sufferers will not heal on their own, so it’s best not to take this illness lightly. When left untreated, it is one of the leading causes of suicide among the elderly.

Depression makes a person two to three times more likely to commit suicide. It hampers functional capacities and is greatly detrimental to physical and mental health.

Therapies

Cognitive-behavioural therapy (CBT) and problem-solving therapy, whether done in person or online, are effective with seniors. These therapies rely on strategies that enable the person to change their mindsets and behaviours, and better address the issues facing them.

For therapy to work, two things are required: the senior must trust the therapist and be resilient  (This hyperlink will open in a new tab)..

Psychotherapy is recommended for light to moderate depression.

Antidepressants

Antidepressants combined with CBT are deemed effective for the treatment of clinical depression.

Several prescription drugs are available on the market. A blood sample could be required before obtaining a prescription or determining whether or not the drugs will be effective.

Doctors will meet with patients every two weeks to determine whether or not the antidepressants are working, identify any side effects and assess any suicidal tendencies. Treatment can take up to 12 weeks.

Dosage is also adjusted as necessary.

In some cases, additional drugs could be prescribed, and therapy could be recommended. Each case is different.

Normally, the patient is slowly weaned off the medication by gradually reducing the dose.

Electroconvulsive Therapy

Electroconvulsive Therapy consists in sending an electrical current through the brain, which triggers a seizure. This is done while under general anesthesia.

It has had some success among seniors for whom antidepressants and therapy didn’t work. It is also used when:

• The risk of suicide is very high.
• The person is suffering from a serious physical illness.
• The person is psychotic.

Be good to yourself every day

Clinical depression symptoms can be so severe that they will keep a person from getting out of bed.

Break the isolation

It’s not easy for a person suffering from depression to break the isolation.

Ask the person what they feel like doing and what would make them feel better:

• Doing volunteer work
• Spending time with friends
• Going for a hike
• Watching a movie
• Joining a support group
• Trying a new hobby
• Etc.

Be there for them during these moments of enjoyment. Your friendship and support are sources of comfort that aid the healing process.

Meditation

Meditation  (This hyperlink will open in a new tab). is one way to avoid ruminating and escape negative thoughts. Activities like yoga, tai-chi and qigong have also been shown to be effective.

Meditating is concentrating on the one thing we have control over: the here and now.

A few minutes a day is all it takes to be calm and serene.

Research even shows that meditation can reduce the symptoms of depression.

Time heals all wounds

Seeing a loved one suffer is never easy. It can make you feel powerless.

However, your caring and support are just what a senior needs to get better. Create a support circle with the person’s loved ones, the community and healthcare professionals.