Depression in the elderly
Introduction
Depression among the elderly is on the rise given that 6.5 million Americans aged 65> suffer from the illness. Some develop depression in early life and others show depression symptoms in later life. Depression in the elderly is an issue of concern in that the mental condition is ignored and perceived as normal. In other words, it is believed that depression is a natural reaction to the developmental and social changes that elderly people go through. Depression is also mistaken as dementia, stroke, arthritis, and other illnesses. The elderly rely on the misconceptions that depression is a personal weakness, depression medication is costly, depression is normal in life, among other misconceptions that make them ignore depression treatment. However, it is important to note that if depression is left untreated, the victim is at risk of developing other long-term consequences such as suicide, and self-injury. The National Institute of mental Health asserts that a larger percentage of elderly with depression are not unidentified. Note that people have stereotypical thinking which hinders the elderly from talking about their feelings and seeking treatment. Organizations that focus on improving the mental health of the elderly such as WHO, NIMA, NIMH, and others assert that elderly are important people in the society and rather than seeing depression as part of aging, people need to recognize depression and provide medication and psychotherapy to make them feel better. Depression in the elderly can be treated and there are a number of strategies that can be used to help the elderly live a normal life. It is the role of the healthcare providers, mental health professionals, and other stakeholders in mental healthcare to come to light and provide long-term care, education, and support to the elderly. Geriatric depression is not a normal reaction but it is a medical problem that deserves special attention from health care professionals who should work together to meet the needs of the elderly.
Aging Perceptions
The first thing to understand about the elderly is that older people are devalued in modern societies. The latter has created a young-oriented culture which does not care about the elderly (Arenson & Reichel, 8). In the youth-oriented culture, children view the elderly as useless since they struggle so much and they do not have anything to offer to the community. Families develop discriminatory thoughts and see the elderly as insignificant and worthless. Respect and devaluation are also found in the place of work, in the media, in the clinical setting, and the society at large (Arenson & Reichel, 8). To make it worse, this is an overlooked problem simply because the societies believe that the elderly do not bring enormous benefits. This research calls for social awakening and develop a positive attitude toward the elderly. Rather than seeing people with gray hair and wrinkles as insignificant and useless, the society should see them as important people with a capability of starting a business, bringing social development, and enjoying life to the fullest. An important point to understand is that even though there are medical conditions such as dementia and heart disease that cause depression, there is evidence that the elderly develop depression as a result of a lack of sense of purpose. Note that older people lose a sense of purpose when society or people around them show disvalue or ignorance. As stated above, older people are excluded and discriminated and the stigmatized attitudes lead to depression in older people (Holm et al. para 3). They live in social stigma and as they develop a sense of being disvalued, they develop depression. To make it worse, healthcare providers do not pay attention to the mental disorder or rather they believe that it is a normal process associated with aging. Therefore, before understanding depression in the elderly, it important to note that society has a negative perception of the elderly. Society sees the elderly as people with undesirable characteristics and develops prejudicial and discriminatory practices toward the elderly ((Holm et al. para 4). Consequently, the elderly experience stigma and they are unable to find purpose in life. Note that for the elderly to find a purpose in life, they need to be engaged, they need support, financial security, mental and physical health, and a sense of self-worth (Holm et al. para 3). Unfortunately, older people are not in a position to achieve these elements since they find a challenge in creating a social network. What happens is that they feel inferior and develop an emotional pain that leads to depression.
Understanding depression in older adults
Depression is a public health problem that increased mortality as a result of decreased physical function and cognitive function. A point to understand is that some older adults experience depression earlier in life or early-onset depression and others in old age or what is known as late-onset depression (Fiske et al. 365). Research and studies find that late-onset depression is genetically influenced or it occurs due to the family history. However, scholars are interested in understanding the late-onset depression and neurological findings report that late-onset depression occurs as a result of structural brain changes (Fiske et al. 365). Some scholars say that late-onset depression occurs due to vascular risk factors and concomitant cognitive deficits. However, following the standard criteria for mental disorders, it is not advisable to put other medical conditions in place when diagnosing depression. Focusing on other medical conditions may lead to underdiagnoses or overdiagnosis. It is important to note that depression is different in other neurological syndromes such as stroke, parkinson's diseases, and dementia (Fiske et al. 36). For example, depression as a result of a stroke is characterized by vegetative symptoms such as intention, and loss of appetite. Depression as a result of dementia is characterized by difficulty concentrating and social withdraw. In general, it is important to use the DSM-IV criteria in diagnosing depression to prevent underdiagnoses.
Causes of depression
Biological factors
Patients with cardiovascular disease are likely to develop depression as a result of rehospitalization, and health care costs. Other contributing factors include neuroendocrine and inflammatory systems. Patients with diabetes are likely to develop depression due to impaired glucose metabolism (Fiske et al. 365). Patients with dementia suffer from cognitive impairment and they are at risk of developing depression due to cognitive and behavioral changes. Patients with stroke suffer from functional impairment and it becomes burdensome hence leading to depression (Fiske et al. 365). Another biological risk factor is chemical changes in the brain where the parts of the brain such as the amygdala are unable to regulate the emotional process.
Psychological risk factors
Individuals with early-onset depression develop neuroticism in later life. This means that they develop negative feelings about themselves. They are disturbed, irritated and develop fear and loneliness. They have ruminative thoughts and as a result of being so concerned about their mental problem, they increase the level of depression (Fiske et al. 355). Note that older people lose a sense of control, and they lack purpose in life. They become helpless and develop negative thinking which aggravates the depressed state.
Social factors
Older people develop late-life depression as a result of financial difficulties and lack of financial support, functional decline, change in the living institution, emotional abuse, and other life stressors (Fiske et al. 375). Some older adults have interpersonal dependency and autonomy but they are unable to accomplish their goals due to lack of close relationships. Older people are unable to cope with the loss of a loved one. They experience social isolation and after the second year of loss, they develop depression. Older people rely on their loved ones such as spouses for financial support and companion and this means that their financial status deteriorates and starts to struggle (Fiske et al. 375). As stated above, older people are underrepresented in society and they are economically disadvantaged. As a result of financial struggle and exposure to unsupportive society, they become vulnerable to depression. Note that elder people lack social support network where they could attain emotional support and other types of help.
Barriers to effective treatment
An issue of concern about depression in the elderly is that the mental condition goes undiagnosed and untreated. Mental health professionals believe that depression symptoms are physical and they do not provide effective treatment to manage the condition (Roose & Sackeim, 29). Thus, older people continue suffering from emotional problems. Simply because the condition is perceived as a response to stress. For example, a wife may develop depression after losing a spouse and mental health professionals may conclude that it is a normal reaction to the grief. Depression in older people contributes to physical and social impairment (Roose & Sackeim, 29). Thus, the more the condition is undiagnosed and untreated the more the older suffer from other medical illnesses. Health care providers and families do not see the need for effective treatment or they pay little attention simply because they are older and old age is associated with weakness. Mental health professionals fail to recognize depression due to inadequate awareness. What happens is that healthcare providers rely on other coexisting medical disorders such as dementia. Thus, they are unable to diagnose depression and to offer the right treatment intervention. There is also a shortage of mental health services. This means that health care institutions lack reimbursement for counseling and training and this makes it hard for primary care providers to offer quality care (Roose & Sackeim, 29). Rather, they give the patients a mental health referral and patients are unable to travel to other facilities to seek specialty services. Another thing that hinder effective treatment is a stereotype. As stated above, people believe that depression is a natural condition, and what happens is that the late-life depression contributes to a broader negative impact not only to the elderly but also the family and society.
Ellison and Verma (28) add that despite the high prevalence of first-onset depression and later-onset depression among older people, the depressive symptoms are not identified. Only less than 40% receive depression treatment and this means that 60% and above do not receive treatment. To make the matter worse, even those who receive treatment do not comply with the treatment. The authors assert that the barrier to care is multiform in that patients, providers, society, and financial organizations play a role in hindering effective care. The patient-related barrier means that the elderly are unable to recognize the changes occurring in life and causing negative impacts. Those who recognize negative changes do not recognized the importance of sharing feelings with a mental health professionals (Ellison & Sumer, 28). They seek a family doctor as they believe that the concurrent medical condition will go away. Some older people recognize changes and the need to communicate with a mental health professional but they do have the confidence and self-esteem to report their feelings. They do understand the health benefits and if they recognize the enormous benefits, they face challenges due to lack of financial resources and where to seek assistance (Ellison & Sumer, 31). Provider-related barriers mean that health care providers rely on patient's coexistence of medical illness and they do not put depression as a priority consideration. Clinicians do have experience or lack knowledge and skills on how to use screening instruments and what happens that they rely on false-positive or false-negative results which may lead to underdiagnoses and overdiagnosis (Ellison & Sumer, 31). There is also a shortage of mental health specialist and this indicates that older people suffering from depression receive care from primary care settings where they are cared for by general practitioners. The organizational barrier means that mental health professionals do not work toward common goals. In other words, they employ different therapeutic approach and they do have standardized clinical decisions (Ellison & Sumer, 33). The majority of mental health facilities have trained professionals who can work in different areas such as counseling and psychiatry. This means that there are no specialty services and this means that it is difficult for the elderly to receive treatment and care from mental health specialty.
Another barrier to effective treatment is the intervention barrier. Note that depression in the elderly occurs as a result of many factors such as aging-related changes and medical problems. There are also different interventions and treatment and mental health professionals do not understand which treatment is effective (Ellison & Sumer, 41). There is limited research or in other words, there is no evidence-based research on depression topic and this makes the professionals lack a scientific understanding. The limited scientific knowledge forces the professional to provide equal treatment without efficacy research. The last barrier to effective care is a societal barrier (Ellison & Sumer, 42). Note that society has a negative perception toward the elderly and local communities do not provide safe and effective treatment simply because society does not recognize the psychiatric disorders.
Interventions
Cognitive-Behavioral Therapy
Roose & Sackeim (288) assert that CBT is effective for late-life depression. CBT means a group of therapies that aim at helping people control their moods and their psychosocial movement. Cognitive-behavioral theorists assert that depression is influenced by genetic and biological factors. Thus, skills acquisition will help the elderly learn about problem-solving, and self-management. CBT is a short-term therapy that teaches the elderly with depression symptoms on how to control their psychosocial environment (Roose & Harold, 288). There is evidence from randomized trials that after treatment, the elderly decrease depression. Elder people can interpret situations that change behaviors and after identifying the distorted cognition, one can use techniques that will distract oneself from unpleasant activities (Roose & Harold, 288). The elderly can alter the unpleasant event and irrational thoughts and increase pleasant events by applying adaptive thoughts.
Interpersonal psychology
IPS works well in the later-life depression. The elderly can focus on stressful life events such as grief and after conducting analysis or having a deep understanding of the event, the elderly will develop better social functioning (Roose & Harold, 290). An elderly may also focus on the social relationship and after identifying the barriers to interpersonal connections, he or she will develop coping strategies and plan on how to solve the issues.
Dialectical behavioral therapy
Older adults with a personality disorder can use dialectical behavioral therapy to improve behavior and thinking. Note that during times of depression, the elderly have a bitter attachment or they find it difficult to accept the reality of stressful life events such as the death of a loved one (Roose & Harold, 292). Secondly, they become problem avoidant or they are unwilling to solve the problem. Third, the elderly may reject support or demand support. Fourth, the elderly develop self-pity and believe that life is meaningless. When the elderly develop these personality disorders, dialectical behavior therapy will help them develop adaptive responses to stressful events.
Problem-solving therapy
This type of therapy is effective in depressed elderly. The mental health professional helps the elderly in identifying problems and creating real solutions. The elderly may also develop an action plan and actionable strategies (Stern, 151). The method is effective in that the elderly will develop confidence that the problem is solvable and he or she will manage the situation.
Brief psychodynamic therapy
In brief dynamic therapy, an older person will gain awareness and insight about a problem. They will understand the emotions and behaviors and recognize that they are behaving in a certain way due to negative feelings and motivations (Stern, 151). Thus, the elderly will employ healthy ways to manage the psychological problems that prevent leading a fulfilling life.
Recommendations to improve access to care
The first recommendation is prevention which should be done by identifying risk factors and working as a multidisciplinary team to reduce the risk factors. The public needs to gain awareness of the signs of depression. Raising awareness will destigmatize depression and people with depression symptoms will gain the confidence to talk about their feelings and seek treatment (Ellison & Sumer, 44). The second recommendation is translational research. This means that health care providers and mental health professionals should apply scientific knowledge and discoveries in the treatment of elderly depression. The scientific knowledge will shed light on the best practices in diagnostic and intervention (Ellison & Sumer, 44). The third recommendation is interventional studies. Note that mental health professionals are facing challenges in providing the best drug intervention. There is a need to conduct clinical trials to understand the safety and efficacy and assess functional and cognitive capabilities. The fourth recommendation is health services research. New practice guidelines, knowledge on the role of mental health professionals, morbidity risks, and the effectiveness of the treatment are needed (Ellison & Sumer, 45). Finally, providers of mental health need to improve their skills and knowledge to provide quality services and encourage depressed individuals to seek treatment. Insurance groups should also provide insurance coverage to the patients of mental problems to make it easy for them to achieve quality treatment (Ellison & Sumer, 46). Depression can be prevented if only health care providers recognize the risk factors and implement prevention strategies.
Conclusion
Depression is common among older people aged 65 years and above. The research paper finds that different factors such as family history, environmental factors such as loss of loved one, psychological factors such as personality traits, and stressful life events contribute to depression. There is also evidence that older people with the physical illness are likely to suffer from depression later in life. An important point to note from the research paper is that whether an elder has earlier-life depression and later-life depression, it is important to seek treatment. Healthcare providers and mental health professionals should not see depression as a natural reaction but they should treat it like other diseases. They should come up with interventions which are effective or which will bring a difference in people's life. There are many interventions to treat depression and it is the role of mental health providers to select the most effective intervention to prevent depression. The main concern about depression in a leader is that older people with depression are unrecognized in society as well as in the healthcare setting. They are stigmatized and the stigma makes them believe that depression is an insensitive topic and so they do not express their feelings. The research paper recommends the use of translational research to come with effective practice in treating depression and preventing future incidents. Current psychological interventions are providing positive results but there are barriers to treatment. An important area that needs improvement is to understand the barriers and remove them to ensure that mental health professionals achieve their objectives, and patients receive quality care.
Work cited
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