Health Tips

We probably hold a common preconception that only adults in their productive years fall prey to depression. Rarely do we associate depression with the elderly population; after all, they’ve already retired and there shouldn’t be much in life to worry about, right? 

On the contrary, many old people are at risk of developing mental disorders, neurological disorders or substance use. Furthermore, as people age, they are more likely to experience several conditions at the same time; some of which are physical illness such as diabetes, cancer and osteoarthritis, while struggling with mental illness such as depression. To make things worse, we often dismiss the classic symptoms of depression like persistent sadness and despair as the normal part of aging, when in reality the elderly may need professional help more than ever.

Depression is NOT a normal part of aging

Sadness and grief are normal responses to life events that occur with aging, such as the death of a loved one or transitioning from an independent life to assisted care. With a period of adjustment and support from the community, they often can regain their emotional balance without falling into depression. 

With that being said, study has found that elderly with the following characteristics are more likely to develop depression in their golden years:

• Female sex

• Social isolation, such as living alone or lack of social connection with people

• Widowed, divorced, or separated marital status

• Lower socioeconomic status

• Comorbid general medical conditions

• Uncontrolled pain

• Insomnia

• A history of sleep disturbance

• Functional impairment

• Cognitive impairment, such as dementia. Not only depression is common in elderly who already developed dementia, depression also increases the risk of developing dementia in elderly who did not have it. 

Other factors include genetics, depression during younger years, abnormal brain chemistry and stress can contribute to depression in older people too.

We would like to emphasize that depression is a real illness. It is not a sign of a person’s weakness or a character flaw. You can’t “snap out of” clinical depression by asking them to “stay positive”. Most people who experience depression need professional treatment to get better.

How serious is the depression in Malaysian elderly?

Unfortunately, depression in elderly is often undiagnosed and overlooked. A study that looked at 2005 older adults randomly selected from the Penang State government's list of elderly receiving aid found that 19.2% of elderly suffered from severe depression. Another study that looked at 2264 community-dwelling older adults in Malaysia found that 16.5% showed depressive symptoms, and the prevalence is higher in females. These numbers are not trivial – for every 10 elderly you meet, there is a chance that 1 - 2 of them have depression. 

The factors that contribute to depression in Malaysian elderly are fairly similar to what was mentioned above: female sex, those who are unmarried, those with no formal education, those with family income less than RM300 per month, and those living in the urban areas.

Detect depression in elderly

There are many symptoms associated with depression, and some will vary depending on the individual. However, some of the most common symptoms are listed below. If you or the elderly you know have several of these symptoms for more than 2 weeks, suspects depression.

• Persistent sad, anxious, or "empty" mood

• Feelings of hopelessness, guilt, worthlessness, or helplessness

• Irritability, restlessness, or having trouble sitting still

• Loss of interest in once pleasurable activities, including sex

• Decreased energy or fatigue

• Moving or talking more slowly

• Difficulty concentrating, remembering, making decisions

• Difficulty sleeping, early-morning awakening, or oversleeping

• Eating more or less than usual, usually with unplanned weight gain or loss

• Thoughts of death or suicide, or suicide attempts

• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment

• Frequent crying

Depression in older adults may be difficult to recognize because they may show different symptoms than younger people. For some older adults with depression, sadness is not their main symptom. They may have other, less obvious symptoms of depression, or they may not be willing to talk about their feelings due to social stigma surrounding depression.

In other cases, they may seek help for less typical depressive symptoms that might initially suggest other types of medical problems, such as heart palpitations, restlessness, fatigue, tremors, body aches and pains, nausea or vomiting, dizziness, shortness of breath, fainting, heavy perspiration, or facial flushing. Any mood disturbance may show up as anxiety, irritability, or preoccupation with death.

Seek help today

If you or any elderly may have depression, seek help by consulting a healthcare professional you trust. 

Image credit: http://mentalhealth.my/where-to-find-mental-health-help/

For psychiatry care in the private sector, check here.

We wrote an article detailing if seeing a therapist would help with mental health problems, read here.

It’s not just seeing a therapist

To address depression in elderly, they need well-rounded healthcare and strong community support. Mental health problems in elderly often coexist with physical illnesses that are something debilitating and unbearable. Both mental and physical health issues in elderly should be handled with adequate medical treatment and most importantly, the support and care from their caregivers and family. 

If you’re not an elderly, you can help by raising awareness about depression in elderly, and spend more time with the older adults in your household. They may have lesser years left than you, but they too deserve to live healthily, happily and with dignity. Depression should not be the last chapter of anyone’s life.

A word from Doc2Us

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References

1. WHO - Mental health of older adults

2. NIH - Depression and Older Adults

3. Medical Journal of Malaysia - Psychiatric Problems Among the Elderly in Malaysia

4. Harvard Health Publishing - Recognizing and treating depression in the elderly

5. UpToDate - Diagnosis and management of late-life unipolar depression

Cover image credit: Photo by alexandre saraiva carniato from Pexels

Written by

Ms Joyce Toh