Senior Mental Health
26 November 2018
There is a crisis going on.
It has been estimated that approximately 15% of the elderly suffer clinical depression. This rate grows higher for people in aged care facilities; for these people the rate of people struggling with depression may be as high as 35%, or possibly higher. Over 50% of people in aged care exhibit some symptoms of depression. This is a serious mental health issue that needs urgent attention.
Why is this happening?
It seems that there are a number of factors that may contribute to the elderly, and especially people in aged care, to suffering depression. These factors include:
• Physical illness
• Degenerative brain illness
• Grief and loss of loved ones and friends
• Increasing social isolation
• Financial stress
• Changing living arrangements
Any of these challenges would be difficult for a healthy young person. For someone whose sense of independence and autonomy is shrinking, as happens to many elderly people inside and outside of homes, these challenges can combine to be almost insurmountable. At times the person suffering depressive illness may take a stoic line, not admitting publicly to the stigma of having a mental illness. The presence of co-morbidity (having more than one illness at a time) with illnesses such as physical disability, dementia and anxiety is also significantly higher for the elderly.
For some people in the later stages of their life, these challenges lead to simply giving up – to stop eating, socialising and interacting - a sort of passive suicide. For a significant percentage of men over the age of 85, active suicide is the only way out.
How should we feel about these issues?
Hopefully these issues provoke a compassionate response. We must be certain the “care” remains in “aged care”. We must also be aware that members of our own family approaching the later stages of life may experience a shrinking world, shrinking autonomy, pain, sickness and possibly loneliness.
What can we do?
The happy news is there are a number of things that we may do to address depression amongst older people.
There are pharmaceutical interventions that can be prescribed by doctors, psychiatrists or GPs; anti-depressants that work quite effectively with a small side-effect profile.
However, if you would like to avoid psychotropic medication, there are non-pharmaceutical therapies that may also be effective. These include behaviour therapy, cognitive behaviour therapy and interpersonal therapy. There is also growing evidence that “reminiscence therapy” may be effective for this group of people. There are also lifestyle factors that defend against depression at all stages of life including gentle exercise, good sleep and eating well.
Of course, simply visiting our relatives in their own home or aged care can greatly benefit their mood and outlook. Letting them know you care and love them is important, as is showing respect for their experience and knowledge.
Hopefully together, as young and old, with strategic and targeted treatment, we can address this terrible problem.
Dr Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.