Prime Time Living - Page 22 - Depression in older adults is on the rise

Prime Time Living
- Page 22
Depression in older adults is on the rise
Understanding the symptoms of depression

By Margit B. Weisgal, Contributing Writer

The nature of the dilemma can be stated in a three-word sentence. I am lonely. Let me emphasize, however, that by stating “I am lonely” I do not intend to convey to you the impression that I am alone. I, thank God, do enjoy the love and friendship of many. I meet people, talk, preach, argue, reason; I am surrounded by comrades and acquaintances. And yet, companionship and friendship do not alleviate the passional experience of loneliness which trails me constantly.

– Rabbi Joseph B. Soloveitchik, The Lonely Man of Faith

Depression is now a major public health problem with those who suffer from it, reaching alarming figures. In May 2018, Cigna, a global health service company, in partnership with the research firm Ipsos, released survey results that stated most American adults are considered lonely. The percentage of people who feel as if they don’t connect with others is on the rise, with nearly half feeling alone or left out. A month later, the Centers for Disease Prevention and Control (www.cdc.gov) published data that suicide rates are on the increase, making it the 10th leading cause of death.

Dr. Marc Zisselman, medical director of geriatric services at Sheppard Pratt Health System ( www.sheppardpratt.org ), says, “Minor depression, a very real diagnosis, is more common in seniors. It has a significant impact on one’s ability to function. Those who suffer from it have to take it seriously to maximize quality of life.

It is not a normal consequence of aging. Changes at that stage of life have a greater influence, so it’s important to recognize the symptoms and get treatment.”

What, exactly, is depression? The National Institute of Mental Health ( www.nimh.nih.gov ) defines it as “a medical condition that interferes with daily life and normal functioning. It is not a sign of weakness, or a character flaw. The most common include:

•Major Depression – severe symptoms that interfere with your ability to work, sleep, concentrate, eat and enjoy life. Some people may experience only a single episode within their lifetime, but more often, a person may experience multiple episodes.

•Persistent Depressive Disorder (Dysthymia) – depression symptoms that are less severe than those of major depression, but last a long time (at least two years).

•Minor Depression – depression symptoms that are less severe than those of major depression and dysthymia, and symptoms do not last long.”

Zisselman says, “Many of the causes that can bring on depression revolve around change: change of social status as peoples’ incomes decrease, change in living circumstances – shifting from independent to dependent, such as moving into a retirement community, a senior living facility or a nursing home – loss of friends and family members, loss of physical integrity, having physical limitations, and due to age, medical problems and increased stress.

“But there is more,” he adds. “They can’t engage in activities they formerly did, don’t get enough exercise and often not enough nutrition. The worst is when they Isolate themselves, a prime consequence that puts them at risk of suicide.”

Single older white men are at the greatest risk, and the CDC’s data affirms this. It’s a combination of retirement, being a widower, being isolated, and, often, suffering from physical ailments and untreated pain. Their identities are wrapped up in their work, defining them. So, when you no longer have a job, title or position, you feel excluded and have a lesser sense of self. “Sadly,” says Zisselman, “they also self-medicate, usually with alcohol, drinking to reduce anxiety. But that does nothing to alleviate the symptoms, and often make them worse.”

An article in Kaiser Health News ( www.khn.org ), a nonprofit news service under the aegis of the Kaiser Family Foundation, had this warning: “In a nation where suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults – including the 2.2 million who live in long-term care settings – are often overlooked. A six-month investigation by Kaiser Health News and PBS NewsHour finds that older Americans are quietly killing themselves in nursing homes, assisted living centers and adult care homes.”

The most common assessment used to determine feelings of solitude is the UCLA Loneliness Scale, originally published in 1978 and since revised twice.

It’s a 20-item scale designed to measure one’s subjective feelings of loneliness as well as feelings of social isolation. On the front line of addressing and helping those with depression are our primary care physicians. It’s often up to them to recognize the symptoms by asking just two screening questions:

•In the past month have you been feeling down or hopeless?

•Have you been bothered by little interest in doing things?

Therefore, the first step is recognition. It’s normal to feel some loneliness. When it’s more often, though, we should consider getting some help, but we balk at

Depression, continued on page 29