The South African Depression and Anxiety Group Is depression to be expected in adults older than 6o years? Janine Shamos, South African Depression and Anxiety Group (SADAG) Sadness and stress in older adults is common, and so is clinical depression; however, that doesn't mean that being depressed is a 'normal' part of ageing. Depression in later life affects about 1% of the population but very few people receive the treatment they need. Depression in the elderly is often thought to be part and parcel of getting older, or is confused with the effects of illness and their treatment. Health problems and related financial concerns contribute to depression, especially if the individual is not on a medical scheme or if it will not cover all expenses. Experts agree that the risk of depression in the elderly increases with the diagnosis of other illnesses and when ability to function is limited. Chronic pain, recent loss, retirement or relocation, living alone with no social or support network, financial worries, illness and fear of death can all contribute to depression in later years. But because depression in older adults often coexists with medical illnesses, and because with the coming of age people are expected to 'slow down', doctors and sufferers may miss the signs. Treatment of depression gets delayed and many seniors find themselves trying to cope, alone and in silence, with symptoms that could have been treated. The South African Depression and Anxiety Group (SADAG) emphasises that it is vital to evaluate and treat any person who one is concerned about. "Even if the depression is mild, if you are concerned about someone being depressed, get them help," said SADAG's Cassey Chambers. Worryingly, depression tends to last longer in elderly adults and, according to doctors and researchers, depression increases the risk of heart disease in the elderly. "I find Monday's are the most emotionally challenging. For the residents, weekends feel too long, as they often have nowhere to go," says Sister Honey, a nurse at a Johannesburg old age home. "Many feel particularly lonely and down on Sundays, especially when no one comes to visit them and their children are living far away." Change, loss, regret - all an inevitable part of ageing, but all can mean an increased risk of depression. SADAG Support Group leader, Sally Smith, said that as people get older, they often deal with unrealised potential and regret. Having no purpose, no 'reason to get up in the morning', dealing with the changes that age brings, can be disheartening, such as when children become independent and leave the family home. Social support, being 'needed; having a hobby are all vital to adapting to change, and leading a happy and emotionally healthy old age. "I see many men become depressed after retirement, because they often don't have hobbies, interests and not many male friends either. It may be easier for women because they are more adaptable and find ways to keep themselves busy," said Sally. Chronic pain, recent loss, retirement or relocation, living alone with no social or support network, financial worries, illness and fear of death can all contribute to depression in later years Statistics show that in SA, suicide in the over 60s is actually dropping but, according to leading suicide researcher, Prof Lourens Schlebush, this does not mean that seniors are not committing suicide. "This age group often uses silent suicide - they fade away by neglecting their diet, hygiene and socialisation, until they go to sleep and don't wake up," said Prof Schlebusch.
Depression may be expressed through physical complaints rather than traditional symptoms, like saying you feel sad or anxious. Depressed older people may not report their depression to doctors or loved ones because they believe they are 'supposed to feel this way' or that there is no help. "Stigma can keep elderly patients from acknowledging they are depressed, even to themselves," said Chambers. Elderly people may also be unwilling to take their medicines because of side effects or cost, or they get tired of taking medication or being ill and alone a lot of the time. Depression, suicide and suicidal behaviour are not normal responses to ageing; different treatments work for different people but getting help early is the key. "You may have to live with aching muscles and loss of hearing but you don't have to live with depression," said Chambers. Older people are more sensitive to medicines, so antidepressants may take longer to start working for them than they do in younger people and older patients may need to be on treatment for longer. However, studies have shown that 60% of patients older than 70 years who took antidepressants and stayed on them for two years after their symptoms disappeared were less likely to relapse than those who stopped their medication. Talking and connecting with other people is crucial. Most depressed people find that support from family and friends, involvement in support groups and counselling are helpful. People who don't want to take more medication or can't because of side-effects, can still receive help for their depression. "Psychotherapy helps older adults deal with a broad range of functional and social consequences of ageing and help them adjust to these changes and cope with depression," said Prof Schlebusch. Depression is not a normal part of ageing. While emotional experiences, change and feeling sad and grieving are normal, feeling so low that it interferes with your ability to function on a daily basis is not. Many people believe that depression is an acceptable response to illness and the difficulties (physical, social and financial) that often accompany ageing. This is a mistaken and dangerously faulty belief that often means that people don't get the help they need, when they need it. Depression can - and should - be treated, no matter the person's age. SADAG runs a 15-line call centre and has an extensive list of mental health professionals and support groups that can help older people living with depression. SADAG can be contacted seven days a week from 8.am to 8pm on 0800-20-50-26 0800-20-50-26 or 0800-21-22-23 0800-21-22-23 . SF