I’ve been writing about the nature and causes of depression in older adults. I posted earlier about the role of genetic predispositions and past experiences in producing depression in the elderly. Current stressors also play a role, and that will be the topic of this post. Stress entails demands; the person’s resources are taxed as they attempt to satisfy those demands. For example, when I took a job 11 years ago teaching college, I was stressed by the demands of preparing lessons, giving lectures, grading assignments, and advising students, all tasks that I hadn’t been faced with for over 20 years. Fortunately, I was able to meet these demands, and the stress abated. There are many forms of stress, of course, and some are particularly associated with an increased risk of depression. Among these, stresses that often occur in late adulthood include:
- Medical problems. The risk of depression is elevated in those with chronic health problems, especially those that result in disability. In particular, there is an increased risk of depression associated with cardiovascular disease, stroke, diabetes, and chronic pain. Also, some medications can cause depression.
- Losses. The most damaging loss is that of a spouse, but losses of close friends and family members can also be quite troubling. Most grieving older adults are sad but not depressed; nonetheless, some do develop a full-fledged depressive disorder. Other losses that can have a significant impact on an older adult’s mood can include loss of one’s career, of status in the community, or of ability to perform valued activities. These factors can in turn produce—
- Powerlessness. A major reason that depression rates are elevated in nursing homes is that many decisions are made for residents and they have little control over their lives. Powerlessness is particularly stressful for those who had the greatest degree of power earlier in adulthood. White males are particularly likely to be affected; their loss of power contributes to a higher suicide risk for this group.
- Loneliness/isolation. Here are the words of Steve, age 91 and living in a nursing home, as reported in the Marin Independent Journal: “Once we were very handsome and were chasing the girls away. Now no one seems interested in us except our caregivers, and that gets old, too. . . . My mind is spry and alert, but my body is decrepit. I get lonely often. Sometimes I even call my health-care provider and make up an excuse about my health so that I have the nurse to talk to.” As friends die off and mobility decreases, many of the oldest old spend their days sitting and waiting in vain for someone to visit. It’s not surprising that such isolation can lead to depression.
Whatever factor or combination of factors has caused a disturbance in mood, it’s advisable to seek treatment. Next, I’ll post about medication and psychotherapy, the two most commonly used forms of treatment for depression.
Recognizing that the stress you are experiencing can sometimes lead to depression is the first step to preventing it — and burnout. To take that step, talk about your feelings, frustrations, and fears with the palliative care team’s social worker or mental health professional. Talking helps you understand what’s going on for you and for the person in your care. It helps you come to grips with the fact that you are not in total control of the situation.