What to look out for

As our population of adults over the age of 65 years grows, so will our diagnosis of illnesses. What is often difficult, is that we don’t have a say in how old we get and we don’t get to decide what our diagnosis will be. Apart from our physical health, our losses will grow. Losses include the loss of a loved one, but also losses within ourselves and our abilities. Although this is a phase in which we celebrate our lives and what we have accomplished, it can also be a phase where our mental health suffers. Knowing the signs of late-life depression and how to get help is important to avoid a downward spiral of despair.

Detection

Late-life depression is one of the most common mental health problems in older adults (Depression in older adults: Diagnosis & management, 2017:171). This mental health problem can affect a person’s motivation and interfere with the treatment of other geriatric medical problems such as Parkinson’s, a stroke, cognitive disorders etc. (Depression in older adults: Diagnosis & management, 2017:171). It is important to take note of the risk factors to be considered when making a diagnosis. These risk factors include:

• Previous clinical depression
• Physical and chronic disabling illnesses 
• Problematic substance use 
• Persistent sleep difficulties 
• Being widowed or divorced 
• Lacking social support 
• Having caregiving responsibilities for others with significant illness
• Recent bereavement 
• Change of residence
• Adverse life events such as loss, separation, financial crisis, declining health, marital problems etc.)
• Physiological symptoms such as weight loss, gastrointestinal distress, headaches, insomnia, fatigue, agitation

 (Depression in older adults: Diagnosis & management, 2017:172).

A diagnosis of depression is made through using a diagnostic criteria which we refer to as the DSM-5. A clinical psychologist can make a diagnosis, as well as a general medical practitioner or a psychiatrist. Once the diagnosis is made, there are options for intervention. These options include psychotherapy, pharmacotherapy or a combination of the two. 

Psychotherapy, Pharmacotherapy or a combination of the two

Psychotherapy

When looking at psychotherapies that can be used in treating late-life depression, therapies include cognitive behavioral therapies, problem-solving therapy, interpersonal therapy and reminiscence & life review therapy (Depression in older adults: Diagnosis & management, 2017:173).  

Cognitive behavioral therapy is based on the theory that the way we interpret events in our life affects how we feel about it and how we act upon it. If we can change a negative or unhelpful view, we can change our emotions that accompany it and we can improve our mental well-being. 

Problem-solving therapy teaches a person ways of identifying problems in their life, coming up with solutions together and implementing those solutions. The effects of this implementation and the impact it had on your life is then measured in terms of the desired outcome you wished for. 

Interpersonal therapy is based on the principle that our current and past onset of depression is related to interpersonal relationships in our life. If we can analyze these relationships, our roles in these, conflict behavior and feelings in relation to this relationship, we can develop insight and understand our feelings better. Understanding how we feel and identifying ways to change our behavior leads to reduction in feelings of depression. 

Reminiscence and life review therapy is about looking back at your life and the various stages of development from infancy until late adulthood and very old age. The focus is on positive life events as well as negative ones. Negative ones are re-framed in a way that is acceptable and that can be integrated into your life story.

Pharmacotherapy

Pharmacotherapy is medications that are prescribed in order to alleviate symptoms of depression. With older adults, it is important to bear in mind the physiological changes that come with age, for exp. degenerating cardio-vascular system, reduction in speed of motor responses and processing information, decreased muscle mass, changes in renal and liver function and in the central nervous system etc. Comorbidities and contra-indications should also be considered when various medications are prescribed (Depression in older adults: Diagnosis & management, 2017:173).  Other factors that also need to be taken into consideration by medical health professionals include:

• Previous responses to treatment
• Type of depression – psychotic and bipolar depression often require additional agents
• Other medical problems 
• Other medications being used 
• Potential risk of overdose

 (Depression in older adults: Diagnosis & management, 2017:173).

Combination of both

In this study referred to in this article it was recommended that people who experience milder forms of late life depression first receive psychotherapy before pharmacotherapy is considered. Those with moderate severity first receive pharmacotherapy before psychotherapy is considered and those with severe late life depression receive a combination of both from the start, where medication is first introduced (Depression in older adults: Diagnosis & management, 2017:172).

Compiled by Angelique Oosthuizen – Social Work Department 

Blackburn, P., Wilkins-Ho, M. & Wiese, B. 2017. Depression in older adults: Diagnosis and management. British Columbia Medical Journal, 59(3):171-177. 

Angelique Oosthuizen

Faircape Health Social Worker