Old age and depression

The role of a carer, in case of elderly Depression or other numerous illnesses, is fundamental.  The attention and care that they provide can prove to be unexpected help.

> Understanding the causes

While its development can be related to physical and psychological factors linked to old age, depression should not be considered a natural consequence of ageing. Depression is linked, more precisely, to specific health problems and the negative effects of ageing.

Depression, which is caused by a chemical imbalance in the brain, is a source of suffering, both for the elderly person and their entourage.

• Ageing - factor for depression:
While its development can be related to physical and psychological factors linked to old age, depressions should not be considered a natural consequence of ageing. Depression is linked, more precisely, to specific health problems and the negative effects of ageing.

• Psychological and psychosocial causes:
o Identity crisis, brought on by isolation (widowhood, distance from family) or retirement (reduced revenue, sense of uselessness...)
o Prolonged hospital stay, which has a negative effect on morale.

• Physical and physiological causes:
o Biological transformation, loss of autonomy, illnesses such as diabetes;
o Use of medication: secondary effects (ex. through treatments for hypertension), overdoses, drug interactions;
o Increase in lesions in the white substance that makes up the internal part of the brain (study completed by Inserm);
o “Secondary depression” caused by neurodegenerative illnesses: almost 25% of alzheimer-affected elderly are depressed.

> Understanding the symptoms

To prevent and heal elderly depression, it is important to recognize the symptoms. They can include:

• Sense of sadness without cause, close to desperation;
• Gives up easily, lacks motivation;
• Isolation and rejection of others;
• Irritable, hostile;
• Weight loss or loss of appetite;
• Sleep disorders (insomnia, untimely awakenings, drowsiness during the day);
• Permanent fatigue;
• Difficulty concentrating, chronic indecision;
• Thoughts about death or suicide;
• Sense of uselessness, loss of self-esteem
• Complains frequently about physical pain;
• Neglects dress or care of body, unclean;
• Alcohol, drug or tobacco abuse.

Nevertheless, with the elderly, depression doesn't always manifest itself through sadness. It is rather the lack of energy and loss of interest for normal activities that should alert their entourage.

> Choose the right treatment

Elderly depression needs to be treated, as it can have disastrous consequences, most importantly suicide. You must be attentive in order to prevent a desperate act by listening to the sick person and verbalise their suicidal ideas. Treatment with antidepressants is usually necessary to end their depression and eliminate the suicide risk.


• Listen to and spend time with the elderly: a first step towards healing
In order to best take care of a depressed elderly person, the first step to be taken is to recognize their problem. Do not hesitate to use the word “depression” and underline the fact that it is a real sickness which can be treated and then healed.

The principals of the treatment must be explained to the elderly person: what they can expect (the effect won't be immediate, and the treatment could last several months), and possible side-effects.
With regards to the elderly person's entourage, they must be reminded of the importance of being patient and kind, and listening to and encouraging the elderly person. The family must know that it is useless to force their relative to "take control of themselves". It is preferable to provide daily support and enhance their self-worth.

• What drug options exist today?
It is necessary to direct the elderly person towards an attending physician. The doctor will choose a treatment to best meet the seriousness of the situation. Once diagnosed, 80% of depressed subjects, including the elderly, can be effectively treated through one or a combination of the three following treatments.

Treatments with antidepressants are always the first step. Doses should be gradually increased. It takes approximately six weeks to evaluate the efficiency of the treatment.

Psychotherapy complements the drug treatment. It helps find the psychological causes of the depression and helps support the patient.

Electroconvulsive therapy (electroshocks), which involves delivering an electric shock to the skull, brings on a generalised convulsive reaction accompanied by a loss of consciousness. Criticised in the past, this method – efficient in treating severe depression – is today given under anesthetic, and with the consent of the patient.

Other less conventional methods exist: light therapy for seasonal depression, acupuncture, tai chi, reflexology, as well as improvement in diet (vitamins, Omega 3, even chocolate…).