 Welcome to the educational lesson, Understanding Depression in Later Life. My name is Sean Brotherson, Extension Family Life Specialist with the NDSU Extension Service, and I will be sharing some information today about the topic of understanding depression as individuals grow older. I am also joined on this topic by Jane Stroman, Extension Aging Specialist with the NDSU Extension Service. Thank you for your interest in this topic. And how it might be of relevance in your life and work. There are a number of key issues that we would like you to become familiar with as you follow the lesson outline today. Key objectives for this lesson include, first, to understand key issues relating to depression, anxiety, and suicide in later life, to learn about signs of depression and related mental health concerns that can occur in later life, to explore specific strategies for managing depression or related concerns in later life, to gain knowledge of specific resources to deal with depression and related concerns, and finally to educate the community about mental health issues that can occur in later life. I'd like to begin our discussion on the topic of depression in later life by exploring a few statements related to the topic of depression and whether they are true or false. Please think about the statement as it is asked and whether you perceive it to be true or false. The first statement is, depression only develops when someone has had a major traumatic experience in life, such as the death of a spouse, a heart attack, or other major health concern. Do you consider this to be true or false? The answer to this statement is false. It is a myth that depression occurs only when people experience major trauma in life. Perhaps think about some of the factors that might contribute to the experience of depression in later life. The reality is that depression is a commonly occurring mental health condition that can arise in a person's life due to a variety of factors, including genetic influences, body changes, stresses in life, personal losses, or other factors and influences. Let's consider the next statement on the topic of depression in later life and whether it's a myth or a reality. Again, please think about the statement as it is made and whether you perceive it to be true or false. The statement is, individuals dealing with depression usually can overcome it if they just work to cheer themselves up or pull themselves up by their bootstraps. Do you consider this statement to be true or false? Again, the answer to this particular statement is false. It is a myth that depression can typically be overcome simply by telling yourself to feel better or pulling yourself up on your own. The reality is that depression is a complex medical and mental health condition that typically does improve with a variety of approaches, which may include therapeutic support, social support from friends and relatives, exercise, a healthy diet, rest, and medication as prescribed under the direction of a physician. Here is a final statement that we'd like you to consider and whether you perceive it to be true or false. The statement is as follows, seeking assistance from a doctor or mental health professional for depression is a sign of an inability to handle your problems or a personal weakness. Do you consider this statement to be true or false? The answer to this statement is false. It's also a myth that is sometimes commonly perceived that individuals dealing with depression are emotionally weak or unstable or that seeking help is a sign of weakness. The reality is that depression is a condition that anyone can experience. Seeking assistance from competent professionals often is necessary and it signals wisdom, understanding, and strength on the part of the individual who is seeking assistance. Depression is an important condition to understand because it affects a significant number of people and it can have severe consequences. For example, it may disturb a person's thoughts and feelings, alter a person's behavior, and cause physical difficulty and emotional distress. However, depression can be treated effectively when diagnosed and managed with care. It's everyone's responsibility to understand depression and help individuals find effective solutions. There are many factors that may raise the risk of depression for aging community members, such as living alone, having no relatives or friends nearby, or experiencing recent losses. Being aware of these risk factors can enable greater awareness of this condition. So what is depression? Depression is a mental health condition characterized by an inability to concentrate, insomnia, loss of appetite, physical tiredness or fatigue, feelings of extreme sadness, guilt, hopelessness, and helplessness, and thoughts of despair, discouragement, and death. It's also called clinical depression. Almost 4% of people age 55 and over living independently in the community suffer from major depression in any given year. Depression usually is marked by a variety of symptoms occurring together during a period of more than two weeks. Occasional episodes of fatigue, discouragement, or anxiety are common for all individuals. However, when a wider array of symptoms develops and lasts longer than two weeks, then clinical depression may occur. Some individuals may experience symptoms that are substantial risk factors for depression, such as social isolation, personal history including chronic medical illness or prior depressive episodes, and family history of mental health issues or alcohol abuse. It's important to assess a person's experiences to consider the risk for depression in his or her life. Among older adults, challenges with anxiety often occur, but at the same time as depression. Research on this topic indicates that 26% of people with anxiety also experience depression, but in addition, about 48% of people with depression also experience anxiety. Thus, depression often is accompanied by anxiety as a kind of traveling partner when it occurs in older adults. Anxiety is a common mental health condition that often accompanies depression. The experience of anxiety is typically marked by intense mental worry or confusion that becomes debilitating. If a person experiences anxiety that is intense or frequently present, carrying out basic tasks or functioning in a social setting can become difficult. About 1 out of 10 individuals over the age of 55 undergoes the experience of dealing with an anxiety condition in any given year. So what are some symptoms to be aware of? Symptoms of anxiety often include mental and physical signals. For example, the mental symptoms of anxiety can include a high sense of worry or fear, a feeling of being paralyzed, or a sense of panic. Anxiety is also often indicated by a variety of physical signs. First of all, this can include fatigue, disturbed sleep, or feeling jittery. Other physical signs in your muscles or head can include tight or sore muscles, feeling dizzy or lightheaded, or having an upset stomach. Some additional signs include a shortness of breath, increased heart rate, dry mouth, or sweating. If you or another person is experiencing anxiety, focus on strategies to calm down and feel more in control, such as getting to a familiar setting, sitting down and breathing regularly, or other strategies. As with depression, a variety of risk factors contribute to the possibility of experiencing anxiety. If a person has a personal history of previous encounters with depression or anxiety, a chronic illness, a history of substance abuse or a tendency towards social isolation, these are personal factors that increase the likelihood of anxiety as an older adult. Other risk factors include a family history of alcohol abuse, or family members who have experienced anxiety or mood difficulties. Women are more likely than men to deal with anxiety in their later years. An exposure to a traumatic event can also increase the risk of anxiety. An awareness of risk factors for anxiety can help individuals be more sensitive to what they or others might be experiencing. Next, we're going to focus on grief, loss, and depression. Following is a short video from the National Institute on Aging that tells the story of an older woman who dealt with depression for years, but is now in recovery. My symptoms included loss of appetite, inability to sleep. I guess for a while I was irritable, I would begin to shun people because I knew something was wrong and I didn't want them to know. Peggy Templeman is 78 years old and has experienced depression throughout her adult life. It would come and then it would go for maybe over 40 years. About 2 million older adults in the United States suffer from full-blown depression. Another 5 million suffer from less severe forms of illness. Depression and later life can be caused by a variety of factors. The triggers for depression are changes in health, traumatic events, major changes in one's life circumstances, loss of people who are dear to you, loss of the ability to do the kinds of things that you are used to doing and give you pleasure. The triggers for Peggy's bouts of depression included high levels of stress, an inner ear disease and losing a valued psychotherapist. And so I began to get sicker and sicker. My husband had to go to work. No one was at home. I was sick. And so I did not take the medication. And so finally I did make an attempt to harm myself. I was seeking help. Peggy did get help and the combination of talk therapy and medications made a significant difference. With the medication initially and with talk therapy, psychotherapy, then I really began to get back on my feet. I had a marvelous psychotherapist who I continue to see periodically now. Peggy's experience with depression involved a spiritual side, which she says was key to her improvement. She even wrote a book about it. The medications, all of that, and the talk therapy led to the spirituality, the meditation, the sitting in silence, the communing with the Almighty. Although depression is treatable, people should realize that it may take time to find the right treatments and for those treatments to work. Patients for it typically need to be approached as something that's going to take a considerable period of time in order to have a beneficial effect. Peggy's journey out of depression was long and difficult, but she is now in recovery. And she has a message for those who may be suffering with this disease. Talk. Tell it to the family. Tell it to the friend. Tell it to the family doctor. Is here. Help is there. As one ages, many older adults experience losses in their lives. These losses can be very painful. Examples of losses that older adults may experience include moving from your long time home to be closer to family or going to an assisted living facility or nursing home. Spouses, family and friends passing away. Loss of a long time career that provided a professional identity or status. Loss of health. The inability to perform daily activities resulting in the loss of independence. Or the loss of the ability to get around or drive. Grieving over these losses is normal and healthy. Even if the feelings of sadness last for a long time, you can see in the stages of grief listed that depression is a normal stage of grief, manifesting itself with the same signs and symptoms as clinical depression. Sometimes telling the difference between grief and depression is difficult. Grief is a roller coaster involving a variety of emotions and a mix of good and bad days. Even in the middle of the grieving process, you will have moments of pleasure and happiness. With depression, on the other hand, the feelings of emptiness and despair are more constant. Grief after a significant loss, such as losing a loved one, is a normal reaction that generally does not require professional mental health treatment. However, when grief is complicated and lasts a very long time following a loss, treatment may be required. The experience of depression also is associated with suicide. Age consistently has shown that there is a strong linkage between depression and the likelihood of suicidal feelings or suicide itself. Older adults have the highest rates of suicide of any age group in the United States. Therefore, we suggest it is important to be aware of this topic and to consider what to watch for and how to get help if it is needed. In fact, suicide rates are particularly pronounced among older men. White men age 85 and older are more likely to commit suicide than Americans in any other age group. Suicidal behavior in older men can be a reaction to perceived loss of social status among other factors. For example, a person may feel discouraged due to loss of physical mobility, diminishing involvement with others in retirement, or other changes in status. This group's high rate of suicide may be linked to loss of the ability to control impulses, which can be a feature of cognitive changes in ageing or even dementia. If a person loses much control of their emotions or mood, then it becomes more difficult to resist impulses associated with severe depression that can include suicidal feelings. Identifying a person at risk of suicide can be difficult, even for a trained professional. However, here are a few common events or situations that may place an older adult at higher risk for a suicide. Withdrawal from activities they used to enjoy, such as getting together with friends for breakfast or walking with a neighbor. Negative thoughts, including frequent talk about death, such as statements like I just want to disappear or it's time for me to move on. Strong feelings of guilt or self-doubt, a decline in one's appearance or hygiene, such as not washing clothes, brushing teeth or bathing, or stop piling of medication rather than taking a prescription as prescribed by a physician. Be attentive to these warning signs in yourself or among others that you know or care about. If you are unsure whether a person is immediately at risk for suicide, seek help and take him or her to the nearest emergency room for an evaluation by healthcare professionals. You may also contact www.suicidepreventionlifeline.org or call 1-800-273-TALK or 8255, which is a 24-hour suicide prevention lifeline, which is connected to a national network of crisis response services. By calling this number, you can reach call specialists who focus on helping those who are having thoughts of suicide or individuals who have a concern about someone and their possibility of suicide. You have some signs to look for if you are concerned about someone being depressed. The signs include physical appearance, emotional state, personality change, and living conditions. Knowing the signs of depression or anxiety is valuable in being able to get help if needed or provide assistance to others. Some signs of depression may be in the physical appearance of an individual. Depression results in physical fatigue and diminishes motivation. As a result, at times you may find an older person is dealing with depression if he or she has not bathed or washed clothing, looks unkempt, gives little attention to clothing or appearance, has lost or gained significant weight, or struggles with lack of sleep. Another aspect of a person's life that may display signs of depression is his or her emotional state. An older person dealing with depression may act anxious or nervous, be suspicious or blaming of others, act in an angry or irritable manner, be subject to rapid mood changes, make statements such as no one cares what I do or leave me alone or I'm just alone, and reflect a sense of hopelessness or discouragement. The personality of an individual is another aspect of life that is affected by depression. Signs to watch for in this area include decreased social contact with others, lack of care for oneself or one's surroundings, limited eye contact, constant preoccupation with losses or health concerns or life challenges, lack of interest in hobbies or family members or friends, and difficulty in making personal decisions even in small matters. Be attentive to the living conditions of an older person and what might reflect depression. Some signs of depression might be walks or lawns that are left without care, neglect of pets or other animals, little or no food in the home, neglect of surroundings such as dirty dishes or piled up mail or trash, little attention to time or what day or week it is, neglect of gardens or home or limited involvement with others outside the home. Be careful to note the difference between signs of depression and what may occur due to physical difficulty or other challenges. There are a number of key health factors in managing the effects of depression. Some of the positive factors that protect someone from depression or limit its difficulty include seeking effective medical care or sources of support and treatment, identifying and increasing support from family and community members, as well as professional support such as a counselor and having a regular support checkup such as a weekly counselor visit or a monthly check-in with your physician or nurse. Some additional factors that help in the process of managing depression include focusing on healthy living practices such as getting a good night's sleep, regular exercise such as walking or swimming and a healthy diet, increasing your personal skills in problem-solving and stress management by taking a class, meeting with a support group or working with a counselor, and exploring cultural or religious beliefs important to you that promote hope, optimism and personal care or connection with others. An important consideration for any individual with concerns about emotional health is seeking treatment and support for depression, understanding the steps associated with getting treatment and support for depression is helpful. Many people do not seek help because of the stigma associated with mental health concerns. The key first step for many people is to focus on getting help and then getting better, not on being embarrassed or isolating oneself if there are concerns about depression or anxiety. In general, the beginning point for many people in seeking help is to discuss concerns with their personal doctor, usually a primary care physician or general health practitioner. A medical professional can assist you or another in seeking an opportunity for medical screening that will help to assess emotional and mental well-being and any potential diagnosis regarding depression or anxiety. To emphasize this point, a visit with one's personal doctor or a trusted counselor, pastor or friend can be an important step in the journey of getting help and increasing hope. At times there are barriers to diagnosis and treatment of depression that need to be recognized and carefully managed. Individuals in later life may be reluctant to seek assistance or support for a variety of reasons. Identifying barriers to assistance for a particular individual may be important. Some of the common barriers include age-related changes, such as dementia with limited recognition of one's emotional health needs, illness, which may keep an individual at home due to limited mobility or occupy a different health focus, attitudes of others, meaning concern about what others will think or perhaps others dismissal of their particular needs, denial, which often means a person insists that they are doing just fine, health complaints that distract from or overshadow the issue of depression, alcohol or drug use that co-occurs with emotional difficulties, or, as already mentioned, a sense of stigma about dealing with mental or emotional health difficulties. If you have identified barriers that stand in the way of access to mental health support and treatment for yourself or someone you know, take steps to reduce the barriers and get the assistance that can make a difference in a person's health. So what can you do to help someone who may be experiencing depression? Avoid talking to the person if he or she is upset or is under the influence of drugs or alcohol. Be kind and gentle. Avoid using a confrontational approach. Avoid using labels because they may carry a heavy stigma. Take into consideration the person's age and ability to understand. There are additional suggestions for ways that you can help. Be consistent and patient in your expression of concern without exerting undue pressure on the individual. Be direct and treat the individual as an adult. Express a non-judgmental attitude, but share concerns openly. Give specific examples of behaviors or attitudes that concern you. Use statements such as, I'm concerned about you. Other ways to help include the following. Be prepared with referral information. Don't be discouraged if the person is not ready to accept your assistance. Don't worry if you don't say things perfectly. What is important is you convey your message of concern and express your willingness to help. Encourage a person to get proper professional assistance from a primary care doctor, mental health professional or other trusted professional source. A critical question is where can I get help? If you think you or someone you care about might be experiencing depression, you may want to visit your doctor first to determine if this is a problem for you. If so, your doctor may find a medication to help you or could refer you to counseling. In North Dakota, you can call 211 for confidential listening and support, as well as information and referral. This concludes the lesson on understanding depression and later life. We hope that you found it helpful.