 Welcome to the topic, Key Helping Strategies for Depression and Later Life. This is Sean Brotherson, Family Life Specialist with NDSU Extension. I am also joined on this topic by Jane Strowman, Extension Aging Specialist. Thank you for your interest in this topic and how it might be of relevance in your life and work. This is video number five in a series of short educational videos on the topic of understanding depression in later life. In this short video, we are exploring the topic of depression in later life, what to watch for and key strategies for getting help for depression. Depression is an important condition to understand because it affects a significant number of people and can have severe consequences. Research indicates that depression is quite common in later life, affecting over five million Americans age 65 and older each year. Depression is not a natural part of aging. If it is left unaddressed, depression may result in serious challenges including difficulties with emotional distress, mental anxiety and decreased quality of life. You should watch for signs in a person's physical appearance, emotional state, personality and living conditions that may indicate the presence of depression. Also, there are several important strategies for getting help in managing depression for yourself or others you may know. Let's explore some of what we know about what to watch for related to depression in later life and then share information on how to get help if it is needed. 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. 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 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 and 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 a general health practitioner. A medical professional can assist you or another in seeking an opportunity for a 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, 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 their dismissal of one's 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. Press 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. 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. 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 video number five in this series, Understanding Depression and Later Life. Thank you for viewing this resource. We encourage you to seek out further understanding on key issues related to depression, anxiety, grief, suicide, and helping resources in later life by viewing the other short educational videos in this series. These and other educational resources can be accessed on the Ande issue extension YouTube channel or at the web link on your screen. This educational resource has been brought to you by Ande issue extension. Extending knowledge, changing lives.