In this module you will review common changes that may take place in later life. You will look at adjustment to change, grief, depression, behavior changes, and the importance of attitude in successful aging. You will also learn or review what you can do as a caregiver to support and encourage successful aging.Click on a topic below to go to that area of the page:
6 Signs and Symptoms Suggesting Depression
7 Recognize Signs and Symptoms Suggesting Depression
8 Depression In the Elderly Often Goes Undetected
9 How Common Is Depression In The Elderly?
11 Tools To Help You Recognize Signs and Symptoms Suggesting Depression
12 Possible Causes of Depression
14 Behavioral Changes and What to Do
16 Supporting a More Positive Attitude and Adjustment to Change
Click here for a list of all modules.
Aging is another stage of life like childhood, adolescence or young adulthood.
“To everything there is a season, a time for every purpose under the heaven; A time to be born, and a time to die; A time to plant, and a time to pluck what is planted; A time to kill and a time to heal; A time to break down, and a time to build up; A time to weep, and a time to laugh; A time to mourn, and a time to dance; A time to cast away stones, and a time to gather stones together; A time to embrace, and a time to refrain from embracing; A time to gain, and a time to lose; A time to keep, and a time to throw away; A time to tear, and a time to sew; A time to keep silence, and a time to speak; A time to love and a time to hate; A time of war, and a time of peace.” -Ecclesiastes
This well-known passage from the Bible reminds us that there are many stages in everyone’s life, some good and some bad.
People age differently and experience aging differently based on heredity, lifestyle, and attitudes. We don’t become more alike as we grow older, but more of who we are as individuals. As some people grow older they may no longer hold back from saying and doing things that they have always thought.
Chances are good that a demanding 80 year-old was a demanding 35 year-old. So the best way to predict how an older person will act is to look back at her behavior in earlier life.
Although our personalities don’t change much with aging, we may express ourselves in different ways. If we don’t have to worry about what classmates or co-workers think of us, we may more feel free to say what is on our minds.
Change and LossAging is a process of adjusting to continual changes.
- Retirement. Retirement is not the same for everyone. While some people adjust very well to retirement, others find the transition more difficult. In general, those who retire to meaningful activities are more satisfied than those who retire from a job and have no outside interests.
- Changes in vision, hearing, and other senses. All of our senses tend to change with age. Our eyes have more difficulty focusing on near objects and adjusting to changes in light intensity. Our lenses gradually become clouded. We may have difficulty hearing tones that have a high pitch. Such changes may be especially disruptive for those who have never experienced sensory loss.
- Health. As we grow older, we become more likely to develop chronic health problems. Adjusting often depends on our prior health and how well the conditions can be controlled. Someone who has been healthy most of his life may struggle with accepting health problems as he gets older.
- Mobility. Those who are inactive and/or have health problems may experience declines in strength, endurance, and mobility. These may limit daily activities.
- Memory. We process and retrieve information in different ways as we grow older. For example, we may take longer to recall information. Such changes are usually slight. However, stress, medication interactions, depression, dementia and a number of other conditions can cause serious memory problems. Any significant change in memory should be evaluated by a physician.
- Death of spouse, other family, and friends. One of the most difficult changes is loss of significant people in one`s life.
- Home and personal possessions. Moving is a chore at any age, but it can be especially difficult for someone older. One may be leaving a home of several decades or moving into a smaller home that can’t accommodate all of one’s personal possessions. The loss of familiar surroundings or things requires adjustment.
- Income. Incomes usually decline at retirement. Since older people don’t know long they’ll live or what their expenses will be, they may be reluctant to spend money and/or worry about their financial security.
- The changes that many older adults experience can affect how they see their lives. Many feel that they have lost their independence. They may experience a loss of self-esteem and may lose a clear image of who they are at this time in their lives. So many changes and adjustments can lead to a lack of confidence in their ability to live a meaningful life and continue to make valuable contributions to the community.
We all have different ways of coping with loss and change. If we have adjusted fairly well during the first 50 years of our lives, we`re likely to be able to adjust during the next 50 years. On the other hand, if we`ve resisted change throughout our lives, we will probably continue doing so—and experience negative effects that may include the following:
- Physical complaints: There`s a clear relationship between mental and physical well-being. Those who have undergone losses are more likely to experience both minor and major illnesses.
- Denial: Some people cope by refusing to acknowledge that change has occurred. They may have an “ignore it and it will go away” philosophy.
- Guilt: People may feel that they could have prevented a loss by acting in a different way.
- Loneliness: Isolating oneself may be a way of mourning the loss of familiar people and a former lifestyle.
- Sense of helplessness: People may feel that they are at the mercy of their health problems, living arrangement, income limitations, or negative events.
- Projection: Some people become overly critical, suspicious, and/or paranoid. They do not trust easily and may feel that they are being taken advantage of.
- Rigidity/stubbornness: Those who feel out of control may try to regain control by taking on an attitude of “my way or no way.”
- Selective memory: Some people may cope by remembering either the best or the worst about events and people in their life. They may distort the reality of how the events happened or who the people were. They hold on to a fantasy instead of a reality.
- Regression: Going back to old behaviors or ways of coping may be ways to deal with painful events.
- Rage: When people feel that they have little control over the present or have regrets about the past, they may react in anger. They may lash out at family members—sometimes being most critical of those who are most supportive, since they know that these people will still love them in spite of their anger.
- Depression and anxiety: Although not something that most people want to discuss these are very real reactions to loss and uncertainty for anyone at any age. It is important to help someone know that these feelings are normal and to get help if the feelings interfere with daily living beyond a few days of feeling sad.
- Grief. Grief is a normal reaction to the loss of people, former lifestyles, relationships, health, vision, hearing, ability level, mobility, or independence.
Groundbreaking research on death and dying by Elizabeth Kubler Ross identified stages of grief that are now recognized as normal for any type of loss or change. The grieving process does not take place in steps but in cycles. People move in and out of the following stages at their own pace.
- Shock. In this stage of grief the individual describes a sense numbness and not being herself. She may not believe that she is experiencing a loss.
- Denial. In this stage a person is unwilling or unable to accept the loss. She does not want to talk about the loss and often does not realize that the loss has occurred.
- Emotional release. During the stage of emotional relief, someone may cry, become enraged, or be overly critical or sarcastic. In this stage a person`s usual behavior and emotions may be magnified.
- Depression, loneliness, and sense of isolation. In this stage the individual may withdraw, sleep more than usual, overeat or not eat enough.
- Physical symptoms. A person may experience headaches, stomach ailments, ‘heartburn` sensation, fatigue, or a general sense of not feeling well.
- Panic. In this stage a person may feel fear and a lack of control over her situation and environment.
- Guilt related to the loss. A person may think that she caused the change or loss. A person may also experience ‘survivor guilt` because she has been spared from death or illness and is less “deserving” than a loved one who has died or gotten sick.
- Hostility. Part of the emotional reaction may be hostile behavior, starting arguments, verbal attacks, and “acting out.”
- Inability to resume usual activities. A normal stage of grief is a difficulty in “moving on” after the loss.
- Glimpse of hope. Gradually, those who`ve experienced losses begin to have better days and assume more normal activities.
- Acceptance. In this stage the person is able to accept that the loss has occurred or the change has happened and that things will not be the same. The person begins to live the new life after the change although the memory of the old life or the person who is gone remains.
Problems happen when a person is ‘stuck` and is unable to work through the grief or denies that there are problems. Knowing these stages will help caregiver understand what is normal. As caregivers we can help the person struggle with the loss. We also may be experiencing loss ourselves. We may have lost a parent or spouse as we once knew them or the loss of a lifestyle because of our caregiving responsibilities. For further information see ” Loss and Grief” ~Module 13.
Simple,commonsense actions can help a caregiver support a family member and build a better relationship.
- Listen. Most people spend more time speaking than listening. We’ve all heard the saying, “There is a reason that we have one mouth and two ears. ” This reminds us that listening for what someone wants is more important than telling someone what he or she should do.
- Visit when possible. One of the biggest sources of stress and sadness for older adults is loneliness and feeling isolated and forgotten by others. Family members can help the older relative feel more involved by spending time with them. Family members can take turns visiting with a relative, taking them out to eat, going shopping, or doing other activities they enjoy. Allow the older person to choose the activities.
- Keep in contact by phone or e-mail if you can’t be there in person. Having regular and consistent communication with older family members is important, especially when their other social contacts may be limited. If you make a commitment to call or send an e-mail, follow up.
- Don’t offer too much help. If your older relative has lost some of his ability to function, don’t lose sight of what he can still do on his own. Sometimes too much help can be as harmful as too little. You can help by recognizing tasks that are difficult and offering no more help than is needed with those tasks.
- Seek medical and psychological help when needed. The stress of caregiving can cause fatigue and lead to illness or depression. You can provide assistance only if you are healthy and take care of yourself.
- Build Resiliency. Give your older relative time to mourn a loss, but help her to move on once sufficient time has passed. The time that people need to mourn a loss differs for everyone but most people need at least a year or so for loss of a spouse, for instance.
Signs and Symptoms Suggesting Depression
Depression is more than an occasional feeling of sadness or the natural grief associated with a loss. It is a group of long-lasting or recurring emotions and behaviors that interfere with a person`s normal activities. If you or someone you know has experienced several of the following signs of depression for two weeks or more, professional help should be considered:
- Changes in eating habits.
- Changes in sleeping habits (insomnia, hypersomnia).
- Decreased energy or fatigue.
- Depressed mood most of the day, nearly every day.
- Feelings of worthlessness, hopelessness, helplessness.
- Feelings of inappropriate guilt.
- Inability to concentrate or make decisions.
- Irritability, short-temperedness.
- Loss of pleasure in daily activities.
- Persistent sadness or anxiety.
- Significant weight loss or gain.
- Change in mobility either by slowing down or nervous gestures.
- Feelings of worthlessness, self reproach, excessive guilt.
- Diminished ability to concentrate.
- Lack of attention to physical appearance.
- Memory loss, confusion, disorientation.
- Overly concerned with physical problems. Chronic aches or pains that cannot be attributed to physical disorders.
- Suicidal thoughts/ideation.
- Withdrawal from formerly pleasurable activities and relationships.
- Increased dependence on family.
- Unexplained crying.
Recognize Signs and Symptoms Suggesting Depression. Recognize the Signs of Depression:
It`s important that family members identify the signs of depression in their elder relatives, according to Dr. Charles Reynolds, a medical researcher who focuses on mental health in the older population. Often senior citizens do not realize they are depressed, or do not seek treatment for emotional problems.
Depression In the Elderly Often Goes Undetected
Many older adults who have depression are never diagnosed. Often they and their families accept their symptoms as an inevitable part of aging, so no help is sought. Many are so embarrassed by what they consider to be the stigma of mental illness and the shame of their symptoms that they are unwilling or unable to discuss their feelings with a professional.
If the signs of this illness are recognized and appropriate help is sought, most elderly patients can experience improvement within weeks. That improvement can extend to every phase of the person`s life: memory, interest in activity, and overall physical health.
Many older adults who have depression are never diagnosed. Often they and their families accept their symptoms as an inevitable part of aging, so no help is sought. Many are so embarrassed by what they consider to be the stigma of mental illness and the shame of their symptoms that they are unwilling or unable to discuss their feelings with a professional.
If the signs of this illness are recognized and appropriate help is sought, most elderly patients can experience improvement within weeks. That improvement can extend to every phase of the person`s life: memory, interest in activity, and overall physical health.
How Common Is Depression In The Elderly?
The actual number of older people with clinical depression may depend on where they are living, says Dr. Reynolds. An NIMH study found that 2 to 3 percent of elderly people living in the general community — not in hospitals or nursing homes — may be clinically depressed.
However, eight to 10 percent of seniors who visit primary care clinics may fit the diagnosis for clinical depression, between 20 and 25 percent of older people in hospitals have depression and one in three senior citizens living in nursing homes may be suffering from the illness. Some estimate that as many as 65% of the elderly suffer from this condition.
- The elderly have the highest suicide rate of any group in America – 50 percent higher than the general population.
- Each year, 6,000 older Americans kill themselves. Unlike younger people, the elderly do not attempt suicide impulsively. They plan it carefully over the course of months.
- Depression is one of the most common risk factors for suicide.
- The highest rates of suicide in the USA occur in persons >= 70.
For white men, suicide is 45% more common among those aged 65 to 69 years, > 85% more common among those aged 70 to 74, and more than three and a half times more common among those >= 85 than among white men aged 15 to 19 years. - Suicide rates do not increase with age among women.
- The elderly are less likely than younger patients to seek or respond to offers of help designed to prevent suicide. The elderly make fewer suicide gestures but more often succeed at suicide attempts.
- As many as 70% of elderly persons who completed suicide visited their primary care physician within the previous 4 weeks.
By recognizing the following signs that a person is contemplating suicide and contacting a medical or behavioral health professional immediately, family and friends can intervene in time:
- Mention of desire to die.
- Self-denigrating comments such as “my family would be better off without me.”
- Neglect of self-care, personal hygiene.
- A sudden interest in putting affairs in order.
- The giving away of possessions.
- A sudden interest or disinterest in religion.
Tools To Help You Recognize Signs and Symptoms Suggesting Depression
- www.Feelingblue.com (The Aurora Depression Self-Test).
- www.Depression-screening.org (Sponsored by the National Mental Health Association).
- For free brochures on depression and its treatment, call NIMH at 1-800-421-4211. Brochures are also available online at www.nimh.nih.gov/publicat/depressionmenu.cfm
- For a free Age Page brochure, “Depression: A Serious but Treatable Illness” from NIH`s National Institute on Aging, call 1-800-222-2225.
- The Mental Health Association of Tarrant County Online Screening
Tool: https://www.mentalhealthscreening.org/screening/welcome.asp
The above links open in new windows.
Following are possible causes of depression:
- Stress and loss: As people grow older, their losses can multiply. They lose loved ones, their health, their physical strength, financial stability and formerly rewarding career or family responsibilities. Their losses can become too much to cope with, and depression may result.
Note: What often adds to the grief of the elderly is that these losses are likely to: a) be multiple or come one right after another.
- Substance Abuse: Alcohol, prescription and non-prescription drugs.
- Physical Illness:
- Research has established a clear link between brain chemistry and depression.
- Medical illnesses can increase the likelihood of depression.
- Known causes can be Parkinson`s Disease, thyroid changes, strokes, diabetes, and certain forms of cancer.
- Hormonal changes.
- Medications:
- Some blood pressure medications increase the risk.
- Interactions of medication causing unwanted side effects that can trigger depression.
- Lack of physical activity.
- Lack of emotional and social outlets.
- Poor stress management tools.
- History of a major depression increases risk of recurrence.
- Family history of depression.
- Get help! Talk to your relative`s physician.
- Ask your relative`s doctor about possible side effects of medications.
- Talk about changes in how the person is feeling and changes in his usual behavior and routines.
- Ask the doctor about a referral to a mental health professional who understands older adults.
- Ask the doctor if your older relative can benefit from medication therapy.
- Talk to your older relative about changes in how she is feeling and changes in usual behavior and routines.
- Medications frequently prescribed by physician include the seratonin uptake inhibitors (SSRIs): Zoloft, Paxil and other anti-depressants. These medications have fewer side effects that many older medications.
- Contact the Mental Health Association or local Mental Health Mental Retardation (MHMR) Center.
- Find support systems from friends, family and the community.
- Recognize and get help for yourself. As a caregiver you may also experience depression.
Click belowfor more information on depression in the elderly:
http://psychologyinfo.com/depression/seniors.htm
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Behavioral Changes and What to Do 2
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Changes in a person`s usual behavior and routine can indicate a change in health and mental status.
- Be observant.
- Tell your older relative about the changes you observe and ask what he/she may be experiencing.
- Make sure that current medical treatment and medications are working.
- Take some practical steps:
- Really listen to his/her concerns. For example, stop cleaning the house or driving or preparing a meal and sit down, make eye contact, and really listen.
- Ask your family member what he/she needs and work with him/her to come close to meeting their need.
- If your older relative is no longer able to do something that he wants to do, help him find alternatives.
- Set some healthy limits for yourself. Tell your family member what you can and cannot do based on your skills and your other time, work, and family commitments.
- Talk to siblings and other family members and ask for their help.
- Set up a Job Jar or “To Do” list. Talk to your older relative and ask him/her to make a list of things that need to be done. Ask for help from other family members, church volunteers, neighbors, or other people who have offered to help.
- Housecleaning.
- Mowing the yard.
- Checking on bank statements and finances (if your relative consents).
- Making minor repairs around the house.
- Calling the Area Agency on Aging or Meals on Wheels to get information or to arrange for services.
- Doing internet research for health resources, Medicare or other information.
- Taking your relative to the doctor or physical therapy.
- Taking your relative to the senior center, out to eat, shopping or to a movie.
Attitude and Successful 2,3
Aging Texas Well
tdoa.state.tx.us
Successful aging depends on an older adult’s attitude and ability to compensate for changes.
People who have coped successfully earlier in life usually continue to do so in later years. Some people act “old” early in their lives and others act “young” well into their later years.
The Texas Department on Aging has adopted as its motto”Aging Texas Well” and provides information and Internet web links on issues including:
Family, Health, Legal, Housing, Volunteering, Money, Work and Career, Education, and Spirituality. You will find help and information for you and for your family member.
Supporting a More Positive Attitude and Adjustment to Change
- We help by LISTENING. That means not just hearing what someone says but listening behind the words to determine what the person really means. When someone repeats the same things over and over or complains, try to find out what may be causing him/her to be upset or angry.
- As we show compassion and kindness, others feel understood and are more likely to open up and accept help.
- Remind older relatives of their successes. These serve as reminders that they have overcome hard times before.
- Recognize their efforts to maintain independence. Don`t provide more help than is necessary since this may create an unnecessary sense of dependence. Allow the older relative to be as independent as she is capable of being.
“When I am Old”
When I am old I shall wear purple.
With a red hat that doesn’t suit me.
And I shall spend my pension on brandy and summer gloves.
And satin sandals and say we’ve no money for butter.
I shall sit down on the pavement when I’m tired.
And gobble up samples in shops and press alarm bells.
And run my stick along public railing.
And make up for the sobriety of my youth.
I shall go about in my slippers in the rain.
And pick the flowers in other people’s gardens.
And learn to spit.
But maybe I ought to practice a little now,
So people who know me are not too shocked and surprised.
When suddenly I am old and start to wear purple.
~ Jenny Joseph
2 As we grow older, it generally takes longer to recall information. This is a normal change. However, severe memory loss is not normal and should be evaluated by a doctor. Medical problems, poor nutrition, depression, and medication interactions may all interfere with memory.
- Encourage your older relative to keep his/her mind active, since this enhances memory and problem solving skills.
- Activities that keep memory sharp include reading, study, chess, crossword puzzles, card games, and board games such as bingo.
- Consider the use of memory aids, such as lists.