Managing Depression, Growing Older

A guide for professionals and carers

Kerrie Eyers, Gordon Parker, Henry Brodaty

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135709150
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Awarded the book prize for 2012 by the Australasian Journal on Ageing!

Even when he's grey around the muzzle, the black dog of depression can still deliver a ferocious bite. Depression can strike at any age, and it may appear for the first time as we get older, as a result of life circumstances or our genetic makeup. While older people face the same kinds of mental health issues as younger people, they can find it more difficult to deal with them owing to the stressors which accumulate with age. There is also a high incidence of undiagnosed depression in older age, presenting extra challenges for carers.

Managing Depression Growing Older offers a systematic guide to identifying depression in older people, supporting them at home or in an aged care setting, and the importance of diet, exercise and attitude in recovery. It is essential reading for anyone who works with the elderly.

1

And Now We are 65

Why are our days numbered and not, say, lettered?

Woody Allen

This book is intended for professionals and carers involved with those who are growing older. There are perspectives from both sides of the clinician’s desk: stories from those growing older and from the people involved in their support. We wish to present ageing in a positive context, tackling some of the myths, fears and prejudice that surround this phase of our life, and consider some solutions to age-related difficulties.

We ask your indulgence for the span of the material. It ranges in complexity from the everyday experience of people with depression and what they have found helpful, carers and their perspective, and more complicated material from specialist clinicians. Where terminology becomes technical, equivalent words are provided in brackets to assist the lay reader’s better understanding.

We also explore the differences in the causes, presentations and management of depression that may arise as people grow older, and the influence of age, biology and psychological and social factors on mental health. Increased understanding and empathy help destigmatise mood disorders and may encourage those affected to more readily seek diagnosis and treatment.

The material presented here is about ageing and related issues in Western industrialised countries. It affirms and emphasises that clinical depression is not a’normal’response to ageing, and attempts to trace a path through the maze, from diagnosis through to weighing up the factors that contribute to the onset and maintenance of a depressive episode and to its successful reversal. We emphasise that, when the black dog comes sniffing at the door, there are effective treatments and strategies to enable older people to banish or master depression and to re-engage with their life.

The Emerging Claims of Age

I don’t do alcohol anymore—I get the same effect just standing up fast.

Anon

With advancing age, we are called upon to shape our lives in a way that has not been expected of us before. The freedoms and disengagements of older age bring a more diffuse range of options than we may be used to. Previous stages—our younger lives—were shaped and codified, with clear roles: from birth to teens, the structure was provided by family and educational institutions; then 40 years of workplace obligations; the ’mating game’, the search for a partner, a suitable match, maybe forming a family; the intensity of the child-rearing years; and then perhaps (sometimes to tide over a mid-life crisis) a final run up the career ladder and/or the start of a new intimate relationship.

By the age of 65, some of this involvement has waned and we have time to contemplate with pleasure, apprehension or a mixture of both what we can see is the shortening time remaining and our plans for what to do with it.

Many on the verge of leaving the accustomed routine of the middle years don’t really have strategies, other than financial, for this disengagement. We presume that we’ll be glad to be’free’ and to have more time to ourselves, perhaps take up golf, bridge, bowls, a foreign language, a community involvement—pursuits we’ve never had the time for previously. It is wise (but not usual) for us to anticipate such a change and to weigh up our options when younger in order to better understand our preferences and possibilities for this next stage of life.

External Circumstances Intervene

Inside every older person is a younger person wondering what happened.

Jennifer Yane

Many of us assume that as we grow older we will be able to continue much as before, but with engagement in the paid or voluntary workforce more on our own terms—’dying in the saddle’, as it were. Instead, we may be faced with more limited choices than we had envisaged. While those who transition from the workforce into part-time, self-employed or temporary employment often remain healthier and more engaged,¹ older workers are seen as lacking the energy, speed and technological know-how that internationally competitive organisations require. Despite rhetoric to the contrary, analyses of companies’ recruitment behaviour and workforce composition demonstrate the reason that many senior would-be workers have given up seeking employment: organisations are just not interested in employing an older person.

The following account from ’Alex’, a 73-year-old man formerly working in top executive roles, illustrates how unprepared we are for stepping away from the workplace where many of us, for four decades, have spent more than a third of our waking hours. In a reversal of Lord Kitchener’s British World War I recruitment poster ’Your Country Needs YOU’, Alex has been shown that he is inessential.

My depression emerged suddenly

My depression emerged suddenly, upon retirement, and I fear black moods will stay with me for the rest of my life . . .

I’m not sure how high I rate on the ’depression scale’, as it has never been assessed professionally. Identifying the severity of one’s depression is elusive. Obviously, there are few outward symptoms: nothing showing on your body, no ache or pain or anything indicated by x-ray. How much of my problem is just ’old age’ is hard to evaluate, but it is pretty clear that these depressive cycles are debilitating and have changed my character.

My confidence in dealing with other people has reduced. I am often asocial and dread leaving the house. I don’t want to meet new people. I stress over minor issues and irritations—hiring a tradesman for house repairs or having the car serviced can be very disturbing. I spend most of my days at home alone. When I make the bed, it’s hard to stop myself getting back into it. My daily shower has become less than that and I have let my hair grow rather long.

After three score and ten years of life (plus a couple more), I fear being consumed by my own anxiety and anger. I worry about the appalling performance of parliamentarians; teenage girls’ binge drinking; obesity; climate change; ’shock jocks’ inciting racial hatred on the radio; young lads with massive bank balances from sport not knowing how to avoid trouble. Somehow, I feel responsible that things are not better.

My previous high-profile working life was successful by most standards. There were disappointments, but none seemed to drive me down. I held senior positions in both the public and the corporate sectors, rubbing shoulders with politicians and leading businessmen. Large numbers of people reported to me. I made decisions that impacted on people’s lives and I mentored the young and inexperienced. In the 1990s, I was the CEO at a retirement village and hostel. It is to my deep regret that I never initiated any programs to handle depression. In retrospect I realise that many residents would have been suffering from it, usually in silence.

The onset of retirement and the removal from regular interaction with others seems to be one shortcut to depression. For some of us elderly, that depression will become a constant. Irrelevance and invisibility take over. The phone hardly ever rings, extended families have too much on their plates to worry about you. Even ex-workmates, some still employed, are often too busy to meet for a drink. You are ’yesterday’s man’, somewhat alone and certainly forgotten. It is likely you will spend a lot of time in a chair, staring into space and wondering what happens now. You are not valued anymore. Years of experience, survival of hard times, wars, tragedy and success don’t count.

In older age, you had expected to be revered; sought after to scatter pearls of wisdom and dispense sage advice; have the satisfaction of a grandchild on your knee attentively absorbing your knowledge and adventures. Such dreams are nothing but fantasy. The only reality is that you are being sucked into a vortex of introspection, loneliness, even despair. Previously, you had never felt irrelevant in your life. Now, it’s there every day.

That irrelevance and invisibility brings on intolerance and impatience. (Everything seems to start with ’I’.) You show intolerance in many ways. You become angry with people who express a contrary point of view. You cancel the newspapers because the writers get it wrong. If you ask for something, you seem to be low down on the priority list. Your blood boils while you wait. But nobody notices. After all, you are invisible.

So what to do? Perhaps seek professional medical advice. What if you tell your doctor that nobody seems to be listening anymore and your stressed-out GP doesn’t have time to listen either? Anyway, most men will only visit the doctor for an obvious problem or to get a script renewed! For my age (they say), my health is good. I don’t feel inclined to share moods of anger, loneliness and despair. I don’t want to be prescribed medication to be taken for the rest of what is left of my life. The catastrophic results of people giving up these medications or forgetting to take them are well documented—not a danger that an older person needs.

I sleep pretty well, although the dreams are often quite horrendous and almost always relate to past events and people. I go to bed as late as possible. I have no debt, and a working wife, so money is not an issue. We’ve had the overseas trips, holidays and cruises. When the holidays end, I am usually back into moods of despondency almost before the unpacking is completed. My only regular activities are a commitment to crosswords to activate the brain, and a weekly class to exercise the body. There has been some urging that I should take on volunteer work. Frankly, I fear being useless should my mood turn sullen, and the depressing fact that you are probably dealing with people whose needs are real and greater than yours. I have never felt suicidal—at my age, death is a companion who doesn’t need any help.

So, where to from here?

That I recognise where I am now is obviously a good thing. Writing this has been somewhat therapeutic. But the reality is that only by finding something bright and inspiring will I be sure of being able to fight the times of darkness. Religion can be uplifting, but having lived as an atheist I expect to die as one. People often ask somebody they’ve just met: ’And what do you do?’ Retirement translates as ’Nothing’ and they are inclined to move on. You are often judged by what you do rather than what you are.

But I firmly believe my problems, depression and anguish, would diminish with any sort of a job, just something I could talk about to strangers and be proud about. Not often does a 73-year-old get a second chance, but what a great antidote to depression if you can pull it off.

Dream on? Alex

This scenario—though stingingly fresh to Alex—is commonplace and sanctioned. Those growing older move (or are moved) aside to make room for the energy and innovation of the young. The remedy for people so displaced is less obvious, however, and requires some ’bespoke’ tailoring of capacities to opportunities.

What should Alex do, how does he regroup, where does he invest his energy and sense of self now? Because of the contrast with his previous effectiveness, does one judge that his present dark outlook is ’depression’, or is it the shock of a role change that’s not yet absorbed? Is he describing ’clinical depression’, or is this normal sadness?

Assessment might weigh the following concerns. Are his current feelings impairing him substantially? Enough to warrant some sort of intervention? Does Alex seem likely to self-regulate, and eventually bounce back and adjust to his circumstances and find new opportunities for re-engagement? In his present mood, his negativity and feelings of hopelessness are eroding his capacity to function effectively. Intervention that addresses factors involved in his present ’dis-ease’ might usefully act as a circuit-breaker.

We have become increasingly ’psychologically minded’ in the last decades. Depression is more readily diagnosed and treated— some would say too readily—but consulting an astute mental health professional during a transition of this kind can help address risk factors and foster a more positive resolution.

Personal Circumstances Intervene

A further account of leaving the workplace—in this case a ’forced’ retirement of a different sort—comes from the daughter of a man who had to step away from his work when vulnerabilities from his earlier life suddenly assailed him.

This Is Your Life

I warmly welcomed over thirty people into my home to host my dad’s recent birthday party. Mum had spent the previous days preparing a wonderful selection of foods. My husband and children had ex...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Foreword
• 1. And Now We are 65
• 2. On Growing Older
• 3. Untreated Depression in Older Age
• 4. Reaching a Diagnosis
• 5. A Structured Assessment for Depression
• 6. Melancholic and Non-melancholic Depression
• 7. Late Onset: Depression Specific to Ageing
• 8. Therapies and the Role of the Therapist
• 9. Ageing and Coping with Care
• 10. Managing Severe Depression
• 11. Ageing and Self-efficacy
• 12. Caring for the Carers
• Appendix I: Risk Factors for Self-harm
• Appendix II: Further Information for Older People and Carers
• Appendix III: Clinician Contributors’ Short Biographies
• Notes
• Index