Depression and anxiety are common throughout the life cycle; depression and older age have commonly been associated with one another. Late-life depression is a major medical, social and economic concern for the elderly population. There are many factors that can cause late-life depression. It can be caused by inherited traits, certain medications you take, an illness (especially an extended one), or a stressful life event. Things like death of someone close to you, moving to a new area, or experiencing a natural disaster could each be contributing factors to feelings of depression.
After years of planning, dreaming, and expecting the golden years to be the highlight of one's life, the increased number of stressors related to aging causes feelings of depression. Case of Maria Maria’s life has taken a drastic change and she feels like her life has no purpose. She has to learn how to cope with the death of her husband, retirement, moving to a new town to be closer to her daughters, regaining her mobility due to knee replacement and most recently memory loss. Studies have shown that depression and dementia frequently coexist (Jorm, 2001).
According to Jorm (2001), history of depression nearly doubles the risk of dementia. The experience of grief wears many faces for individuals whose lives are challenged by change, turmoil, illness, death and/or the loss of hopes and dreams. Maria needs to express how she feels regarding the death of her husband. Grief is a process not easily acknowledged in our society, particularly the grief of losing a loved one. Grief is often an integral part of most life changes and experiences. Grief is a natural and normal reaction that has a natural form and sequence.
It is, at times, intensely painful and frightening, and it may therefore be avoided, repressed, or distorted out if it’s natural forms. Grief is experienced in each of three major ways--psychologically (through your feelings, thoughts, and attitudes), socially (through your behavior with others), and physically (through your health and bodily symptoms). Individuals who can acknowledge their grief and learn healthy ways to express their pain can then free their emotional energies to focus on life and the challenges ahead. Grief that is not allowed a healthy release requently finds expression in anger (Newman & Newman, 2012), abuse and/or neglect of a loved one, substance abuse, and illness and sometimes by the sabotaging of another's efforts to help. Grieving individuals should express their needs to their family members during this painful time in their lives. Maria should discuss her wants/needs to her daughters. One way Maria’s daughters can decrease her stress is by decreasing the time she spends with their children. Maria needs to socialize more with her peers and participate in activities she enjoys. Depression Late-Life Adulthood
Depression in the elderly, undiagnosed and untreated can cause needless suffering for the family and for the individual who could otherwise live a fruitful life. Depression in older patients is frequently associated with adverse life situations--loss of jobs, productivity, health, friends, loved ones, and homes. When he or she does go to the doctor, the symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.
Depression in older people is strongly linked to physical illnesses such as cancer, diabetes, hypertension (Newman & Newman, 2012), and Parkinson's disease. Depression can exacerbate many physical symptoms and interfere with recovery from these illnesses, but can also be brought on by physical ailments. Specifically, strokes, hypertension (Warshaw, 2006), and coronary artery disease (Carney et al. , 1995) make many older individuals vulnerable to depression. Special considerations may be necessary when working with older adults relating to such things as social and environmental context, but also looking at the developmental stages as well.
Social/environmental differences are based on maturing during specific time periods, leading to a focus on generational groups such as Depression-era generation, GI Generation, Baby Boomers, rather than on specific age groups. Developmental maturation leads to relatively minor changes, such as slowing down and the use of simpler language, but also to greater emotional complexity and a wealth of life experience upon which to draw (Knights, 1996). Specific challenges means that due to the high prevalence of chronic medical problems and neurological disorders, a higher percentage of psychological assessment nd therapy is related to medical problems. There is also a higher frequency of grief work and of attention to care-giving issues. Working with elderly may require modifications because earlier born individuals have different skills, different values, and different life experiences according to the time period they were born and raised. Specific challenges of later life all may require specific knowledge and therapeutic skills because of the problems they pose for clients, not because of the client's age (Knight, 1996). Intervention
Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for a physical problem, or they may be caused by a co-occurring illness. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Efficacy studies show that late-life depression can be treated with psychotherapy.
Psychotherapy is effective in reducing symptoms in short-term depression in older persons who are medically ill (Lebowitz, et al. , 1997). Recent research suggests that brief psychotherapy (cognitive behavior therapy helps a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication.
Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caretakers. By the time later adulthood arrives, depression may relate more to fear of being abandoned or rejected, being seen as unworthy, having a view of the self as being inherently bad or damaged, feeling hopelessness that allows a sense of failure and despondency to be reinforced each time something goes wrong. The client may also adhere to internal ideology that reflects the negative opinion of themselves.
This mode of thinking is what allows depressives to proceed with a pseudo-healthy life since although they are unworthy at the core, they can see themselves as being good to others. When they are confronted with criticism or loss, they inflict self-hatred or self-blame in order to explain why things happened the way they did. The depressed client internalizes loss as being their own fault, further lowering their already diminished self-esteem (Sable, Dunn & Zisook, 2002). In terms of specific challenges, if the older clients are physically ill, this will pose new issues in both assessment and also in intervention with them.
Sorting out physical and psychological influences on symptoms and problems is an ongoing assessment issue. Specific knowledge about the effects of different chronic illnesses as well as both the skill and emotional readiness to work with physically disabled clients become essential. Conclusion Throughout the course of our lives, we all experience episodes of discontent, sorrow or grief. Depression is one of the most common psychological problems, which occur in person of all genders, ages, and backgrounds.
It is difficult working with elderly clients of a different gender, ethnicity, class background, or occupation-based lifestyle. It does require sensitivity to the possibility of the difference. It also requires some knowledge of family history before they were born or at least the willingness to learn that history from the clients. When working with clients with death and dying issues, therapists need to have basic skills in death counseling and grief work. References: Carney, R. M. , Freedland, K. E. , Eisen, S. A. , Rich, M. W. , & Jaffe, A. S. (1995).
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