Depression & Anxiety in Seniors

The holidays are over. The bright lights are put away. The busy time has slowed.

This is the time that depression and anxiety can creep in – especially as we age.

“It’s three weeks after the holidays,” Nancy L. Florio, Community Relations Coordinator at Penn Highlands Geriatric Behavioral Health Services, said. “Now, the letdown comes. For a lot of people – older people especially – things have changed significantly since they were younger – or even a few years ago,” Florio said.

“Families do things together around the Christmas period, and while around the family or friends, we can keep it together because it’s cheery and people are paying attention.” But after the holidays, families from out-of-town leave; community and church events are over. The blues can start.

Sometimes, a little of the blues is normal. Life has ups and downs. But if the blues go on for more than two weeks, it might be time for a helping hand. Depression is not a normal part of aging.

“A lot of times, people won’t recognize it on their own,” Florio said. “Today’s older generation – in their 80s and 90s - is one who thinks, ‘I got to pull self out of this.’ They think it will get better.”

Most people who are depressed don’t even recognize it. It can start gradually. For example, a person who goes to the senior center for lunch daily can wake up and decide she doesn’t want to go out in the bad weather. Then, she decides it is easier to stay home than to get oneself ready to go out. This affects how much this person socializes and feels about herself, and she is missing a nutritious meal. “It’s so gradual, they don’t realize it is happening to them,” Florio said.

“Depression is more common in women and those who have had physical health problems. It is a huge risk after heart surgery, hip fractures, cancer and stroke, and for those with heart disease and macular degeneration,” Florio said. “Most of those affect the way we think about our independence and its possible loss.”

The symptoms of depression in older adults include:

Inability to sleep. “You may go to bed very early and wake up very early, and can’t sleep at night. Then you nap during day, and then start a cycle which slims the chance of socialization,” Florio said.

Memory problems and confusion, not being able to make decisions. It may be hard to decide between a bologna and egg salad sandwich, let alone a bigger decision. “We think of those things as dementia – but it could be depression as well. When screening for early stages of dementia, we also screen for depression,” Florio said.

Irritability that is unusual or demanding behavior. “We see this a lot, especially in nursing home residents – want it now and do it this way not that way. It’s critical and demanding.”

Changes in appetite, especially with weight loss or weight gain. Most people lose weight, but some gain. Keep in mind weight loss or gain could also indicate a medical issue.

Withdrawal from social situations. Even in a group, the person may not feel present, but he is sitting there in his own thoughts and not really participating. Or it may be dramatic. One goes from shopping and lunch with friends on Tuesdays for years and then, she stops doing that.

Vague physical complaints of aches and pains. “People go to a doctor who consistently runs every test but yet cannot find a reason for the pain,” Florio said. This not only leads to anxiety and negative thinking, but depression can magnify aches and pains. “We cannot separate our brain from our body – what happens in brain affects how the body works, and what happens to the body affects how the brain works,” Florio said.

Feelings of worthlessness. Though everyone looks back on their lives, some look back and feel guilty about how they behaved or what decisions they made. Someone may feel worthless and say “Why am I still here? I have nothing to offer anybody.” A person might have recurring thoughts and talk about speeding up process of death – that is a passive suicidal thought.

What could trigger depression?

Many things can affect us:
• A decline in physical health is a big reason. We can feel worthless and helpless feeling if our physical health isn’t good.
• For many seniors, social isolation occurs. It can be due to health, but hearing or vision problems can isolate anyone – even in a crowd.
• Hormonal changes can cause depressed moods.
• The increase the use of alcohol and drugs.
• Some medications have side effects that lead to depression.
• And as we age, we lose people we love. Grief can evolve into a clinical depression if not dealt with through its stages.
• Family history of depression can play a role, also.

Anxiety

Then, the longer they have the blues, anxiety can creep in.

For each person, it is different. Anxiety is the feeling of fear, worry, apprehension or dread when it’s disproportionate to the event. For example, a job interview or planning a wedding can cause anxiety. That is normal and positive anxiety.

But negative anxiety causes someone to be almost paralyzed from his thoughts. He cannot more forward due to fear or worry. “It is excessive,” Florio said.

Symptoms in older person can show as uncontrollably worry, she said. For example, a person’s child lives across town. She is so worried that the adult child isn’t going to get home ok. She calls repeatedly until she knows they are home and safe.

Anxiety causes physical symptoms, such as fatigue, irritability, restlessness, sleep disturbances and difficulty concentrating on things. These can be a sign of other problems, too, so sometimes, it gets blamed on other things.

“Anxiety is a natural alarm system in your body,” Florio said. “Our alarm system is set for fight, flight, flee or protect.”

Anxiety can also cause isolation. If the fear is of falling – even if you know you are safe, you may not go out or may be upset when you do.

There is help.

Patients can find help in psychotherapy or counseling, Florio said. It helps people cope with the feelings they have and helps change behavior patterns that contribute to depression.

There are medications that can help balance the chemicals in the brain. Within 2-8 weeks, they start working, and in 3-4 months, one can show significant improvement.

“At Penn Highlands Healthcare, we have a wonderful program to help older folks with anxiety, depression and other problems,” Florio said.

There are outpatient services to offer counseling and visits with physicians for medications, if needed, at Penn Highlands Clearfield, Penn Highlands Brookville and Penn Highlands DuBois. Inpatient units for those 55 and older are available for those who need care for an extended time frame. They are located at Penn Highlands Brookville, Penn Highlands Clearfield and Penn Highlands Elk.

Then, brand new to the region, is the Outpatient Group Therapy Program at Penn Highlands Brookville Behavioral Health Center. “The reason we started this new outpatient group therapy was to work with folks with anxiety and panic disorders, unresolved grief, confusion and memory loss related to depression and adjustment to life changes,” Florio said.

On scheduled days from 9 a.m. to 1:30 p.m. at least once a week, patients gather together with Jeanne Drayer, licensed clinical social worker.

“Group is different than individual therapy,” Florio said. “It makes people realize they are not alone. Jeanne will guide members of the group to help them with issues. Everyone has a goal about what they want to work on chosen by them and they therapist. They also have social interaction and time for recreational therapy.” Recreational therapy is led by Tia Forrest, facilitator.

PH Brookville also provides transportation within a 20-25 mile radius of Brookville to the sessions. One must be age 60 and older, but some younger patients are taken on case by case as appropriate. “The group should be cohesive and similar by age,” Florio said.

Confidentiality agreements are signed by all, and there are rules for the group too.

For more information about Outpatient Group Therapy, call 814-849-1396.