HanyAbdelaal,DO
PresidentVNSNYCHOICEHealthPlansatVisitingNurseServiceofNY,andaleadinghealthcareexpertfocusedonelderindependence.
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CombattingLate-LifeDepression,System-WideandOneLovedOneataTime
Posted:12/28/20152:11pmESTUpdated:53minutesago
WhenJaniceT.camefromMinnesotatoNewYorktovisither82-year-oldmotherfortheholidays,shefoundthe
apartment'sshadesdrawnandhermotherstillinabathrobeat3p.m.Janicewasnotsurprised.Herfatherhaddiedtwo
yearsago,andmanyofhermother'sfriendshadeitherpassedawayormovedtoFlorida.Sheknewhermotherwaslonely.
Sinceshelived1,200milesawayandcouldonlyvisiteveryfewmonths,Janicewasnotsurewhathermotherdidallday.
Sheusedtolovecookingandbaking,butnowwithdiabetesandhypertension--andnofamilyaroundtocookfor--Mrs.T.
saidshehadlostinterestinfood.Aretiredschoolteacherandlifelongreader,hermotherhadcataractsandsaidshehadn't
pickedupabookornewspaperinmonths.
Janicethoughthermother'sdepressivesymptomsmustbeanormalpartofaging,untilachanceconversationwitha
visitingnurseinthebuildingledhertoexploretheconditionfurther.It'simportanttonotethatlate-lifedepression,while
notuncommon,isnotsimplyanaturaloutgrowthofagingoranormalreactiontochronicillness,limitedmobilityandloss.
Rather,depressionisdiagnosableand,moreimportantly,treatable.
TheNationalAllianceonMentalIllness(NAMI)estimatesthatdepressionaffectsmorethan6.5millionofthe35million
Americansaged65yearsormore.Forthosewhoarehomebound,theprevalenceisevengreater,from13.5percenttoas
highas46percentofthatpopulation.Thegoodnewsisthat80percentofclinicallydepressedindividualscanbeeffectively
treated,includingbymedicationandpsychotherapy,accordingtoNAMI.
"There'sadifferencebetween'Thingsaren'tasniceasI'dlikethemtobe,'and'I'mclinicallydepressed,'"explainsKathleen
Wolfe,LCSW,directorofsocialworkandbehavioralhealthatmyorganization,VNSNYCHOICEHealthPlans."It'simportant
forolderpeopletoknow:Youdon'thavetofeelthisway.Depressioncanhappenatanyage,andtherearemostcertainly
waystotreatit,pharmacologicallyandbehaviorally.Themostimportantthingstodoareunderstandit,giveoptions,offer
connectionsandinstillhope."
KathleenischargedwithinfusingbehavioralhealthstrategiesacrossVNSNYCHOICE,includingworkingwithprimarycare
physicianstoexploresuchissuesasdepressionandanxietywiththeirolderpatients.Oneinnovativeserviceavailableto
membersofourFullyIntegratedDualsAdvantageprogram,orFIDA,isengagementwithpeerspecialists,carefullytrained
individualswhohavelivedwithandovercomementalillnessthemselvesandcansharecopingstrategiesandresources.
"Theyhaveasharedexperience,"notesKathleen,"andtheysendapowerfulmessageofhope."
Recognizingthatisolation,depression,andanxiety--ifunaddressed--createadownwardspiralofhealththatexactsa
financialandhumantoll,wemustcontinuetocreateservicesforthehomeboundelderlythataddresstheirmentalaswell
asphysicalneeds.
Onanindividuallevel,Kathleennotesthattheholidaysareagoodtimetocheckinwithelderlyfriendsandrelatives,and
begintheconversationifyounoticesignsoflate-lifedepression,whichinclude:
•Feelingsofhopelessnessorpessimism
•Fatigueanddecreasedenergy
•Difficultyconcentrating,rememberingdetailsandmakingdecisions
•Insomniaorexcessivesleeping
•Overeatingorappetiteloss
•Persistentachesorpainsthatdonotgetbetter,evenwithtreatment
Kathleenencourageslovedones,aswellasprimarycarephysicians,toasktwokeyquestionsiftheysuspectdepression:1)
Areyoufeelingdown,depressedorhopeless?2)Haveyoulostinterestinthingsyouoncefoundpleasurable?A"yes"
answertoeithershouldpromptanexplorationofdepression."Ibelieveinaskingdirectquestions,"saysKathleen."Itopens
theconversation."
Shealsosuggestsaskingyourlovedonetodescribeatypicalday."Whendoesyourmothergetoutofbed?"shesays,by
wayofexample."Doesshegetoutside?Doessheseeanyone?Isthereanythingshelooksforwardtoduringtheday?"
Ifyoucontinuetosuspectdepression,takeaction,including:
• Scheduleanappointmentwiththeprimarycarephysician(PCP).Don'tsimplysuggestthatthelovedonegotothe
doctor,becauseinabilitytofollowthroughisasymptomofdepression.Maketheappointmentyourselfand, if
possible,accompanyyourparent.
• RevisitmedicationswiththePCP.Certainmedicalconditionsandmedicationscancontributetodepression,so
makesurethatyourlovedoneistakingonlythemedicationheorsheneeds.Depressioncanbeasideeffectof
medicationstotreathypertension,andconditionssuchasheartattack,stroke,hipfractureormacular
degenerationareknowntobeassociatedwiththedevelopmentofdepression.Inaddition,makesureall
medicationsarebeingtakencorrectly.Askyourlovedonetodescribewhenandhowshetakesthemedications,
andcheckthisagainsttheprescribedinstructions.
• Callyourlovedone'sinsurertoseewhatthebehavioralhealthbenefitsinclude.Ifit'shardforyourlovedontoget
out,explorethepossibilityofin-hometherapy."Weemphasizetoourmembersthatwhiledepressionmightbe
newforyou,it'snotnewforus,"saysKathleen."Ifyou'refeelingdepressed,wecanexplorewaystotreatit,
includingright inyourhome."
• Schedulephysicalactivity.Ifyoutakeyourmothershopping,don'tdropheroffatthedoor.Ifshecanwalk,have
hertakethosefewextrastepswithyou.Activitygoesalongwayagainstdepression,includinghelpingimprove
sleep.
• Createopportunitiesforsocialactivity,andfollowthrough."Weare,likeitornot,socialbeings,"saysKathleen.In
fact,arecentstudybyUniversityofChicagoresearchersfoundthatextremelonelinesscanincreaseanolder
person'schancesofprematuredeathby14percent.Youcanstartsmall,withadailywalktotheapartmentlobby.
Alsoexplorevisitstonearbyadultandsocialdayfacilities,whichoffer arangeofsocial,culturalandhealth
activities,includingyoga,nutrition,artsclassesandevensomebehavioralhealthservices.
• Askwhatactivitiesbringpleasure.Iftheansweris,"Nothing,"explorefurther.Revisitpasthobbies,andseehow
yourlovedonemightreturntothem.Large-printbooksorbooksontapearegoodalternativesforabooklover
whoseeyesightisfailing.Ifyour80-somethingfatherlovedbigbandmusic,getholdofaniPodandcreateplaylists
ofhisfavoritegenres.Can aphotographypassionberesurrectedwithaniPador asmartphone?
"Rememberthatthisisapopulationthatgrewupinaculturethatdidn'trecognizeandcertainlydidn'ttalkabout
depression,"notesKathleen."Someofthemdon'treallybelievementalillnessexists.Itdoesexist,it'sreal,butthegood
newsisthatit'streatable.Theroadtohopebeginswithawareness."
In afuturecolumn,I'llexplorehowtorecognizethedifferencesbetweenlate-lifedepressionanddementia,aswellas
betweendepressionandnormalbereavement.