2004-05-12 / Health & Wellness

Dialogue with doctor can help late-life depression

Disturbances in normal eating and sleeping routines are warning signs of depression in older adults, according to Dr. Nitin Nanda, medical director at St. John’s Geriatric Center of St. John’s Regional Medical Center, and these disturbances can swing either way (causing too much or too little food or sleep).

People may get insufficient sleep because of difficulties falling asleep, staying asleep or waking up too early. Or they may oversleep, even unable to get out of bed in the morning. Their appetite may also wax or wane, resulting in either weight gain or weight loss. Energy levels typically drop, leaving them feeling tired, empty and drained.

"Any changes in your sleeping, eating, or energy level should be reported to your doctor," Nanda said. "It’s an easy way to protect yourself from a serious, treatable illness."

Commonly, patients—especially older adults—have difficulty telling their doctors about the emotional symptoms of depression such as sadness, helplessness, hopelessness and worthlessness. Even the cognitive symptoms make some people uncomfortable: difficulty in concentrating, recalling things, making decisions, or being preoccupied with death or dying. Reporting the physical changes is the easiest way to begin dialogue with primary care providers about depression.

Researchers estimate that 8 to 20 percent of the community’s older adults experience mild to severe symptoms of depression, and these rates almost double for those in medical settings. Yet the majority of those experiencing symptoms of depression will never be diagnosed or treated. One study found that just one in 10 older adults received proper care for this treatable but potentially lethal disease.

"There are many reasons why individuals over age 65 aren’t getting the care they need for depression," Nanda said. "Some older adults still harbor outdated misconceptions about mental illness—they blame themselves, feel ashamed and silently endure the pain of a treatable illness. Other times, the illness is masked by a co-occurring illness and mistakenly viewed as a symptom or side effect of something else."

  Adults over age 65 have the highest suicide rate of any age group. The rates for those over age 85 are double the overall national rate. Depression is a leading cause of suicide in individuals of all ages.

  According to Nanda, even though depression can be more medically complex in late life, treatment success rates are high. Between 60 and 80 percent of older adults experience relief from symptoms with proper care.

The positive outcome of treatment is critical compared to the potential consequences of the illness. Effective treatment, which is usually some combination of medication and counseling, helps normalize appetite, sleep and energy levels, improves mood and outlook, and increases concentration.

For more information about late-life depression, please call St. John’s Geriatric Center at (805) 988-2604.

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