Winter: Greys, Whites, and BLUES.

We’ve been spoiled. It’s January, and the weather is in the high 40’s, birds are singing, and there are no snow bankings. Can it last? Sadly, no. If our friendly Meteorologists are right, flakes may fly before this article goes to print. It’s not just the snow and ice that get us down, but it’s also the grey sky, the cold, the darkness, and all that comes with it. There are the underfoot concerns and slippery contributions to falls, our ultimate foe. There is an impact, even if our elder is mostly staying in the house during bad weather and times of slippery surfaces.

Our sunset is creeping forward, minutes at a time, but by and large, by 5:00 pm it’s very dark. Our days of sunshine are few and far between. The feeling of being housebound and the cumulative effect of these factors can contribute to elder depression.

Causes of Depressive Episodes

  • Times of year when anniversaries fall: wedding, birthday, traumatic events, and deaths

  • New losses that trigger deep pain

  • Worsening of health status or new diagnosis

  • A loss of independence. Needing to: relinquish driving, receive professional help, etc.

  • Relocation to alternate housing: Assisted Living, family member’s home, or Nursing Facility

Enlist the Help of a Health Care Professional

Your loved one will receive a depression screening at their annual Primary Care visit; however, they may or may not answer it honestly. I was just at an appointment with an elder relative for whom I have responsibility. The questionnaire to screen for depression was given out at the onset of our appointment. I was delighted to see this, as it was one of the reasons I had made the appointment. During the screening, my elder loved one was not at all insightful about her mood or behavior. She did not see her current mood in the same way I do. Fortunately, since I was present as a nurse, a family member, and as her Health Care Proxy, I was able to intervene and share my observations.

Dramatic behaviors indicating depression will hopefully get the attention of the medical community and family, but the subtle, under the radar expressions of depressive feelings may be more difficult to detect. You, as the loved one, are in the best position to identify and determine if you see one, or many, of the following symptoms. Keep your eyes WIDE open, use your skills of observation, and bring this vitally important information to your loved one’s medical provider.

Remember: YOU know your loved one best. If you suspect that there is an element of depression present, you may need to be an “advocate supreme” when visiting their health care provider, to ensure that these concerns receive the attention they deserve.

Overt Signs That Your Loved Ones May Be Experiencing Depression

  • Sleeping more or having difficulty sleeping

  • Decreased appetite and or weight loss

  • A decline in hygiene habits

  • An unkempt home environment that is new

  • Refusal of offers to go out or have visitors

  • Tearfulness, flat affect, or withdrawn behaviors

  • Expressing feelings of being a burden to others

Any of these symptoms, if extreme, will likely get your attention. Mental Health care in our current system is lacking. It is one of the most under met needs of the general population, regardless of age. You, as the reader, know that mental health concerns in our youth population are increasing at an alarming rate and continue to climb. The same is true in our elder community, but often these diagnoses go undetected and worst: untreated.

Get Some Support

While our elders may not be enthusiastic about talk therapy, these services are offered in ways that do not feel like the traditional “shrink” sessions. Casual conversations, life review, and acknowledging the many losses that our elders have experienced in their lives, can be a balm to a wound. The pain may not ever be erased but helping validate it in a caring and supportive environment can promote healing and relieve the sense of carrying the burden alone.

Groups that specifically focus on grief and loss may be a “turn off” for your elder loved one. However, those who have participated often find a new friend group, meaningful and beneficial support as they navigate old pains or new unchartered painful issues, and a “safe space” to share feelings within a peer group that they may not feel comfortable doing with family.

Can Medication Help?

There are times that medication is helpful. There are options in the category of “anti-depressants” that are very effective. Dosing and the particular medication choice will be a discussion you want to participate in with your prescriber. These are not “crazy pills” and should not carry a stigma. If your loved one had a cardiac condition, you probably would not balk at medication that was suggested by a Cardiologist. Should you wish to consult an expert in the field of Mental Health, rather than have a general practitioner prescribe an anti-depressant for your elder, ask your clinician for a referral. There are medical practices on the North Shore that are specific to mental health concerns, and you may wish to take advantage of that expertise. You may have complete confidence in a suggestion made by your loved one’s PCP, and in addition, you may wish to consult trusted others as you consider this option. You may find that these medications are used more than you realized and have worthwhile benefits.

It Takes a Village

You know the interventions that are helpful, but it’s sometimes hard to “pull this off” on your own. In Manchester and surrounding communities, we have outstanding resources in our Councils on Aging and Senior Centers. If you don’t know where to start, making that phone call is the perfect first step.

What Can You Do To Help?

  • Keep active socially. Use town transportation options if no longer driving.

  • Put lights on timers; this eases the transition from day to night.

  • Make regular telephone check-ins.

  • Assess your senior’s mood; always better done in person than on the phone.

  • Look at clothing, cleanliness, and appropriateness of wardrobe.

  • Watch their affect: such as, facial expressions, lift in voice, smiling, and responsiveness to engagement.

  • Evaluate the movement of food from the refrigerator.

  • Ask the tough questions:

    • “Are you sad? More than before?”
    • “Do you know why? Can we talk about it?’
    • “You are not alone. Let’s see what we can do to help.”

Destigmatize Depression

Knowing that you care and are willing to address this personal situation, tells your loved one that their whole self is your concern. It’s challenging to discuss sensitive topics with our loved ones. We are afraid of causing them discomfort, embarrassment, or shame. Although that may be a small piece of what happens temporarily, we are extending ourselves profoundly and authentically to those we love, who need help. Don’t be afraid to peel the onion. Take the plunge. Depression is still stigmatized. Help the elder one you love, leave the darkness and come back into the light.

Written by Joanne MacInnis, RN and Certified Dementia Practitioner.

Originally published in the Manchester Cricket Newspaper, January 2019. 

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