Treatment Considerations for the Elderly

Treatment considerations - Increasing engagement to help with depression

The treatment of depression in later life is often complicated by many other factors. These include difficult life situations, loneliness and medical complications, among others. Treatment considerations must therefore include a thorough assessment and plan to take these into account. 

Everyone is unique and complex

Ageing is a time of change for many, and with these changes come a unique set of challenges and stress. Each of these factors must be evaluated and targeted, in order for treatment to have its best effect.

Role change/loss

For some, there may be a sudden change in their role in the family – for example, from being the primary breadwinner to being a dependent, following a major health crisis like a stroke or fall.

Grief

Some of their friends can also start to succumb to ailments and pass on. Apart from the grief and realisation of their own mortality, these losses also worsen the sense of loneliness in some elderly.

Health, financial, relationship worries

As we become increasingly burdened with disease and its associated costs, this is a frequent source of worry and stress for the elderly. There may also be underlying worries about their own family, for example worries over their children’s well-being.

Multiple medical issues

Almost inevitably, people start to experience more medical issues as they age. Medical problems can contribute to depression in the elderly, either directly or as a psychological reaction to the illness. This is particularly true of conditions that are chronic (long-lasting), disabling, lifestyle-changing or painful. Examples of some conditions include:

  • Parkinson’s disease
  • Renal failure
  • Heart failure 
  • Diabetes
  • Cancer
  • Stroke
  • Severe vitamin B deficiency 
  • Thyroid problems 

Potential for drug interactions

Multiple medications and polypharmacy impact on treatment considerations in the elderly

Likewise, as the number of medical conditions increase, many elderly find themselves having to take multiple medications each day. There may be just 1 or 2 medications for each condition, but bit by bit, these all add up.

As an integral part of treatment consideration for elderly depression, it is therefore important that all of these medications be looked at. Some could result in additive side effects, for example, or even influence the way drugs are processed by the body. It is best to bring along a list of all medications and supplements during a consult,

Helping depressed elderly loved ones

Listen – even if it is just silence initially

Just being there for them is important, even if they may not feel like talking very much. Start with more neutral topics to chat about; or if they prefer to start the conversation, just spend the time listening. Don’t worry about having a “right response” or even having to give advise – just listen, and show that you care.

Start on physical activities 

There is often a vicious cycle of poor motivation leading to worsened mood, and vice versa. It is important to start with small achievable activities – even if it means just a 5-minute walk outside of the home. Help them along with genuine praise and encouragement. Gradually, move on to other activities that they used to enjoy.

Arrange social activities

Short group outings, visits from friends and family, or activities at  community centers for example can help decrease social isolation. It is often useful to have the company of someone close during these activities, to help with feelings of insecurity or fear. 

Treatment considerations - increasing outdoor activities to improve symptoms of depression

Encourage keeping to treatment and reviews

It is important that your loved one should seek medical help as soon as possible, especially to address some of the medical complexities discussed above. Even then, it may be difficult for them to have the motivation to continue treatment or reviews. Help by encouraging them to keep to the prescribed treatment, and point out improvements along the way as encouragement.

Help with medications

The elderly often have to grapple with multiple medications at various times of the day. Speak to the treating doctor to discuss any existing medications or supplements that your loved one may be taking, and inquire about potential interactions. Sometimes, the treating doctor or psychiatrist could also simplify the medication regime. It is also very useful to remind your loved one to take their medications correctly and in a timely manner.

Monitor risks

Seek immediate professional help if you suspect that your loved one is thinking about suicide. Accompany him or her to the nearest emergency department of any large hospital to seek medical help, or engage the emergency services if there are impending risks. At no time should your loved one be left alone, unaccompanied.