As people go through the different life stages, they experience changes in different aspects, ie physical, emotional or social. The golden years are associated with many changes, and with these changes come a unique set of challenges and stress.
Very often, depression is associated with the losses that one experiences in life. Each of these factors must be evaluated and targeted, in order for treatment to have its best effect. As elderly do not share about their feelings as freely as the younger generation, it is important to understand the different losses they experience and their significance.
Genetic risk factors
A family history of depression may predispose one to developing depression. However, the genetic contribution to depression is not straightforward – i.e. if your parents both had depression, it does not mean that you will develop depression. The onset of depression is also influenced by many other factors, such as life events, stress, social isolation and medical conditions, for example.
Role change/loss
Men and women traditionally play different roles in the family. Men are the breadwinner of the family, and as the enter retirement, the loss of this role do affect them in a significant way. For some, a major health crisis like a stroke or a fall might result in them being physically and financially dependent on their family instead. This loss of role in the family and role reversal has a significant impact on the elderly’s mental health.
Grief
Some of their friends or loved ones 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. In addition, grief in later life can also take the form of loss of roles as described above.
Especially in the context of the loss of loved ones or a traumatic life event, the symptoms of grief can often resemble that of depression. It is, however, a risk factor to developing depression especially if the initial grief is not well taken care of, or if the elderly is not adequately supported emotionally.
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.
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
Cultural Factors
Commonly, the elderly do not share their worries and feelings as freely as younger people do. This may be due to cultural upbringing, their own personality, or even feelings of embarrassment.
Being able to share about our own feelings and getting emotional support is a powerful way to feel better. On the other hand, social isolation and loneliness increases the risks of developing depression.
Health conditions that may contribute directly
Other than worrying about worsening health issues, there are also medical conditions that contribute directly to depressed mood. Very often, mood problems associated with these conditions improve over time as the underlying condition is treated.
Examples include:
- stroke
- severe vitamin B deficiency
- hypothyroidism (low thyroid hormone levels)
Less commonly, some medications can also contribute to depressed mood in the elderly. Some examples are drugs used for Parkinson’s disease, beta blockers for high blood pressure, and oral steroids.
It is important to rule out any other causes of low mood, including both medical and psychological/social contributions, before attributing depressed mood to medications. More importantly, do not stop prescribed medications on your own without consulting and discussing with your treating doctor.
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