Paru le jeudi 2 octobre 2008 sur The Globe and mail
Over 65 and living with depression
Article Comments (1) ANDRE PICARD
From Thursday's Globe and Mail
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October 2, 2008 at 9:41 AM EDT
Seniors are healthier, more affluent, more independent and living longer than ever before.
The vast majority of the 4.3 million Canadians over the age of 65 are active, engaged participants in family and community life, and many are international globetrotters.
We do our elders a great disservice by clinging to stereotypes of them as a burdensome army of aging, sickly patients with bad hearts, cancerous tumours, weakening bones, bothersome bladders and faltering memories.
There is no denying that with aging comes health challenges. But most seniors live their lives with vim and vigour, and even those with chronic health conditions tend to manage them well. It helps that there are an increasing number of specialized treatment programs and advocacy groups for everything from Alzheimer's disease to herpes zoster (shingles).
Breakdown: Canada's mental health crisis
Yet there is one glaring exception: Far too many seniors struggling with mental illness remain isolated, lonely and disabled. And according to new research released this week, most aren't getting the help they need.
About one in five people over the age of 65 living in the community suffer from diagnosable mental illnesses such as depression, bipolar disorder or schizophrenia - about the same rate as the general population.
But the data exclude residents of nursing homes, retirement homes and long-term-care facilities, where rates of mental illness range from 40 to 90 per cent.
The numbers can also be deceiving. While the rates of mental illness may be comparable, living with depression as a 35-year-old man with a full-time job and a family is not at all the same as living with depression as an 80-year-old woman whose husband of 60 years just died and whose children live two time zones away.
Reaching out for help when you are depressed is difficult at the best of times, but seniors face additional barriers.
Chief among them is the myth of the "sad old lady."
Family members and health professionals too often have an attitude that is summarized as follows: "She's getting older, of course she's depressed."
Depression is a scourge among seniors, but one that is rarely spoken of, too often overlooked, and grossly undertreated.
But depression is no more normal for a 75-year-old than for a 25-year-old. Nor is it part of the natural process of aging.
There are, however, biological changes that make depression more likely. Levels of brain chemicals and hormonal balances shift as we age. Many illnesses, including Alzheimer's disease, congestive heart failure and chronic obstructive pulmonary disease, are associated with higher rates of depression. The condition can also be triggered and exacerbated by medications.
Then there are the feelings of sadness that come from losing friends and one's abilities, and the powerlessness and marginalization that too often accompany old age.
But sadness is not depression. Depression is something more profound, an overwhelming anguish of the soul, a physically and mentally debilitating brain disease.
Depression can and should be treated regardless of a person's age.
The greatest barrier to treatment is not biology, it is sociology. The prejudices we have about older people and people who suffer from mental illness are pervasive and powerful, and they can make for a debilitating double whammy for an older person who is depressed.
To begin with, the identification of depression in seniors can be complicated.
People of a certain age - to generalize - tend to be reticent to talk about their emotions. They are also burdened by stigma, having been raised in an era when depression and other mental illnesses were seen as signs of weakness or moral failure.
For health professionals, it can be a real challenge to diagnose depression in patients who do not necessarily articulate their feelings.
Research shows that seniors, when they are depressed, will identify their symptoms as listlessness, trouble sleeping, lack of appetite, and vague neck and back pain rather than speak of feelings of hopelessness and helplessness.
Depression can also be overlooked as a symptom of another medical condition. And there can be a reluctance to treat, particularly with antidepressants, for fear of interactions with other drugs used to treat conditions perceived as more serious, such as high blood pressure or arthritis.
The combination of these factors results in some pretty dismal treatment numbers.
New research, published in this week's edition of the Canadian Journal of Psychiatry, shows that fewer than 20 per cent of seniors with depression are being treated for the condition. Older patients are also more likely than younger ones to abandon their medication for a host of reasons, including interactions with other drugs.
The consequences of untreated mental illness can be grave at any age. Seniors are no exception.
Just because Granny and Gramps are stoic does not mean they are not suffering horribly.
As many as one in five seniors who suffer from depression commit suicide. In fact, the group with the highest suicide rate per capita in Canada is men over the age of 80.
We should not abandon people to mental illness because they are older. The retirement years should be golden, not blue.
Detecting depression in the elderly
A simple checklist has been specially developed to detect depression in the elderly. Subjects are asked to describe how they felt over the past week. Answers indicating depression are in the bolder type.
Each answer counts as one. A score from 5 to 9 indicates a strong possibility of depression, while a score of 10 is almost always a sign
1. Are you basically satisfied with your life? Yes No
2. Have you dropped many of your activities and interests? Yes No
3. Do you feel that your life is empty? Yes No
4. Do you often get bored? Yes No
5. Are you in good spirits most of the time? Yes No
6. Are you afraid that something bad is going to happen to you? Yes No
7. Do you feel happy most of the time? Yes No
8. Do you often feel helpless? Yes No
9. Do you prefer to stay at home rather
than going out and doing new things? Yes No
10. Do you feel you have more problems with memory than others? Yes No
11. Do you feel it wonderful to be alive now? Yes No
12. Do you feel pretty worthless the way you are now? Yes No
13. Do you feel full of energy? Yes No
14. Do you feel that your situation is hopeless? Yes No
15. Do you think most people are better off than you are? Yes No
SOURCE: CANADIAN NETWORK FOR MOOD AND ANXIETY TREATMENTS