What triggers depression in the elderly?
DEPRESSION manifests differently in the elderly than it does in other people. There is no known reason for this.
Datuk Dr Andrew Mohanraj, deputy president of the Malaysian Mental Health Association, says, “It is postulated that in the elderly there is a little bit of reluctance in actually talking about depression or even admitting the fact that they are depressed because after all they have done so well all their lives, they have educated their children, brought them up till they are financially well off and independent.
“At that stage of their life when they have sort of completed all their tasks in life, it would be very difficult for them to admit that they are depressed because it would be seen as a sign of weakness.”
There are many events in life that can trigger depression in the elderly.
Among them are:
Dr Mohanraj says the loss of independence after retirement can trigger depression.
“They might have had a very important position while working in their professional career. They would have been used to having people around them all the time and after retirement they might find themselves feeling lonely.
“Others may look at it and say this is the time to do things and achieve whatever you wanted to in life but never had the time for. But they are so used to having power and people surrounding them that they suddenly fall into depression,” says Dr Mohanraj.
According to him, post-retirement depression is quite common and it is seen more in people who have held senior positions during their professional career.
He says that women seem to handle retirement a bit better because they would have played a key role at home all along and are not at a loss when they no longer have to go to the office daily.
No significant role to play
When the elderly have retired and feel like they no longer serve a key role in the family, they can be prone to depression. “Sometimes they might be isolated by their families, simply because we no longer have the extended family as more and more nuclear families are seen, which means the elderly do not have a significant role to play in the family itself. That also causes them to feel lonely. In addition, they feel worthless because they are unable to contribute,” explains Dr Mohanraj.
A big depression trigger is the loss of their spouse, more so if they depended on their spouse for everything – not just companionship, but also to make everyday decisions and to take care of certain chores around the house and the banking.
Illness and disability
Living longer is not necessarily a boon as it often comes with diseases, illnesses, disability and mental problems. “Because people are living longer, they are going to live their lives saddled with physical problems like disability or having illnesses like cancer, for example. Many would have had a cardiovascular problem or a heart attack previously, or they would have diabetes.
“All of this would have a psychological impact on them because they feel like they are already disabled in a way by these illnesses. They have to go to the hospital regularly, some may have had an amputation as a result of diabetes. Others would have some form of debilitation as a result of these physical illnesses,” says Dr Mohanraj.
According to him, it has been proven that 50% or more of people who are recovering from stroke will have depression.
Those with dementia can also have depression.
Most of the elderly would have a lot of medication and health supplements that they take on a daily basis. The result of having to take so many pills can be depressing. In addition, the chemicals in the medications when taken over a prolonged period of time, can also result in low mood, or even a full-scale depression.
“Statin (prescribed for those with heart problems) has a strong tendency to cause depression as well. Prolonged use of steroids can also contribute to depression,” says Dr Mohanraj.
In a society that is rapidly ageing, aged care needs should be looked into. If they are not, many of the elderly will be neglected and some might even be “dumped” at nursing homes and care centres.
Being isolated and neglected by their family can also lead to depression, and this can worsen when they are forced to live in a new place where they don’t know anyone and don’t receive enough necessary care and attention.
“The elderly people would feel unwanted by the families and at the nursing home, if they are neglected or worse, abused, they would sink further into depression,” says Dr Mohanraj.
The elderly who are isolated from family and friends and don’t have anyone to talk to regularly are also prone to depression.
Living longer means they would need more money to spend on their post-retirement life and later years care.
“They might retire at 55 and then live on for another 30-40 years in a post-retirement state. That’s actually very frightening for a lot of people who start wondering if they will be able to manage financially for that long. The elderly people can also be subjected to financial scams.
“Also, you’re saddled with illness, and if you don’t have proper insurance coverage, how are you going to manage tackling all these kinds of complications? So, there will be a tendency, a temptation, particularly for those who have just retired or are about to retire to put their money in some schemes that will promise them all sorts of things. If they are not careful, people will take advantage of them,” says Dr Mohanraj.
He advises those reaching retirement age to make plans and have a proper financial plan so that they will have enough after retirement.
It is a common scenario for adult children to tell their elderly parents to pack up and move in with them. It sounds like a win-win situation. The elderly parents can look after their grandchildren, and the adult children can keep an eye on their elderly parents. But just moving out of their homes, where they have spent many years surrounded by familiar neighbours, shops and roads, to move in with their children in an unfamiliar place is not easy, nor is it a happy event for the elderly.
“You think it’s as simple as that? They move to KL and then develop depression in KL. And then you wonder why? You have provided a nice house, the whole morning till night they can watch Astro, there’s a helper who can make food for them, and there’s a garden and a pond. So, why are they feeling depressed?
“They’ve moved from a place they’ve lived all their lives or half their lives to a totally new place,” says Dr Mohanraj.
There are many factors and events that can cause depression in the elderly.
Apart from the family members, Dr Mohanraj says healthcare providers also need to be aware of the signs and symptoms.
“Every medical doctor, every pharmacist, every nurse, everyone related in the health industry should increase their knowledge a bit and become more aware of the mental health issues, particularly in psychosocial complaints, because the elderly population will not present to you with typical symptoms of depression.
“If we all have some knowledge about this, it will be good, as far as healthcare providers are concerned, as we will be able to spot it and offer help.”