Elderly Depression Symptoms and Suicide Prevention: Introduction
The most severe depression symptoms among the elderly are often easily recognized by others. However, it is usually much more difficult to distinguish the milder forms of depression from the normal emotional reactions to sadness and grief in everyday life. Depression symptoms among the elderly are not different in many ways from the depressive symptoms experienced by the younger age groups. Major depressive disorder is the most severe form of depression, followed by dysthymia which is milder, grief and atypical depression.
Mental health disorders are very different from medical conditions in that there are no biological markers to objectively identify their existence or severity. There are no laboratory changes or tissue abnormalities that can be used to identify and diagnose depressive disorders among the elderly.
The system used by psychologists, psychiatrists and other mental health clinicians to diagnose specific mental disorders is referred as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders Fifth Edition). The symptoms for a major depressive episode from the DSM-5 follow below.
Major Depressive Episode Symptoms:
A person may be suffering from a major depressive episode if they are experiencing a persistently low mood and/or loss of interest in normal activities continually for two weeks or more and five of the following symptoms. The symptoms must also differ from the individuals normal functioning and include:
• Low mood;
• lack of interest in daily activities;
• a significant change in appetite or weight gain:
• sleep disturbance, either insomnia or hypersomnia nearly every day;
• psychomotor agitation or retardation;
• loss of energy or fatigue;
• excessive or inappropriate guilt;
• reduced ability to concentrate;
• frequent suicidal thoughts or ideation.
A diagnosis of major depressive episode is the same for the elderly as for other age groups. The diagnosis is usually more certain when there is an apparent family history of prior episodes of depression or mania, or when there are precipitating factors such as the use of medications that are known to cause depression or the experience of a recent stroke.
Additional symptoms related to depression include delusions and disorganized thinking. Also, seniors will frequently have disturbances in cognition and bodily functions such as having constipation and a decreased sex drive.
Major depressive episodes may be mild, moderate or severe and are defined as “single episode” or “recurrent”. In the milder episodes there is very little change in daily functioning or functional impairment, and it may not be easily apparent whether a depressive episode is present. Severe major depressive episodes are distinguished by various debilitating symptoms including a significant decline in mood and interference with an individual’s social and job-related responsibilities. Severe depression can make it difficult to function in every aspect of an individual’s life including socializing, working and even getting out of bed in the morning. It can even become disabling to the point of being unable to feed and dress themselves and maintain normal hygiene.
Suicide Among the Elderly:
A major complicating factor associated with depression is suicide. It is the 11th leading cause of death in the United States with one out of every 16 people diagnosed with depression dying from suicide. Two thirds of people who die from suicide are depressed. Individuals most at risk for suicide in the United States are elderly white males who live alone, along with those who make prior attempts, individuals who abuse alcohol or drugs and/or refuse psychiatric evaluation and treatment. Although women attempt suicide 3 to 4 times the rate of males, men are actually 3 to 4 times more likely to be successful in their attempts.
An unfortunate factor associated with suicide is that possibly up to three quarters of people who die from suicide have visited the medical doctor in the prior month. This may indicate that they may have known something was wrong at the time, but they or their doctor did not identify or feel it was necessary to treat an existing depression. While it is not possible to accurately predict who will attempt suicide, there are warning signs that a depressed person may make an attempt. In many cases family and friends are unaware of the warning signs or the severity of the symptoms until it is too late.
Suicide Prevention Among the Elderly:
The most important step in preventing suicide among the elderly is to recognize risk factors and warning signs, and to take preventative steps to get appropriate evaluation and treatment by a trained mental health clinician. The basic signs include:
• A family history of suicide or previous attempts;
• verbal threats or statements about a desire to die;
• acquiring the means such as purchasing a gun;
• neglecting an individual’s home, pets or finances;
• personality changes and drastic changes in mood;
• self-imposed social isolation;
• frequent use of drugs or alcohol;
• putting an individual’s affairs in order and giving away important belongings;
• suddenly being cheerful or calm following a period of depression
• exaggerated complaints of pain or aching.
It is important to understand that many people have some or several of these symptoms but are not suicidal. Also, not all people who commit suicide have these risk factors.
Elderly Depression Symptoms and Suicide Prevention Conclusion:
It is very important to understand that the elderly may be just as susceptible to depression as younger people. The symptoms are about the same along with the relevant treatment which usually includes psychotherapy and/or depression medications. Treatment is equally successful as well. Suicide prevention is also very important to consider among the elderly, with the highest risk among elderly white males. Always take depression symptoms of the elderly seriously rather than considering them as a natural byproduct of getting older, being in a nursing home or having increased physical illness. Recommend them to a qualified psychologist, psychiatrist or other mental health clinician who has experience working with seniors in the community.
By Paul Susic Ph.D. Licensed Psychologist
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