If you or someone you know is at risk of suicide, please call US National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for more information.
Prior to her death, country music icon Naomi Judd had been open about their experiences with mental health issues, especially depression and suicidal thoughts. Although no official cause of death has yet been shared, Judd the girls attributed his death to “the disease of mental illness”.
Judd’s death is a grim reminder that mental health issues can affect anyone – and that some older people may face particularly high risks of developing a mental illness like depression. But there are effective treatments, and sometimes all it takes is an honest conversation to get people the help they need and deserve.
Mental health issues in older adults are common
Depression in the elderly is generally rare, with prevalence rates at or below 5%, Centers for Disaster Control and Prevention estimates. But among those who are hospitalized or need home care, the rate of depression is much higher (between 11.5% and 13.5%), according to the CDC.
This is partly due to the link between health problems and depression; people who have chronic health conditions (such as diabetes, heart disease, or chronic pain) are more likely to have certain mental health conditions as well. Older people tend to have more health problems, with 80% of them suffering from at least one chronic health condition, the CDC explains.
There are a variety of other risk factors older adults may encounter as they transition to this stage of life, said Patrick J. Raue, a professor in the Department of Psychiatry and Behavioral Sciences today. Washington University. This can include the loss of loved ones, limited social contacts and even retirement, Raue said.
As people age, they may also be less able to engage in the healthy coping mechanisms they used to use, such as exercise or socializing. “And COVID has made that even more pronounced,” Raue said. “Social connections are important to all of us. But for an older person who may be a bit isolated and having issues functioning or leaving the house, it can hit those people even harder.”
Recent search found that about 20-30% of adults in the United States reported symptoms of depression and anxiety during the pandemic. And Raue said his research found similar numbers for depression in older people.
There is also a perception that many of these factors are simply part of natural aging, leading people to overlook depression in the elderly, Dr Christine Yu Moutier, chief medical officer at the Foundation, said today. America for Suicide Prevention. “But the truth is, it’s also a treatable disease in the older years. And it can be a fatal disease if left untreated,” she said.
Look for these signs of depression
There are two hallmark signs of depression to watch out for in loved ones: persistent depressed mood and loss of interest or pleasure in things they once enjoyed doing, Dr. Sue Varma, board-certified psychiatrist and clinical assistant professor of psychiatry at NYU Langone Medical Center, TODAY’s Hoda Kotb told TODAY.
Other signs of depression may include changes in appetite or sleep patterns, irritability, difficulty concentrating, and physical symptoms (such as pain or digestive problems) that do not improve even with treatment. according to the CDC.
Suicidal thoughts can be symptoms of depression, Raue said. But it’s important to remember that not everyone with depression experiences these thoughts and there is a range of suicidal ideation. Some people may experience what is called passive suicidal ideation, leading to thoughts of wanting to die or not waking up the next morning without a specific plan to kill themselves. More active suicidal ideation may be accompanied by a plan to die by suicide within the next few days or weeks, Raue explained.
Any suicidal thoughts are concerning and worth reporting to a provider or therapist, but active suicidal thoughts are rare, Raue said. And most people who have suicidal thoughts don’t die by suicide.
“It doesn’t get as much attention in the media, but the truth is, older adults have much higher suicide rates than younger adults,” Moutier said. In fact, adults ages 75 and older have some of the highest suicide rates in the United States, according to AFSP estimates.
Sometimes older people who develop depression have also had episodes of depression before in life, while other older people may experience it for the first time later in life. But doctors can’t use screening tools to look for depression or suicidal ideation in older people, Moutier said. And these patients may be less willing to say they are confronted with these thoughts, unless specifically prompted by their doctor.
“They don’t see it through the prism of a clinically addressable and potentially treatable health condition,” Moutier said.
There are effective treatments
The mainstays of depression treatment are evidence-based therapy techniques and, for some, medication. But to research shows that certain psychotherapy and counseling approaches can be just as effective as medication, Raue said. “It’s really great news because people have all kinds of preferences.”
In particular, a form of cognitive-behavioral therapy called behavioral activation is helpful in older adults. This approach focuses on the link between behaviors and feelings, as well as participation in meaningful activities for each individual.
If formal counseling isn’t right for you, there are other options that can help build connections and reduce the stigma of talking and seeking help for mental health issues in older adults. This could include peer support groups or emerging alternatives, such as the Do more, feel better Raue is developing a program based on a simplified version of behavioral activation. “It helps depressed older adults gradually re-engage in activities that they find meaningful, important, and rewarding,” he explained.
How to start the conversation
There are many myths about depression, Raue said, many of which contribute to stigma that makes it harder for people, especially older people, to seek help. For example, depression is not part of normal aging and you are never too old to seek mental health care.
Also keep in mind that depression is not a character flaw or weakness. “You have to recognize that this is a medical condition,” Varma said. “Nobody does that. People don’t choose to be unhappy.
If an older person in your life is showing signs of depression, you can reach out to them.
- Start by being empathetic and willing to hear what your loved one may be going through, Raue suggested. Varma recommended starting with an open-ended question (simply, “How are you really?”) to get things going. Moutier also suggested asking smaller questions about what’s going on in their lives, such as the quality of their sleep or if they’re still in touch with their old group of friends. “So many times we don’t want to get involved. We’re afraid of interfering or being too nosy,” Varma said. “So we don’t ask a person what their truth is.” But asking these questions and actively listen to the answers is the best thing you can do.
- Remind them that their doctor wants to know about their changes in mental health and emotional well-being. “You might be used to just talking to your doctor about physical issues, but you can talk to them about it,” Raue said.
- Don’t assume someone is fine just because they have a full schedule of things to look forward to. It’s important not to make assumptions about people’s lives based on their circumstances, Moutier said. “You have to realize that when someone has a mental health issue, it lives in their brain; it distorts your thinking and your brain lies to you,” she explained. “So while you can have a caring family, success, wealth, fame, whatever – plagued by depression or a mental health issue, it just doesn’t sync up.”
- Offer to go to doctor’s appointments with them as support and, if asked, to share your observations and concerns, Moutier said. If your loved one is in therapy or on medication, Varma suggested continuing to ask how it’s going and if you can help.
- Know that your loved one may not open up the first time you try to have the conversation with them — and that’s okay, Moutier said. “You can be patient and kind and not push him unless there’s a real pressing reason to do so,” she explained. By letting them know you’re always there to listen without judgment, they can come see you later when they’re ready.
The most important thing to remember is that everyone has a role to play in supporting the mental health of the people in our lives,” Moutier said. You don’t need to take any special training, all you have to do is show up and show interest in other people’s lives, she says.