By: Brian Neese
Around 7 million of the nation’s 39 million adults ages 65 years and older are affected by depression, according to the Centers for Disease Control and Prevention (CDC). Although a majority of older adults are not depressed, they have an increased risk of developing depression, which is a persistent sad, anxious or empty feeling, or a feeling of hopelessness and pessimism.
Unfortunately, depression in older adults is often not recognized or treated. Symptoms may be mistaken for natural reactions to illness or life changes that occur during aging. Geriatric depression is associated with an increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, reports the Annual Review of Clinical Psychology.
Due to its consequences, geriatric depression is regarded as a major public health problem. On a more positive note, the CDC says that it is “fairly easy to detect” and “highly treatable.”
Depression can cause feelings of sadness or anxiety that last for weeks at a time. Additionally, a wide range of other symptoms may be present.
- Feelings of hopelessness, pessimism, guilt, worthlessness and helplessness
- Irritability and restlessness
- Loss of interest in activities once pleasurable
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Sleeping difficulties or irregular sleeping patterns
- Overeating or appetite loss
- Thoughts of suicide
- Persistent aches or pains that do not get better, despite treatment
Depressed individuals over the age of 65 are less likely than younger individuals to exhibit dysphoria, which is a state of unease or general dissatisfaction with life, a study in the Journal of Gerontology found. Older individuals with depression are more likely than younger individuals to experience sleep disturbance, fatigue, psychomotor retardation, loss of interest in living and hopelessness, according to Psychological Medicine.
Additionally, older depressed individuals commonly complain of poor memory and concentration. The Archives of General Psychiatry found that patients with late-life depression had slower cognitive processing speed and performed poorer in all cognitive domains.
“Non-genetic biological risk factors for depression are particularly important in old age,” says the Annual Review of Clinical Psychology. Several factors have been associated with late-age depression.
- Endocrine dysregulation, bone loss and certain medications (beta blockers, central nervous system medications, hormones, anti-Parkinson agents, certain cancer medications and others) may cause late-life depression.
- Around 20 to 25 percent of heart disease patients experience major depression, and another 20 to 25 percent experience symptoms of depression not meeting criteria for major depressive disorder, according to Biological Psychiatry.
- Dementia may be a risk factor for depression, but diabetes is not. Rather, the evidence suggests that depression is a risk factor for diabetes.
- Stroke patients have the highest rates of major depression (20 to 25 percent) among other neurological disorders. Rates are intermediate (15 to 20 percent) for Parkinson’s disease compared to Alzheimer’s disease (10 to 15 percent).
- Anxiety disorder and sleep disturbance are also risk factors for depression among older adults.
Social risk factors for depression, though less important in old age, can become more significant in very old age when individuals face greater losses and fewer resources. As with other ages, Psychology and Aging found that late-life depression is linked to the number of stressful life events experienced. Also, troubled relationships can explain depressed older individuals, including spousal depression, marital conflict and perceived family criticism. In The Journals of Gerontology, financial trouble is one of the most common stressful life events experienced by older adults.
Treatment and Prevention
In a review of evidence-based therapies for depression in older adults, Clinical Psychology: Science and Practice named the following as beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and reminiscence therapy. A behavioral treatment plan for depression in nursing homes was successful in Clinical Case Studies. It found a strong increase in positive affect and activity level after a 10-session program for increasing pleasant activities was administered. In the Journal of Mental Health and Aging, a meta-analysis found that psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being in older adults by about one half standard deviation and clinician-rated depression by more than one standard deviation.
In 2007, an expert panel recommended home- or clinic-based depression care management (DCM) along with cognitive behavioral therapy for older adults with depression, the American Journal of Preventive Medicine reports. DCM uses a team approach with a trained social worker, nurse or other practitioner alongside a primary care provider who prescribes treatments in consultation with a psychiatrist. Clinical trials link DCM to a reduction in depression symptoms, higher remission rates and improvements in health-related quality of life, reports the CDC.
Prevention efforts are often directed to those who are at an increased risk of disorder. The American Journal of Psychiatry found that treating all patients with subsyndromal depressive symptoms could prevent 24.6 percent of new depression onsets in that period. In Aging & Mental Health, cognitive behavioral therapy demonstrated significant benefits in the prevention of depression in nursing home residents. Treatment of insomnia and other sleep disturbance is a valuable opportunity to prevent depression in older adults, given the highly effective nature of cognitive behavioral treatments for insomnia in this age group. The American Journal of Geriatric Psychiatry identified that individual educational interventions for subjects with chronic illness, individual therapy for at-risk bereaved older adults, cognitive-behavioral interventions to reduce negative thinking and life review were interventions with the most empirical support. Programs to reduce social isolation may also help prevent depression in older adults.
Helping Seniors in the Community
Human services professionals can join healthcare professionals and families to provide support for older adults who have or are at risk for depression. From clinics and nursing homes to homeless shelters, a variety of environments exist where individuals are particularly at risk for developing depression. Professionals trained to work with older adults and lead initiatives in the community can make a difference.
Southeastern University offers an online B.S. in Human Services and an online M.A. in Human Services to positively impact seniors. Both programs equip graduates with the knowledge and skills needed to work in and lead human service environments. The master’s program offers a gerontology specialization, and both degree options take place in a convenient online format.
How New Tech Can Support Caregivers as They Support Seniors
Up to 42% of Americans over the age of 65 take five or more medications, and in 2018, at least one in every five seniors experienced an adverse drug reaction. Such reactions are more common when seniors can’t properly adhere to the instructions that accompany their prescriptions.
In fact, according to U.S. Pharmacist, nonadherence accounts for about half of treatment failures and a quarter of hospitalizations every year. This, combined with the fact that healthcare providers are largely overwhelmed and overburdened, means caregivers have a unique opportunity to improve senior health outcomes. Caregivers can act as an extension of the medical industry to help seniors overcome the hurdles they face when it comes to medicating themselves properly.
Why Medication Adherence Is Challenging for Seniors
Experts agreed that the therapeutic efficacy of any medication requires an adherence rate of 80% or higher. To medicate properly, seniors must closely follow the instructions on each drug’s label and keep a consistent routine around consuming the right doses to avoid complications.
Unfortunately, the current average for medication adherence for chronic health conditions is only about 50%. For most patients, this isn’t enough to improve or stabilize their conditions — much less boost their life expectancy. But nonadherence is often a combination of hurdles that can be difficult for seniors to overcome on their own.
For example, the instructions on drug packaging may be confusing, and age-related memory loss can lessen the chances of proper adherence. The side effects of certain medications may also be uncomfortable, making patients hesitant to stick with them. Overall, keeping track of when and how to take various medications can be overwhelming for anyone.
The Important Role of Caregivers
Daily routines and medical schedules can be much easier for senior patients to adhere to with the assistance of a caregiver. As caregivers, a patient’s family members, friends, loved ones and volunteers can help ensure seniors take their prescriptions as directed and eat regular meals. What’s more, they can better monitor changing behaviors or symptoms that could indicate a poor reaction to medications.
Because the healthcare system is becoming increasingly overburdened, healthcare providers don’t always have the time or means necessary to devote to helping patients adhere to medications. Instead, the healthcare system should focus on providing caregivers with tools they can use to make senior care more manageable, especially when it comes to drug adherence. This will become even more necessary as the senior population grows.
The following tools can help caregivers address the medication adherence problem plaguing American seniors:
- Automated medication dispensers: Medication dispensers have come a long way — from manually organized pillboxes to modern, automated dispensers that ensure people get the prescriptions they need. One of the most valuable aspects of automated medication dispensers is that they can sync with a mobile application to alert caregivers of missed doses and low prescriptions.
- Personalized medication reminders: Medical alert systems and healthcare apps — or even simple reminders on a smartphone calendar — are vital to helping seniors prevent missed doses. Some apps are more detailed than others, so consider whether simple reminders will suffice or whether caregivers should receive confirmations as well.
- Home delivery of presorted medications: In terms of convenience, having presorted medications delivered directly offers a critical advantage for both seniors and caregivers. Automated delivery systems can be synced with medication reminders to create a convenient, holistic routine that makes adherence more accessible than ever.
When Medication Adherence Is Easier
There are very clear, immediate benefits to practicing better medication adherence — the most obvious being the success of the medication. Data suggests that for every 10% improvement in medication adherence, healthcare costs can be reduced by 29%.
Adherence also has a halo effect on other aspects of a patient’s life, improving chances of eating healthy, exercising regularly and taking one’s own personal wellness journey more seriously. Better adherence is key to improving seniors’ quality of life and reducing the burden on the healthcare system, and caregivers are in a great position to help make it happen when armed with the right tools.
Loneliness May Be Due to Increasing Aging Population
Despite some claims that Americans are in the midst of a “loneliness epidemic,” older people today may not be any lonelier than their counterparts from previous generations – there just might be more of them, according to a pair of studies published by the American Psychological Association.
“We found no evidence that older adults have become any lonelier than those of a similar age were a decade before,” said Louise C. Hawkley, PhD, of NORC at the University of Chicago, lead author of one of the studies. “However, average reported loneliness begins to increase beyond age 75, and therefore, the total number of older adults who are lonely may increase once the baby boomers reach their late 70s and 80s.”
The studies were published in the journal Psychology and Aging.
Hawkley and her colleagues used data from the National Social Life, Health and Aging Project and the Health and Retirement Study, two national surveys of older adults that compared three groups of U.S. adults born in different periods throughout the 20th century. They first analyzed data in 2005 to 2006 from 3,005 adults born between 1920 and 1947 and a second time in 2010 to 2011 from 3,377 people, which included those from the previous survey who were still alive, and their spouses or partners. The third survey, in 2015 to 2016, comprised 4,777 adults, which included an additional sample of adults born between 1948 and 1965 to the surviving respondents from the previous two surveys.
The authors examined participants’ level of loneliness, educational attainment, overall health on a scale from poor to excellent, marital status and number of family members, relatives and friends they felt close to. They found that loneliness decreased between the ages of 50 and 74, but increased after age 75, yet there was no difference in loneliness between baby boomers and similar-aged adults of earlier generations.
“Loneliness levels may have decreased for adults between 50 and 74 because they had better educational opportunities, health care and social relationships than previous generations,” said Hawkley.
Adults over 75 were more susceptible to becoming lonely, possibly due to life factors such as declining health or the loss of a spouse or significant other, according to Hawkley.
“Our research suggests that older adults who remain in good health and maintain social relationships with a spouse, family or friends tend to be less lonely,” said Hawkley.
In a similar study, researchers in the Netherlands found that older adults were less lonely than their counterparts from previous generations.
These researchers used data from the Longitudinal Aging Study Amsterdam, a long-term study of the social, physical, cognitive and emotional functioning of older adults. A total of 4,880 people, born between 1908 and 1957, participated.
The study measured peoples’ loneliness, control over situations and life in general and goal achievement. For example, participants rated loneliness on a scale from 0 (no loneliness) to 11 (severe loneliness) based on feelings such as, “I miss having people around.”
Older adults born in later generations were actually less lonely, because they felt more in control and thus most likely managed their lives better, according to Bianca Suanet, PhD, of Vrije Universiteit Amsterdam and lead author of the study.
“In contrast to assuming a loneliness epidemic exists, we found that older adults who felt more in control and therefore managed certain aspects of their lives well, such as maintaining a positive attitude, and set goals, such as going to the gym, were less lonely,” said Suanet. “Additionally, as is well-known in loneliness research, participants who had a significant other and/or larger and more diverse networks were also less lonely.”
Suanet recommended that older adults take personal initiative to better nurture their social ties, such as making friends to help them overcome increasing loneliness as they age. Also, interventions to reduce loneliness should focus more on bolstering older adults’ feelings of control, instead of only offering social activities.
“People must manage their social lives better today than ever before because traditional communities, which provided social outlets, such as neighborhoods, churches and extended families, have lost strength in recent decades,” said Suanet. “Therefore, older adults today need to develop problem-solving and goal-setting skills to sustain satisfying relationships and to reduce loneliness.”
Seniors may also want to make use of modern technology to maintain meaningful social connections, according to Hawkley.
“Video chatting platforms and the Internet may help preserve their social relationships,” said Hawkley. “These tools can help older adults stay mobile and engaged in their communities.”
Articles: “Are U.S. Older Adults Getting Lonelier? Age, Period and Cohort Differences,” by Louise C. Hawkley, PhD, NORC at the University of Chicago; Kristen Wroblewski, MS, L. Philip Schumm, MA, University of Chicago; Till Kaiser, PhD; and Maike Luhmann, PhD, Ruhr University Bochum. Psychology and Aging. Published Dec. 10, 2019.
How Universities Can Better Support Student Caregivers
More than half of family caregivers are between the ages of 18 and 49 years old – and as the U.S. population ages, increasing numbers of these caregivers will be enrolled in colleges. Often categorized as “nontraditional students,” college-enrolled caregivers are responsible for children, spouses, and dependent parents with disabilities and chronic illnesses. Nontraditional students of all kinds are more likely to drop out of higher education because of obstacles in their non-academic lives, and this certainly holds true for those who have to balance caregiving with their studies.
Historically, Student Affairs professionals have developed programs and services to meet the challenges faced by underrepresented and underserved students. Given the growing prevalence of student caregivers, academic institutions should keep their needs in mind when distributing funds and creating student support services. While each student caregiving experience is unique, the fundamentals are constant. Very often, student caregivers must choose between attending to a human being for whom they are responsible or attending to academic tasks.
Students managing such choices, balancing caregiving and academic demands, face significant barriers. For example, the amount of time they are able to spend with faculty and advisors is often limited by their caregiving responsibilities. Furthermore, efforts to disseminate information about support services on college campuses typically focuses on traditional students and thus may miss or leave out nontraditional students who are not part of established campus communication channels.
Student-Centered Teaching Can Help Caregivers
Student-centered teaching focuses on individual learning needs to promote persistence and success. Effective student-centered instruction is based on the understanding that one size does not fit all. When an instructor makes accommodations for student caregivers as emergencies arise, such flexibility demonstrates empathy and can promote success rather than indicate compromised standards.
Consider the following examples from the lives of student caregivers I interviewed in my research:
- Waldo told me about his experience during his first year of college. He began caring for his mom, who had Huntington’s Disease, while he was in high school. He grew up in poverty and was the first person in his family to go to college. He chose to stay at home and commute to college so he could continue to care for his mom and save money. During finals week of his freshman year, his mom required brain surgery because of a fall. He asked his statistics professor if he could take the final at an alternative time due to his mom’s surgery. The professor replied that it was his choice whether he came to the final or not, but he would not alter the time.
- Alex, an assistant professor, cared for his mom who had a stroke while he was completing his PhD. He told me he was lucky the stroke occurred around Thanksgiving, when he had a break from the regular requirements of the semester. As he navigated his mom’s recovery, Alex only had to negotiate with his dissertation chair – who allowed him to alter deadlines to ensure he had the time he needed to care for his mom.
Alex’s dissertation chair practiced student-centered teaching, while Waldo’s professor did not. The advantages to students of such teaching are evident, especially for student caregivers, who need a flexible learning environment to succeed academically and develop healthy coping skills while contending with the overriding needs of those for whom they care.
Student Caregivers, Technology, Insurance, and Health
Student caregivers are at a higher risk for stress-related illnesses than their peers, due to their time constraints and intersecting roles; and such difficulties can be compounded when students lack the time and resources to develop healthy coping strategies. Nevertheless, higher education policies have the potential to improve long-term health outcomes for student caregivers by providing access to appropriate supports and resources. Health is at the core of student learning and success. It is in the interest of university administration to ensure access to institutional support and resources, as the following examples suggest:
- Natalia, a PhD candidate and caregiver, struggled with anxiety and depression. Her dissertation advisor empathized with her situation and allowed her to work remotely instead of commuting to campus when her mom needed care. She was fortunate to have access to all of the university’s technological resources while at home caring for her mom. Natalia’s advisor also encouraged her to apply for emergency funds. The flexibility and knowledge about university resources that Natalia’s advisor provided, helped her develop and employ healthy coping strategies.
- Anne, a master’s degree student, told me about the university resources she received as a student caregiver. Assistive technology provided by her university was installed on her personal computer, allowing Anne, her husband, and their children to navigate various tools for coping with learning disabilities. Student health insurance provided by the university allowed her to get allergy shots, orthotics, and counseling to cope with anxiety and depression. Financial aid both increased and decreased stress. She worried about paying back the loans, but before she enrolled in graduate school her family did not have the financial reserves to weather a crisis.
Toward Equity for Student Caregivers
Like other students, caregivers seek higher education to improve their economic and social resources, but they face many obstacles and graduate less often than traditional students. To level the playing field for all students, administrators should ensure all students have access to health insurance, appropriate personally tailored learning technologies, and the flexible schedules and supportive resources they need to study even when caring for others. Colleges, students, and society alike only stand to benefit if student caregivers face easier routes to degrees.
Read more in Lisa Schumacher, “The Lived Experience of Student Caregivers: A Phenomenological Study,” University of Iowa, 2018.
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