Depression in older people can be masked by other symptoms, so family members and GPs need to be vigilant, writes JUNE SHANNON
POPULAR COMEDIC characters such as Victor Meldrew have given air to the myth that all older people are grumpy and that being miserable is simply a common side effect of old age. This is inherently untrue and may act as a barrier to seeking help in older people struggling with a crippling depression.
Despite the fact that depression is the most common mental illness in older people, a lack of awareness has meant it remains largely under-recognised and under-treated.
It is estimated that between 10 and 15 per cent of older adults living in the community suffer from significant depression, with this figure rising to 40 per cent among nursing home residents and up to 50 per cent among hospitalised older patients.
Data from international studies have shown that older people with suicidal thoughts are more likely to complete a suicide than younger people, and that the rate of suicide tends to increase with age.
The first results from The Irish Longitudinal Study on Ageing (Tilda), a national study of 8,000 older people aged 50 and over, found that depression was common among older adults in Ireland, with 10 per cent reporting clinically significant depressive symptoms and a further 18 per cent reporting “sub-threshold” levels of depression.
The study, which is being carried out by Trinity College in collaboration with researchers from nine other colleges, also found that anxiety was more common than depression among older adults, with 13 per cent reporting clinically significant symptoms.
Tilda also found that depression in the elderly was strongly associated with disability, unemployment and increased use of both medication and health services.
According to the report, two thirds of older adults who suffered from a long-standing illness or disability also suffered with depression.
Depression is not an inevitable part of ageing, says Prof Greg Swanwick, a consultant old-age psychiatrist at Tallaght Hospital and professor of psychiatry at Trinity College in Dublin.
While it is understandable that some older people may feel down as a result of common late life experiences such as disability and bereavement, it does not mean that they are depressed.
The difficulty lies in the fact that when older people do develop depression, both they and their family members tend not to recognise it as depression, but rather mistake it for a normal part of ageing.
“Everybody can sometimes dismiss depression in older people as being understandable . . . because of all the life events that are normally associated with ageing. But what we know from epidemiological studies on older people right across Europe is that that stereotype is not true.
“Older people who have depressive symptoms are generally depressed and it is not explainable by other things that are happening to them,” Swanwick explains.
According to Swanwick, another reason why depression is under-recognised in the elderly is because the condition can present differently in this group.
He explained that on average older people tend to complain less about sadness than younger people with depression and more about physical symptoms such as sleep and appetite problems. Older people with depression also tend to have more anxiety than their younger counterparts.
Another reason why depression in older people may not be picked up is that when an older person complains of a physical condition such as pain, some healthcare professionals simply treat the physical problem rather than thinking that it may be a symptom of depression.
As Swanwick explains, an older person may be complaining of pain because they are depressed. So depression may be the reason that they cannot tolerate the same level of pain they would have easily put up with in the past when they weren’t depressed.
“It can be difficult to tease that out and it is a question of specialised assessment, following them over time and thinking about it. If you don’t think about depression you won’t pick it up,” he says.
“Ask them quite simply, ‘Are you depressed? Do you feel depressed?’ If you ask nothing else, that would be a reasonable thing to ask,” he adds.
Left untreated, severe depression can in some cases lead to deliberate self-harm and suicide. Self-harm is the strongest risk factor for suicide and particularly so in older people.
Worryingly, studies have shown that the majority of elderly people who self-harm have high suicide intent and so are more likely to succeed in taking their own lives.
While international data show that the numbers of suicides rise with increasing age, this is not the case in Ireland. One of the theories suggested for this is that churches may provide a protective factor for older Irish people.
A 2010 study by the National Suicide Research Foundation (NSRF) in Cork, in association with the Department of Epidemiology and Public Health in UCC and the University of Oviedo in Spain, found that older Irish adults had high rates of hospital-treated deliberate self-harm but below average rates of suicide.
The study found that from 1997 to 2006, there were 921 suicides of which 691 were male and 230 female, as well as 175 deaths of undetermined intent among the over 55s in Ireland. It also found that a total of 2,352 deliberate self-harm presentations were made to hospital between 2006 and 2008 by this age group, the majority of which were women.
According to the study, “Ireland’s suicide rate among older adults is lower than most European countries. Older Irish suicide also has a different age association because the Irish rate decreases with age whereas the opposite is seen in many other European countries.”
The researchers stated that, “older Irish adults have lived most of their lives in an Ireland where the Catholic Church was dominant and suicide was condemned religiously and legally.
According to the study, “Ireland’s suicide rate among older adults is lower than most European countries. This may have created a cohort who associate suicide with such stigma and shame that their suicide rate is relatively low”.
The study added that while older people may have turned to religion for support in dofficult times, younger people did not seek such support and “seem far more likely to resort to suicide”.
According to Swanwick, suicidal behaviour and thoughts in older people are more closely linked to depression than in younger people. However, he says it was important to highlight that depression can be treated successfully.
“The steps would be to think about it, pick it up, and then treat it. That would have an impact on suicide rates.”
The Samaritans provides confidential, non-judgmental, emotional support, 24 hours a day for people who are experiencing feelings of distress or despair, including those which could lead to suicide. Tel: 1850-609090 or e-mail jo@samaritans.org
