Holiday Blues - Depression among the Elderly

November 11, 2013 - By the NCPC

Authors: Valerie Michel Buck & the National Care Planning Council

The holiday season offers many opportunities to spend quality time with family and friends. If you are a caregiver or family member of an aging loved one, you may observe a change in their mood or behavior during the holidays. You may notice unusual signs of fatigue or sadness or perhaps limited interest in the holiday season.

The winter holiday season (and the colder months which accompany it) can intensify feelings of sadness which aging seniors often experience. Most often it is not the holiday itself that cause these types of emotions among the elderly, rather the fact that the holidays tend to bring memories of earlier, perhaps happier times.

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD), also termed winter depression, winter blues, summer depression, summer blues, or seasonal depression, was originally considered a mood disorder among those with normal mental health throughout most of the year who experience depressive symptoms at a certain time of year. Recently, in the Diagnostic and Statistical Manual of Mental Disorders, SAD is no longer classified as a unique mood disorder, rather as a specifier for a recurrent major depressive disorder called "with seasonal pattern" that occurs only during a specific time of year and fully remits thereafter. [1] Although initially skeptical, experts now recognize this condition as common disorder, with prevalence among adults ranging from 1.4% in Florida to as many as 9.7% in New Hampshire. [2]

The U.S. National Library of Medicine notes that:

"some people experience a serious mood change when the seasons change. They may sleep too much, have little energy, and may also feel depressed. Though symptoms can be severe, they usually clear up [3] ... The condition in the summer can include heightened anxiety." [4]

Remember to consider SAD as a possible condition your aging loved might be experiencing, even if your loved one is living in a warm geographical area. In any case, the question on our minds should be how can I "light" up their lives and help with the situation?

What causes depression in the elderly?

Depression can be caused by a minor or serious medical problem; chronic pain or complications of an illness; memory loss; poor diet; loss of a spouse, close friend or companion; a move to a care facility; lack of exercise; change in routine; general frustrations with aging. Symptoms to look for include:

• Depressed or irritable mood
• Feelings of worthlessness or sadness
• Expressions of helplessness
• Anxiety
• Loss of interest in daily activities
• Loss of appetite
• Weight loss
• Lack of attention to personal care and hygiene
• Fatigue
• Difficulty concentrating
• Irresponsible behavior
• Obsessive thoughts about death and suicide

How do you know if your loved one is dealing with depression or dementia?

Depression and dementia share similar symptoms. A recent article from Helpguide.org gives some specific differences:

In depression there is a rapid mental decline, but memory of time, date and awareness of the environment remains. Motor skills are slow, but normal in depression. Concern with concentrating and worry about impaired memory may occur.

On the other hand, dementia symptoms reveal a slow mental decline with confusion and loss of recognizing familiar locations. Writing, speaking and motor skills are impaired and memory loss is not acknowledged as a being problem by the person suffering dementia.

Whether it is depression or dementia, prompt treatment is recommended. A physical exam can help determine if there is a medical cause for depression. A geriatric medical practitioner is skilled in diagnosing depression and illnesses in the elderly. If you are a care taker of an elderly person it may be beneficial for you to seek out a geriatric health care specialist.

For more information on senior health services please visit the National Care Planning Council at longtermcarelink.net.

Treating depression in older people

Once the cause of depression is identified, a treatment program should be implemented. Treatment may be as simple as relieving loneliness through visitations, outings and involvement in family activities. In more severe cases antidepressant drugs have been known to improve the quality of life in depressed elderly people. Cognitive therapy sessions with a counselor may also be effective.

How can you help an elderly loved one during the holidays?

As a care giver or family member of a depressed older person, make it your responsibility to get involved. The elder person generally denies any problems or may fear being mentally ill, which can make it that much harder to know if the elder person is having any issues. You can help the elder person feel the magic of the season and feel loved by including them in general activities such as:

• Making holiday cookies - Including distributing them to neighbors, family and friends.
• Church Activities - If you or the elderly person is a church goer, churches are filled with holiday activities that need volunteers.
• Shopping - Holiday shopping can be time consuming, but it’s always nice to have a companion.
• Seasonal Crafts - So much to be made in such a little time.
• Vacation - Make it simple or complicated, visit family or even stay in town and see the sites as if you've never been.
• Caroling
• Decorating - Decorating a house can be time consuming, pulling out all the boxes and going through everything. Get the kids involved, make a day of it.
• Holiday Parties - It seems like people make the rounds, including an elderly person can help keep them occupied and social.
• Gift Wrapping - It seems like this never ends and it is an easy task.
• Christmas Lighting - Adding indoor lights can help get everyone in the season and aid in relief of Seasonal Affective Disorder.
• Volunteering - Remember to find something that fits the physical limitations of the elderly person. If they love kids, visit a children’s hospital. Feeding the homeless can be fun and humbling.
• Event Planning - Have a party you need to throw, help the elderly person feel
  productive and useful by making them the party organizer, even if it’s a small get together. Their opinion is important not only to them. Let them delegate tasks to you.
• Gift Making - Making gifts and being thrifty is the new Rolex of gifts, go on Pinterest and find some easy crafts or projects. Their blog will contain cost effective and fun gifts you can make during the season.
• Having a dance or a talent show - Keeping the kids and the elderly person busy, you can organize something easy and offer a fun prize.
• Ballet - This is a beautiful night out that any soul can appreciate.
• Introduce foods with better nutrition - Some depression can be caused in whole or in part by lack of good nutrition. Introduce and share food with the elderly that are high in Vitamins and Minerals. Remember that some foods can affect medications and spark flair ups of symptoms in certain ailments.
• Exercise - Physical limitations of most elderly make this hard. Try simple exercises and work your way up to more complicated ones with time.
• Getting a treatment
• A great haircut or hot shave can make you feel wonderful. A pedicure is a bonus for both men and women, most salons also do a leg massage during the pedicure.
• Friends - It is easy to neglect friends throughout your life, the same happens with the elderly, especially those who rely on a caregiver. Calling their friends and getting them together regularly can be a big help. No one relates better to the elderly, then the elderly. They are a great support system and can recommend items and products to each other to help with their needs.
• Feelings - It can be as simple as asking how are you feeling internally? Not everyone can tell you, most elderly don't want to burden their caregivers and loved ones. That doesn't mean you shouldn't ask.
• Fresh Air and Sunshine -
• Cold or warm, sunshine and fresh air is good for the soul, it also helps with Vitamin D.

If an elderly person's depression is linked to a passed loved one, the holiday season can make things particularly painful but discussing and reminiscing about the departed may result in sharing feelings that many have and need to let out. After the death of Prince Albert, Queen Victoria had maids set out Prince Albert’s clothing for the remainder of her life. Many of us absorb the grief in different ways. The following might help:

• Scrapbooking about the person
• Caring on their story is very important for younger generations.
• Buying the deceased a gift - This can be a reminder of happier times and assist with openly keeping the deceased's memory alive.
• Making the deceased's favorite food
• Remembering aloud - Go around the room and each person says what you miss/love about those who have passed. This can help younger generations remember the deceased in a good light and help them manage death better in the later years.