You noticed the change right away. Within a month of your mother's 100th birthday, she lost interest in her appearance, gave up on reading the newspapers and started staying in bed half the day instead of getting up for her usual 6 a.m. coffee. Always vivacious, she became increasingly withdrawn. Your husband said it was just a normal part of aging, but you didn't accept that. You called her doctor, who diagnosed depression and prescribed a low dose of an antidepressant. Within six weeks, she was almost back to her usual self.
Good for you! You weren't taken in by the "normal part of aging" line. Data show that depression is clearly not inevitable in those who are 100 or older, regardless of their past or present circumstances. But it is widespread. A 2008 study from Temple University found that at least one in four centenarians suffered from depression, but only 8 percent had been diagnosed with the disease.
Depression can take hold in someone who's 21 or 101. It doesn't discriminate on the basis of age. However, it can be difficult to spot in centenarians. According to Dr. Jeffery Lafferman of Levindale Hebrew Geriatric Center and Hospital, "As people age, their health needs become more complicated. Medical problems, such as high blood pressure and arthritis, are common and can mask the emotional challenges that the elderly face, until it has reached a critical stage." Also, it can slip under the radar by mimicking other conditions, like dementia.
If your mother or father has made it to 100, they've joined the ranks of the oldest of the old--the 60,000 individuals in the US who've lived a century or more. Perhaps they're part of the 20-25 percent of that group who are community dwelling, cognitively intact and generally vibrant and full of life. Or maybe they're among the 50 percent who have some mild form of dementia, or the 60-70 percent who have a disability and may be partially dependent upon others.
Wherever they fall on the spectrum, you can help by being aware of the symptoms of depression and watching out for them. Untreated depression can be particularly dangerous in the elderly. Did you know that the highest suicide rate in the United States is among men who are 85 or older? Moreover, the oldest of the old tend to use violent means to kill themselves, such as firearms or hanging. Depression can also lead our loved ones to cut back on eating or and drinking, or stopping altogether, which can worsen their underlying health conditions.
Don't be caught up by the myth that elderly folks don't get depressed, and being "slow" or "sad" is a natural part of aging. It isn't! Many healthy centenarians remain functionally independent for the vast majority of their lives, yet depression--one of the most easily treated forms of mental illness--can rob them of time and pleasure. When any of my patients say that an elderly parent sleeps all day, stops doing things they've always enjoyed, avoids spending time with the great-grandchildren, isn't picking up after him or herself anymore or is pulling away from them, I always suspect depression. If you see any of these signs, you should too.
Many patients will benefit from antidepressants as well as psychotherapy, sometimes referred to as "talk therapy." Both of these therapeutic interventions have been proven to be successful in the young as well as the very old. There may need to be some adjustments in dosages and discussions, but they still can make a difference. So check in on your elderly loved ones today, and be ready to suspect depression if you see changes in how they act.
References:
1. Davey A, Siegler I, Martin P, et al. Depression and depressive symptoms among centenarians. Program No. 416-2. National Harbor, MD: The Gerontological Society of America; 2008
2. Small GW. Differential diagnoses and assessment of depression in elderly patients. J Clin Psychiatry 2009 Dec;70(12):e47.
3.Voaklander DC, Rowe BH, Dryden DM, Pahal J, Saar P, Kelly KD. Medical illness, medication use and suicide in seniors: a population-based case-control study. J Epidemiol Community Health. 2008;62:138-146.
4. Margrett J, Martin P, Woodard JL, Miller LS, MacDonald M. Depression among centenarians and the oldest old: contributions of cognition and personality. Gerontology 2010;56(1):93-9. Epub 2010 Jan 26.
5. Elderly Depression and Dementia. Medical News Today. Aug 15, 2009: http://www.medicalnewstoday.com/articles/160768.php.
6. Chapman DP, Perry GS. Depression as a major component of public health for older adults. Prev Chronic Disease. 2008 Jan; 5(1): 1-9.
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