Depression in Older People

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Guest: Dr. Linda Austin - Clinical Professor of Psychiatry

Host: Dr. Sally Smith

Dr. Sally Smith: Welcome to Age to Age. I am Sally Smith. Let’s talk. We are lucky to have today on our show Linda Austin Clinical Professor of Psychiatry and a 13 year veteran of a wonderful talk show that many of you probably heard what’s on your mind?. Thank you for being with us today, Linda.

Dr. Linda Austin: Thank you, Sally.

Dr. Sally Smith: I know that one of your major focuses along the way has been depression in people and on this show Age to Age we are talking about people in the later years of their life often as well as caregivers and I feel that depression is central sometimes to both these issues and first I would like to ask you - how does depression present differently in older people or does it present differently in older people?

Dr. Linda Austin: Often, it does present every differently Sally, what you see in older people frequently when they get depressed is not so much of hearing them describe the sadness or the loneliness, but they will actually have memory difficulties and you may think and they may think that they have a early Alzheimer’s, but they will become more forgetful, they may seem confused, and they may seem disoriented. It may be very brief, it may just come and go, but that is often a presenting symptom that really a symptom of depression in older people.

Dr. Sally Smith: Well, you know that must be awfully confusing for families that are dealing with older people to separate out the depression, which might be able to be treated one way from senility or dementia, Alzheimer’s that they suspect might becoming on to. Are those able to be separated out and treated separately?

Dr. Linda Austin: It not only confusing for the families, it can be confusing for the doctors. We doctors even psychiatrist taking care of folks and incidentally of course both things can happen at the same time. Often people with Alzheimer’s or Parkinson’s for example or even strokes will also get depressed and are actually at high risk for depression. So, you can have both processes going on at the same time and often times the only thing you can do is to try treating the depression to see if it gets better because you really cannot distinguish the forgetfulness in an older person that comes from depression from the forgetfulness that might come with Alzheimer disease.

Dr. Sally Smith: So, your number one step, if you see this sort of thing happening is to go to your physician and lay it out there and let them start on this, but when you go home in a family situation, are there things you can do to reduce what might be the depression of an older person on a daily basis through music, lighting, and environmental.

Dr. Linda Austin: Sure, and let me back up first because the number one step absolutely is to go to a physician and often times with especially with a very frail elderly something is simple and treatable as lets say a urinary tract infection or even a mild case of pneumonia can really derailed the person’s thinking process. So, to start with a good physical exam and see if there might be something physical going on that is part of this is important first off. Second to treat, if there is a depression, third there are some great new medications for Alzheimer’s or may be not great, but at least helpful medications. So, I would start with those things. Then turning to what is going at home to make sure that that your loved one isn’t lonely, to make sure that they are safe, to began to have the conversation, and time to began to think about different kind of living situation like assisted living. Many towns and cities have senior centers where there is even transportation, they could be picked up to go in then play you know bingo, whist, or bridge or go on adding those kinds of activities can be so important to keep an older person really alive and connected to friends and community in social life.

Dr. Sally Smith: You know that leads me to thinking about the responsibilities of the family to take them to the doctor, to make these things happen, to sort out whether they will go to day care or whatever. What sort of depression and stress issues are inherent in being the care giver of the depressed older person.

Dr. Linda Austin: Oh! It can be major. I would say of the woman I see who are in their 50s, it is a single most common problem I see depression because of the stress of caring for an ageing parent. Not only the stress, but the sense of hopelessness and guilt that can come from that the feeling that it is never enough, that no matter what they do, momma forgets what they did that morning and complains that they are not their more and so what are the things that is important I think is to understand that it isn’t a problem you can fix, you do your best. Sometimes it is like taking care of a 2 year old where you except that they may not like what you are doing or they may be angry or fussy or even tantrumy, but you just do your best. But it is a big issue for caregivers as well Sally.

Dr. Sally Smith: Well, it is so difficult to think because of each situation being so different, but the caregiver I mean do you - are there certain strategies like taking 5 minutes everyday and first thing in the morning and just getting your head on straight or taking vacations more often or having a walk group or a heart to heart talk group or are their strategies out there that are identified that will help a caregiver have a lot less stress over this.

Dr. Linda Austin: Sure, there are lots of strategies. I think what are the things that I would say is to begin to think about these problems before there are emergencies and to begin to plan. To draw the whole family and so often it falls to the daughter to take care of the ageing parent to draw in the brothers and to figure out what everybody can do to contribute so that the resentments don’t build. I think pacing oneself is so important to make visits may be more frequent, but briefer to figure out what your limits are in. To make visits; maybe more frequent, but briefer to figure out what your limits are and to be okay with that because it is a very stressful and very, very frustrating. To know that this may be a long haul and to really just kind a set of pace that works for you and to take care of yourself as you go through the process.

Dr. Sally Smith: Well, it is such a major issue with so many people I thank you so much for coming and talking with us today and I hope you will come back and talk to us in more depth about some of these issues as we go on with the Age to Age Program.

Dr. Linda Austin: Thank you, Sally, it was a pleasure to be here.

Dr. Sally Smith: Thank you, Linda and I want to thank my producer Betsy Reeves and also thank all you listeners for being with us today and would very much invite your comments and suggestions, questions, and even suggestion of topics you might like to hear more about on Age to Age and you can do that easily on the phone that’s on our website. Thank you so much.

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