Understanding Elderly Depression and … Happiness

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Happiness and contentment are important to a quality, purposeful life. What makes people feel happy and content is different for each person and often changes over time. One of the most important aspects of a caregiver’s job is to help seniors find and maintain happiness so that they will find contentment in the later stage of life. It is impossible to make someone feel happy and content, but caregivers and family can support an environment that helps a person find this themselves.

Physicians, nurses and other medical staff tend to medical issues. Family members provide a special love. In general, caregivers must support the happiness and contentment of seniors more frequently than anyone else.

Understanding Happiness for Seniors

Learning what makes a person happy and content and what type of care will support that happiness must be a goal of very caregiver. Happiness and contentment enhance a person’s health and overall well-being. People vary in their interests, passions and abilities based on their past experiences. No two people are alike. What makes each person happy depends on their life experiences and range from very simple to more complex. Knowing what these are for a senior can help a caregiver redirect them to these things when they are unhappy.

What makes a person feel happy and content tends to change as age advances. As perspectives change, so does contentment. It is common to assume that as persons age they become lonely and unhappy from the inevitable struggles of aging. However, researchers suggest that happiness may rise in the senior years. A study by the University of California at San Diego Center for Healthy Aging, in which 1,500 San Diego residents aged 21 to 99 were surveyed, people were those in their 90s were found to be the most content.[1]

Some factors can contribute to a person’s contentment or its absence. Physical and mental health as well as access to things that make a person happy contribute to contentment. Caregivers should understand what each person requires to feel happy and content and apply care accordingly.[2]

Elderly persons are prone to depression for reasons such as loneliness, loss of friends and loved ones, changes in environment or living arrangements, or physical and mental decline. However, not every senior experiences depression. A caregiver should try to understand a senior’s mood based on the past life they had led and changes they may be experiencing currently.  If a caregiver senses that a person is experiencing depression (which can be brought about with physical changes, memory changes or loss of energy and motivation), it is important to discuss these observations with a physician. Treatment of depression has advanced significantly recently, and it can add significantly to quality of life.

Ideas for adding happiness to a senior’s life

  • Spend time with them each day listening to what they would like to say about their day, life, pains, goals and activities. Just having someone to listen is what many seniors want.
  • Pay extra attention to any senior that you encounter especially when you have the senior you care for with you. It will validate and possibly connect the two seniors even if just for a short time.
  • Take life a little slower. Plan extra time when going to appointments so that there is no need to rush if you decide to chat along the way or stop for a coffee.
  • Try to get others involved in conversations with the senior, especially if you are with them each day. They will appreciate the diversity. You may need to make a special invitation to a person at a gathering if it does not happen naturally.
  • Even if all or almost all their needs are paid for, the senior may want to have some money themselves for their own “treats” or may wish to treat you to a meal.
  • Take scenic drives or, if possible, back into a neighborhood from their earlier years that they may remember.
  • Keep dissension and serious discussions away from earshot. Seniors often believe they are a burden even if they are not and may infer from a discussion that is a problem they have created.
  • Be sure to schedule and hold seasonal celebrations. There is no need to ignore the holidays just because children are not around. If possible, visit a place where younger people are celebrating a day such as Halloween.
  • Discuss their memories. Ask questions about a favorite, positive topic and complete a life review (explained in the last part of this article).
  • Find something they like to do and surprise them, but don’t overdo it or it will not be a surprise.
  • Ask them to help with chores or help in other ways so they feel useful. Most people feel happy when they feel useful and can contribute.
  • Listen to their ideas and implement them if possible. Sometimes ageism takes effect when seniors have ideas and they are ignored without even being considered. Using the senior’s ideas can make them feel valuable and respected.
  • Help a senior to act younger. In general, people who feel young continue to learn and to participate in new and interesting activities, enjoy social time, and engage with others actively.

When you feel that a person may be depressed, you should realize that you cannot make a person be happy. You may use suggestions outlined in the “Ideas for adding some happiness to a senior’s life” block to direct a senior to a happier state. Trying too hard to make a depressed person feel happy may work against you because it may also lead to your own burnout and depression. A caregiver should protect his or her emotional well-being while caring for a person in a depressed state. This can be difficult because the caregiver provides personal care. Do not take the senior’s unhappiness personally. There is only so much a caregiver can do.

Depression is sometimes mistaken for sadness, which is temporary and can be treated by redirection and making daily adjustments. Depression is a more permanent change in chemical balance and is more challenging to overcome because it can be more serious. It should first be addressed and treated by a physician. When in doubt, assistance from a professional should be sought. A caregiver should contact the senior’s primary care physician, who can evaluate the senior and refer a specialist, if needed.

Depression can be serious and cause life-threatening conditions. A caregiver should notify family members or a doctor if depression does not subside and document care plans daily to note mood changes. These notes help navigate what works for the senior and what does not work.

Depression and dementia often go hand in hand. Depression can cause dementia-like symptoms and dementia (or memory loss) can cause feelings of depression in a person. These two conditions share many signs and can be difficult to tell apart. As someone ages, the person’s body and mind change. The person may might start thinking more slowly or make mistakes. Or, the senior may just seem “different” to those who know her well. While these things may be easily attributed to dementia, the elderly person may be suffering from depression instead. How will you know which one is causing the suffering? The best way is to differentiate the signs and symptoms of each illness. That can help point to the appropriate treatment.

Warning Signs That May Indicate Elder Depression

  • Under-eating or overeating
  • Listlessness, exhaustion, fatigue, no energy or vitality
  • Feeling overwhelmed, inability to cope; hopelessness and helplessness; no sense of self-efficacy or ability to assume control
  • Fuzziness, inability to concentrate, memory issues
  • Insomnia
  • Unexplained, chronic aches and pains
  • Negative outlook, crankiness
  • Little interest in activities

Source:  Harvard Women’s Health Watch, Harvard Health Publications, Harvard Medical School (October 1, 2012). “Depression—early warning of dementia?” Available online at http://www.health.harvard.edu/mind-and-mood/depression-early-warning-of-dementia.

 Is it depression or dementia?

A comparison of some of the signs of depression and the corresponding symptom of dementia is useful to know. These are no hard and fast differences and the caregiver should ensure that the physician is consulted because treatment may result in a better quality of life.

Depression Dementia
Cognitive loss is rapid and noticed within days or weeks Loss of cognition is slower, over a longer time
The senior has trouble concentrating, such as an inability to sit still to read a book or view a movie Confusion and getting lost in familiar locations
Language and motor skills are slower but normal Difficulty with writing, speaking or other motor skills
Worrying about memory problem and noticing what is going on Lack of concern about memory loss[3]

 

Using a Life Review as a Life Enrichment Tool

A Life Review is a reflective exercise which involves recalling memories and unresolved past conflicts for reevaluation and resolution that can be used to enhance the self-esteem of an elderly person. It is like reminiscing or sharing stories, which everyone loves to do, but differs in that it is more structured. Often it is performed as part of a therapeutic effort in mental health or, sometimes, in a hospice to help a person come to terms with life in preparation for death. It is also an educational tool for family members who want to hear stories about their loved ones.  Elders have shared their stories with the next generations for centuries, a practice that gave elders a higher status within the society. Reverence for the stories of our aging loved ones is not as commonplace now as it has been in prior times but is being revived by gerontologists and social workers as a tool to address depression and other aging issues.

The following questions developed by Gerontology Professor Deborah Merrill of Clark University this help improve Life Reviews. Several books have been written on this topic.

Sample Life Review Interview Schedule

1) When and where were you born?

2) Where did you grow up?

3) What was your community like when you were growing up?

4) What kind of schooling did you have?

5) Tell me about your parents/stepparents?

6) Did you have any brothers or sisters? Tell me about them.

7) How would you describe yourself during childhood?

8) What was it like when you were a teenager?

9) Did you marry? At what age? If not, why not?

10) Tell me about your marriage, about your first job, about leaving home.

11) Tell me about your career. What were you doing in your 30’s, 40’s and 50’s?

12) Did you have children?  Tell me about raising your children.

13) What was your relationship with your children over the years?

14) Do you have a close relationship with your children now?

15) Who else are you close to?

16) Who have been the most influential people in your life? Why? When?  What were you doing at that time?

17) Who are the important people in your life now?

18) Do you keep in touch with any of your old friends?

19) If you had to pick one person who had a major impact on your life, who would it be? Why?

20) How have your friendships changed through the years?

21) How do/did you feel about retirement?

22) Describe your health and your feelings about it.

23) Could you describe a typical day to me?

24) What makes you happy now?

25) Who are the people you are closest to now? How often do you see them? How many friends would you say you have now?

26) To whom would you go for help with financial aid, housekeeping, transportation, emotional support?

27) What have been the important successes in your life?

28) What have been the disappointments?

29) If you could live your life over, what would you do differently?

30) What about your life would you change?

31) Could you describe any turning points in your life?

32) What have been the most influential experiences in your life?

33) What things frighten you now? And when you were in your 60’s, 50’s, 40’s, 30’s, 20’s, a child?

34) What things give you the most pleasure now? When you were in your 60’s, 50’s, 40’s, 30’s, 20’s, a child?

35) What is your best quality? your worst?

36) Which of your parents/stepparents are you the most like? Why?  How?

37) Do you have a philosophy of life? If a person asked you what the most important thing in living a good life is, what would you say?

38) What do you think has stayed the same about you during your life? What has changed?

39) How do you see yourself?

40) Did you have expectations at various points in your life about what growing older would be like for you? What about when your parents grew older?

41) How do you feel about growing older?

42) What is the hardest thing about growing older? The best thing?

43) What would you still like to accomplish in your life?

44) Do you think about the future? Make plans? What are your concerns about the future?

In addition to these questions about the person’s unique life history, seniors are interested in questions about social history, about how individuals lived through times such as the Great Depression or world wars. Another focus of questioning can be on policy and health care issues facing older people today. The interview schedule can include questions about these areas of shared experience.

SOURCE:  Susan Perschbacher, Professor Emeritus of Sociology, Assumption College

Books on Life Reviews

The Handbook of Structured Life Review by Barbara K. Haight  (Author), Barrett S. Haight (Author) Published by Health Professions Press; 1 edition (October 29, 2007)

Reminiscence and Life Story Work: A Practice Guide 4th ed. Edition, by Faith Gibson (Author), Published by Jessica Kingsley Publishers; 4 edition (February 15, 2011)

The Reminiscence Skills Training Handbook (Speechmark Practical Resource) 1st Edition, by Ann Rainbow (Author), Published by Routledge; 1 edition (January 19, 2001)

>>More articles from SeniorsMatter.com on depression and happiness in seniors. [click here]

Footnotes

[1] J Clin Psychiatry 2016; Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21–100 Years, http://www.psychiatrist.com/jcp/article/Pages/2016/v77n08/v77n0813.aspx

[2] “More and more studies suggest that happiness may actually rise after middle age — at least when scientists take into account some of the non-biological factors that can influence reports of contentment. –contentment. -http://healthland.time.com/2013/02/18/with-age-comes-happiness/

[3] Depression in Older Adults, Recognizing the Signs of Elderly Depression and Getting Treatment.  HelpGuide.org, Authors: Lawrence Robinson, Melinda Smith, M.A. and Jeanne Segal, Ph.D. Last updated: October 2017.