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DEPRESSION IN THE ELDERLY
The elderly often become depressed
and require skilled diagnosis and
treatment.
They are frequently admitted
to hospital in, apparently, a state of severe
depression, but often it is found that
they are suffering from concealed physical
illness, especially infections, say, of the
urinary tract, or chest disorders. Matters are
complicated by malnutrition, the beginning of
hypothermia (when they are unable to maintain
their body temperature), self-neglect and
general isolation. Improvement is often
dramatic, but of course sometimes more serious
conditions are uncovered; depression can occur
with almost any disorder, including cerebral
(brain) tumour, disease of the arteries and
Parkinsonism (also called paralysis agitans or
trembling palsy), in which the muscles become
rigid and a tremor develops.
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The severity of the illness appears
to be linked with the family pattern and with
the symptoms of reactive depression.
Bereavements, loneliness, social
isolation, poor diet, detachment from country
and countrymen (i.e.; immigrants) are potent
factors and quite often lead to suicide or
suicide attempts. Indeed, the rate of hospital
admissions due to servere depression, and
especially for first admissions are highest
between the ages of 60 and 65. Many of these are
what has been described as 'out of kilter
with society'.
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The sufferers' loss of
energy, responsiveness and initiative and a
certain warping of their personalities are part
of the same kind of depression that may occur in
middle age. These factors, together
with the loss of friends and relatives, and
sometimes their rejection by their children, can
produce anxiety and an unconscious transfer of
feelings to other people or things (projection).
Elderly people as part of their depression
frequently develop paranoid thinking, commonly
called a 'persecution complex'. This
can often be relieved by understanding
acceptance, and further reduced by taking the of
a mild phenothiazine.
Sometimes the illness, especially
in a previously stable personality, emerges as a
psychosis. Patients may be less
depressed but may show severe mental
disturbance, such as hallucinations and
delusion.
The cheerful, outgoing individual
has the best chance of escaping this type of
depression. As Cicero said'
'Old men retain their intellects well
enough if they keep their minds active and fully
employed.' The ideal is, of course, is to
keep and treat the elderly in familiar
surroundings, e.g., in their own homes, and,
when the time comes, to allow them to die with
dignity, surrounded by their loved ones.
Any physical disorder should be
studied and where possible treated; this is
often all that is required. Sometimes
it is found that physical complaints are really
caused by the depression and they will both
respond to appropriate treatment. Many of the
elderly are run down due to an inadequate or
badly balanced diet, sometimes for long periods.
Great care should be taken to ensure that they
are fed properly and well, especially as the
temptation to eat little or nothing grows
stronger as ageing progresses.
The elderly are often isolated
socially and much can be done to alleviate this.
Community nursing supervision,
'meals on wheels', day hospital
attendance, Darby and Joan and
'pop-in' clubs, financial
supervision and assistance from social workers
should all be promoted. In particular, there are
many social services and local authority
facilities which might be used to great effect,
especially the Social Services Benefit which is
often under-used. Social outings are a great
pleasure and many groups organize these.
Sometimes placing the elderly person in
specially designed accommodation or in a special
local authority 'ambulant unit' will
transform the situation.
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