102-year-old’s outlook helps him avoid a troublesome issue for today’s seniorsMore than a century of life has taught Tom Pederson how to handle stress: get along with everybody, stay away from grouches and don’t bother worrying.
By: Dave Roepke, INFORUM
More than a century of life has taught Tom Pederson how to handle stress: get along with everybody, stay away from grouches and don’t bother worrying.
“I haven’t got worries. That’s something someone else can do,” said Pederson, a Moorhead Eventide resident who turned 102 last week.
The bitter curmudgeon is a well-worn trope, yet it’s more typical for seniors to share Pederson’s content outlook, said Cynthia Torges, assistant professor of gerontology at North Dakota State University.
“Most people do manage to be very, very peaceful,” Torges said.
But when the life changes accompanying aging do hit – health ailments or losing a spouse, for example – the portion of older people who experience depression run into a vexing conundrum. Mental illness in seniors is often overlooked by relatives, friends, even doctors, mistaken as a physical issue, grieving or the natural and expected byproduct of growing old.
Look at it this way, said Greg Sanders, also a NDSU gerontologist: If an older farmer suffers an injury in an accident, townsfolk may pitch in to help harvest. If the same farmer shows the lack of joy and withdrawal that mark depression or is struggling with substance abuse, people stay away.
“When we have those attitudes, it keeps us from doing what we could do to solve the problem,” he said.
Sorting it out
Diagnosed depression is relatively rare in the older population, occurring in 2 percent or less of women and less than 1 percent of men, said Dr. Julie Blehm of Sanford Health in Fargo.
That rate increases to 10 percent for seniors who receive in-home care and between 12 and 20 percent in nursing homes, Blehm said. And among all seniors, 15 percent report some significant indicators of depression, she said.
“That’s significant,” said Blehm, who specializes in gerontology and internal medicine. “I think it’s underplayed.”
The elderly are far more likely to describe changes in mood as vaguer physical symptoms, such as trouble sleeping, lack of hunger or general pain, said Sanders, who has conducted training sessions on mental health and aging with more than 1,400 North Dakotans.
When descriptions such as those are considered in the context of other health concerns, it’s challenging to connect the dots because there are too many dots.
“There’s so much going on, it’s hard to sort out,” he said “If you have an older adult who had a stroke, how can you tell that they’re also depressed?”
There’s also still demographic and cultural opposition to talking about mental illness among many older people in the area, said the Rev. Steve Streed, a chaplain at Eventide. It’s a generation that wasn’t raised to consider mental illness – the language itself can be a stumbling block.
“They think they’re the only ones,” Streed said.
Recognizing that possible pitfall, training sessions Sanders conducts urge a gentle approach to broaching the topic: letting the person know you can tell something is wrong, encouraging them to share, listening carefully and suggesting “professional help” if it’s clearly needed.
Opening that dialogue can go a long way, said Sarah Sjaaheim, a social worker at Eventide.
“Most of them just want to talk, a lot of them,” she said.
How it hurts
Not catching the signs of depression can have a huge effect on an older person’s life, causing a spiraling degradation of health.
If seniors pull away from friends and family because they are depressed, it only further isolates them. For someone living alone, that can pose nutritional problems, complicate pill-taking schedules and rob seniors of personal contact.
“That becomes a big snowball,” Torges said.
Blehm said the stress of depression can also worsen other chronic diseases, like high blood pressure or diabetes because sufferers don’t manage them as well.
Then there’s the worst-case scenario. According to a study cited by the National Alliance on Mental Illness, 20 percent of elderly people who take their own lives had seen a doctor the previous day and 40 percent in the past week.
Blehm said that’s “startling” and said it was a challenge to identify subtle symptoms of depression during a short office visit, especially for a new patient with whom a doctor has little history.
“You may not pick up on that quickly,” she said.
One of the ways Sanford is trying to address the difficulty of diagnosing depression in an office visit is a new program that has psychiatrists and psychologists working in the same environment as primary-care doctors, an initiative that Blehm said was about a half year old.
That helps because patients are more likely to follow up with treatment when they can go to the same facility as they see their regular doctor and because the mental health experts are available for weekly consults, she said.
“We have to be aware of this,” Blehm said.
Is it grief?
There’s no clean-cut test for figuring out if a person – young or old – is suffering from major depression that requires psychiatric help.
In general, the intensity and duration of the symptoms is a key. The manual of mental disorders used by most psychiatrists uses two weeks as the standard.
Those criteria, however, disregard grief, and at an age when losses come at a quicker clip, distinguishing healthy mourning from severe depression is tricky.
“It’s a real slippery slope,” said Carrie Stenseth, a bereavement counselor at Hospice of the Red River Valley.
The death of a spouse is especially emotionally jarring for many elderly people because their lives were intertwined so long.
“They lose that reflecting person, somebody else who is going through what they are,” Stenseth said.
The intense psychic torment of grief is natural and expected. But if it leads to self-focused pain, relentless rumination and irrational guilt, that’s a red flag.
“You should be able to find little glimpses of something that makes you happy,” Stenseth said.
When Streed talks to residents who seem mired in bitterness, he looks for nonverbal clues they may need professional help: “You hear the tone of the voice. You watch the face.”
Keep in mind, however, that losing close loved ones does often bring shifts in values and personality.
“You don’t snap out of it. You just learn to live with the loss,” Stenseth said.
That’s part of the reason the line between late-life grief and depression is so difficult to discern.
“To be quite honest, it is hard to tell the difference,” Sanders said.
‘Who am I?’
Though seniors who have not had issues with depression earlier in their lives aren’t immune, most cases of late-life depression are, in essence, relapses, according to the National Alliance on Mental Health.
First-time cases late in life are most often triggered by a specific stressor, unlike in younger people, according to the Geriatric Mental Health Foundation.
It can be helpful to consider a person’s personality. Torges said those who deal best with stress and are the least self-critical tend to have happier inner lives as they age. Finding meaning in one’s life is also an important indicator, be it spiritual or otherwise, she said.
Take Pederson, the 102-year-old, as an example. One of his goals in life was to travel widely, especially to his parents’ native land of Norway and to Italy. Now memories of that bring him great joy.
“I think about it a lot,” he said. “I can just sit back and let it play in my mind. It’s like a review.”
Streed said in his work at Eventide, he’s often spoken with seniors who struggle to find meaning and give their life purpose. Without it, rumination can set in.
“I wasn’t a good enough wife. I wasn’t a good enough mother” are comments, he said. “Then we’re back to the question of, ‘Who am I?’ ”
Streed also thinks there’s a cultural predilection to minimize the lives of elders feeding those thoughts.
“We put them in the corner and say bye-bye. They can feel it,” he said.
If you go
Some risk factors
What to look for?
Source: Mental Health and Aging, a North Dakota State University program
About this series
Today’s story on how seniors can deal with depression and grief is one of a series of stories appearing periodically in The Forum that aims to answer questions families may have as they deal with what can be difficult transitions.
If you have a comment or story idea to share, please send it to Dave Olson at firstname.lastname@example.org, or mail it to Dave Olson, The Forum, P.O. Box 6022, Fargo, ND 58107. You may also call (701) 241-5555.
Readers can reach Forum reporter Dave Roepke at (701) 241-5535