Depression in Later Life
Training
Aims and Objectives
To Promote an awareness of mental health issues in later life
Including:
Understanding of the signs and symptoms of Depression
The stigma attached to depression in later life
To be able to use this knowledge to support people who have a mental health
problem
To have an understanding of what treatment options are available
To have an understanding of the Primary Care Mental Health Service
To understand the importance of preventative services.
What is Positive Mental
Health?
Positive Mental Health
Self esteem
Confidence
Having a role
Belonging
Contentment
Friendship
Ability to cope
Loving
Ability to adapt to change
Expressing emotions
Able to relax
What is Depression?
The term depression is commonly used to describe a
temporary depressed mood when one “feels blue”.
Health professionals – use the term to describe a serious
and often disabling illness that can significantly affect
general health and quality of life, sleeping and eating,
family life and social activities.
In older people, depression tends to last for longer
periods and have shorter intervals without symptoms.
Types of depression
Mild Depression
Depression is described as mild when it has a negative but limited
effect on your daily life, for example, you may have difficulty
concentrating at work or motivating yourself to do the things you
normally enjoy.
Moderate Depression
It is described as more severe when it has a major impact on everyday
life, such as being unable to work or look after yourself properly,
people with moderate depression can often be managed in the
community.
Severe Depression
severe depression interferes with an individual’s ability to cope with
their daily life; with eating, sleeping and many other everyday
activities. Some people may experience only one episode but several
episodes in a lifetime is more common, some people need to be
hospitalised.
Depression in later life is very
common but it is not an inevitable
part of ageing.
A quarter of people over the age of 65 (22% of men and 28% of women) have symptoms
of depression that are severe enough to warrant intervention.
The occurrence of depression increases with age from around 1 in 5 among the 65-69
age population to 2 in 5 among those aged 85 and above.
Of the one in four older people with symptoms of depression, around half (12-15% of
those aged 65 and above) meet the clinical criteria for diagnosis of depression.
40% of people in care homes have depression.
Black & minority ethnic groups are disproportionately represented in mental health
services.
There may be a cumulative impact of the experiences of racism and discriminations,
especially in relation to the stress associated with trying to access appropriate services in
older age.
UK Inquiry into Mental Health and Well-Being in Later Life Age Concern England 2007
What causes depression in
later life?
What causes depression in later life?
The common triggers for depression in older people are similar to those for younger age
groups. They include a range of factors, such as;
Physical illness and pain
Loss of role and purpose
Poverty
Loneliness and isolation
Bereavement
Moving home – loss of familiar surroundings
Being a victim
Loss of independence
Drinking heavily
Have been admitted to hospital
Previous history of Depression
Being a carer
Older people are often faced with more of these life events and daily stresses than
Younger age groups and this may explain why they have a slightly increased risk of
Depression. People over the age of 85 are at particular risk.
Social isolation, and the feeling of
loneliness, is also an important
factor.
45% of men and 34% of women over 80 living alone describe feeling
lonely, compared to 4% of men and 10% of women living with a
partner.
The levels of depression are high among isolated people in their 80’s.
People who have experienced discrimination, or have been isolated
because of their experience has been as an outsider in this country –
may feel even more isolated as they get older
Exclusion/Social Isolation
Exercise
Understanding the Signs and Symptoms
of Depression
We all feel down from time to time; it is part of life. But when the
feeling of upset won’t go away and you start to lose interest and
the ability to cope with life, then it may be a sign of depression.
Key symptoms
Persistent low mood/sadness
Loss of interest
Decreased energy and/or increased fatigue
The earlier it is detected the easier it can be to treat, so learning to
spot the warning signs is important.
Other Common Signs
Other common signs
Lose interest in life and things that used to be enjoyed
Withdrawn from family and friends
Reduced concentration & attention, self esteem and self confidence
Loss of appetite or lost weight
Neglecting appearance/personal hygiene
Moving more slowly than usual
Not attending daycare / lunch club
Wringing hands/ pacing the room
Complaining of feeling old or worthless
Crying a lot for no apparent reason
Have difficulty in remembering things
Have unexplained aches and pains
Sleep disturbance
Despair
Missing important medication
Depression is diagnosed when people experience at least two of the above symptoms for
the most of the day, nearly everyday, for at least two weeks.
Stigma attached to Mental Health
Stigma and discrimination can have negative effects on mental well
-being in a number of ways. They can occur for many reasons, including age
and race.
Stigma Can:
Discourage people from seeking help when they suspect something might be
wrong, which may delay diagnosis and intervention.
Nearly half of older people who take their own lives visit their GP in the
month before suicide.
The suicide rate in the UK is highest in the older population, particularly
in older men. As with younger people, suicide in later life can be the end
result of a complex mix of different factors, but the most important
psychiatric risk factor of suicide in older people is depression.
Stigma attached to Depression
Part of getting old
Embarrassed to discuss with GP
Sign of weakness
Fear of being portrayed as mad
Fear of being “locked up”
Lack of awareness
Negative attitudes towards depression
Fear of isolation from family/friends
Ageist attitudes
Overcome obstacles to recovery
Raise awareness amongst staff and encourage and help older
people with depression to seek help.
Reassure older people they are not alone, depression is a very
common illness
Ensure that older people with depression are correctly diagnosed
Ensure older people with depression get the help and treatment they
need
We may be the only point of contact for some people
Practical support - Advocacy services, Information and advice
Age Concern an holistic approach – social inclusion
Depression can always be treated at any stage of life.
Case Studies Exercise
Treatments Options
Medication
Anti depressant medication is the most common treatment provided to
older people with Depression.
Talking therapies
Talking therapies (psychological treatments) including counselling,
Cognitive Behavioural Therapy (CBT) and Brief Therapy are as useful
with older people as any other group.
Social Interventions
Activities that increase social contact are meaningful and improve self
esteem can all help older people with depression. Organisations working
with older people should ensure they have easy access to a wide range
of services, facilities and activities.
Self Management
Self help information is widely available from in leaflets booklets and self
help internet resources (30% of older people now use the internet).
Pathways for NHS Treatment
It is important to recognise that services vary according to locality.
Age Concerns need to identify the location of their mental health services
Primary Care
1. Recognition and diagnosis – usually carried out by the GP
2. Mild depression – this is usually managed at home through primary care, Counsellor,
Primary Care Mental Health Practitioner, psychological therapy through IAPT
(improving access to psychological therapy workers)
3. Moderate –severe depression – this can still be treated at home through primary care
often the community mental health team is involved older people usually need to take
antidepressant medication
Secondary Care
4. Treatment-resistant, recurrent, atypical and psychotic depression and those at
significant risk – Care by Specialist Mental Health Services including Psychiatrist, Crisis
teams and community mental health teams
5. Risk to life, Severe neglect – This usually requires inpatient care in a psychiatric unit or
high intensity support at home. Mental health legislation is sometimes used to admit
people to hospital
Protective factors for good Mental
Health
The following factors have been identified as being important to
the mental health of older people, whether they are living in the
community or in residential care:
Protective Factors Include:
Continuity of place and sense of belonging
Effective pain management and coping strategies for illness
Relationships
Physical health, including the ability to carry out everyday tasks
Financial security
Interests and expertise
Good service provision including access
Social participation and community networks
Good environment
Importance of Preventative Services
Factors for avoiding Depression
Engagement in meaningful activity
Social interaction
Good physical health
Access to financial and practical assistance
Equality and choice
Good Practice Models
Just a few examples of many within
our Region:
Age Concern Bradford over 50’s Group
Age Concern Sheffield Choices Service
Age Concern Calderdale & Kirklees BME Information
and Advice Service
Age Concern Leeds Physical Activity Group
Useful Organisations
Mental Health Foundation - 020 7803 1100
www.mentalhealth.org.uk
Mind Infoline - 08457 660 263
Rethink 020 8974 6814 advice@rethink.org
Samaritans 0845 90 90 90 www.samaritans.org
Saneline 0845 767 8000
If you are interested in this training course please
contact Age Concern Support Services (Yorkshire &
Humber) on 0113 2441860'.