Among older adults in nursing homes, depression is very common and symptoms are often being overlooked, accepted as a normal part of becoming older, leaving many depressions to go untreated.
By Peter Skovbjerg Jensen and Nadja Dam Jensen
“It’s hard to say how it feels. It can’t really be explained. Anyone who hasn’t tries it can’t understand how it feels,” says Elly about her depression. She spends most of her time in an apartment full of warm carpets and wooden furniture, where the shelves and walls are filled with pictures that shows memories from a long life. Her apartment is part of a nursing home in Randers, a city in Denmark. A place where she can interact with other older adults when she feels like it and get help from caregivers when needed.
Around the time when she moved into the nursing home, was when she got her first depression, says Elly. It was not really until her doctor suggested it that she realised she actually was depressed. Until then she had accepted the sadness as a normal part of life.
According to the World Health Organization, WHO, 7 percent of older adults, age 65 and up, will at some point get a depression. However, research from several other countries suggest a much higher percentage, especially among older adults living in nursing homes or other care facilities. Research from several countries around the world shows a big amount of nursing homes residents suffer from depression. Some places they even suggest that around half of the residents have a depression.
Often overlooked and underdiagnosed
Depression in older adults often goes without being recognised. Accepting symptoms of depression as a normal part of getting older is making elderly and their relatives believe that their sadness can not be treated, leading depression to be underdiagnosed. WHO recognises this as a big problem which they are hoping to be able to solve.
According to Dr. Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO, the organization is working on guiding countries to recognize depression as an illness that should be treated. He says many believe that it is just common sadness.
“Many older people and their families are not aware that it is an illness. In some cases it might be true, but in many cases it is a depression that must be treated. So health care providers must be fully equipped to identify such issues and treat them,” says Dr. Saxena.
If there is no permanent person in the elderly’s life to watch for changes in mood and personality it is even harder to discover a depression in that person. According to Lissie la Cour, head of development at Kløvervangen nursing home in Aarhus, Denmark, you need to be close to the resident to be able to see that something is wrong.
“We work closely with a couple of local doctors. They know the patients well and that makes it easier to unravel the depression. If we see changes in a resident’s behaviour that could point towards depression, we talk to their family and hear if they have noticed changes, and then we can take it to the doctors and give the residents the right treatment,” she says.
Dr. Shekhar Saxena from WHO explains what the organisation is doing to solve the problem.
Depression or just sadness of loss
Elly does not have much family left. But she believes that is common when you are as old as she is. All of her sibling are gone, so is her husband and the family that is left lives far away and only comes for visits every now and then.
Losing people that are close to you is a normal part of getting older. According to psychologist, Kim Oskar Carlson, who specialises in working with older adults, it can also be part of what leads an older adult to depression.
“Elderly experience a big amount of losses. Not only people they have cared about, but also in how their body functions and letting go of their career. But especially saying goodbye to family and friends is making them vulnerable to sadness,” say Kim Oskar Carlsen.
Nothing is helping
Elly is still not sure about what triggered her depression. She says it might just come from thinking too much. Since she was diagnosed with depression she has been served a daily dose of antidepressants. She has also been to therapy a couple of times. However, she doesn’t feel any difference. Nothing helps, she says.
“I don’t think it has really helped. Sometimes I even feel like therapy is making it worse, ripping up in everything. I don’t think that helps,” Elly says.
Isolation is clear warning sign
WHO stresses that it is important that depression in older adults is identified early so it can be treated quickly. So it is critical when people overlook the signs of depression.
“People can get better and have a much better life,” says Dr. Saxena from WHO.
There are certain behavioural changes that are clear warning signs of depression, according to Lissie la Cour from Kløvervangen nursing home. Warning signs that are easily noticed when you are close to someone.
“When they start to withdraw. When they no longer want to have dinner with the others. If they do not want to get up in the morning. Older adults often have so many regular routines in their everyday life that it is clear when they start to change,” she says. But there is another thing that for Lissie la Cour is very distinct about depressed elderly.
“There is a slightly tortured look in their expression. It is very obvious to me.”
Not something you talk about
The lights are dimmed in Elly’s small apartment as she fiddles with her fingers, somehow finding it hard to explain it all. Elly says she has accepted the depression as a somewhat permanent part of her life. She does not believe it will ever change or go away.
Elly has sometimes been able to spend an entire day in her apartment, just looking into the air. But she tries to go out and interact with other people. Every Tuesday she tries to take part of the weekly quiz night at the nursing home. Though she does not understand why more people aren’t participating. Everyday she also talks and drinks coffee with the others in the common room, but she never brings up her depression.
“We haven’t talked about it. I don’t know why. I guess it’s not something you talk about. You just keep it to yourself,” says Elly.
Social activity fights loneliness
At nursing home Kløvervangen head of development, Lissie la Cour has focused a lot on finding social activities for the residents to prevent them feeling lonely or unmotivated. This can be cardgames, people meeting over common interests or bus trips out of the house.
Head of development at nursing home Kløvervangen explains how they try to create a better life for the elderly.
“It is important that someone can talk to them. Just for them to be heard. That someone takes an interest in them can make a big difference,” says psychologist Kim Oskar Carlsen.
Recently nursing home Kløvervangen arranged a bus trip for five of the residents. They all grew up on farms and spend an entire day visiting their old homes where they had lots of stories to tell.
“It probably won’t cure them, but can maybe prevent a depression by making them feel less alone. It can make their lives more bearable despite their illnesses. Then they’re not just sitting around, waiting for their medication. There’s more to life,” says Lissie la Cour.