The holidays are here and everyone is merry. Oh wait, maybe everyone isn’t merry! Seasonal depression is very common in all age groups, but depression in seniors is associated with increased falls and falls with injury.
A study of 21,900 Australians over the age of 60 found that those who had been diagnosed as depressed and those taking anti-depressants were 50 percent more likely to fall than those without depression. Ngaire Kerse, lead author of the study and associate professor in the Department of General Practice and Primary Healthcare at the School of Population Health in the University of Auckland, New Zealand, said: "Falls are very common and risk factors for falls are easy to identify. We need to emphasise fall prevention during treatment of depression in older people."
Seasonal Depression in Seniors
It is estimated that 20% of seniors residing in skilled nursing facilities suffer symptoms of depression. That’s a lot of people! There are several different types of depression, including seasonal affective disorder (SAD), a seasonal form of clinical depression typically seen in the fall and winter.
With the seasonal change we have a gradual decrease in natural daylight, which is when we tend to see an increase in the number of seniors affected by SAD. What are you and your caregivers doing to address depression in your home now that autumn is here?
People with SAD feel fine at other times of the year. Approximately 6% of the US population is affected by SAD, and women are more commonly affected than men. Add to this the sense of loss that our seniors feel when the holidays approach. Remember grandma’s special mashed potatoes and pumpkin pie? Grandma isn't celebrating the holidays the way she used to and she misses it.
Signs and Symptoms of SAD in Seniors
So what should we be alert to during this time of year? Signs and symptoms of SAD include:
- Oversleeping, extreme fatigue or sluggishness
- Lack of interest in normally pleasurable activities
- Increased appetite, carbohydrate craving, overeating and weight gain
- Suicidal thoughts
It's important to be aware of these signs and symptoms and to be alert to any signs that a resident is having thoughts of self harm.
Many people (maybe even you) get the “blahs” or the “winter blues.” These symptoms are less severe than SAD and aren't considered clinical depression. The blahs have symptoms that are shorter and there is generally no associated hopelessness. SAD is more of an ongoing event, whereas just feeling blue is what we often refer to has “having a bad day”—it's only problematic if it continues for a length of time.
Remember, residents in your community may be affected by SAD. Be sure to refer to the resident’s individual plan of care that provides instruction on how to care for that resident’s specific needs. Seniors identified as at highest risk of SAD include:
- Recently ill or hospitalized residents with an initial presentation of failure to thrive or vegetative state
- Loss of appetite, energy and disruption in sleep-wake rhythm without clear symptoms of depressed mood
- Residents with a loss of physical and cognitive function out of proportion to or unexplained by a recent episode of illness
- A recent onset of delusions, hallucinations or disruptive behavior
- Presentation of depressed mood, sadness or tearfulness
Improving Outcomes for SAD Residents
The American Psychiatric Association’s guidelines for managing major depressive disorders include interventions such as:
- Exercise (especially Tai Chi)
- Counseling
- Antidepressant therapy
- Light therapy
- Comforting relationships with caregivers
- Effective referral networks
- Careful follow-up on medication regimen
Depression isn’t something you just "snap out of," and it's important to recognize the signs and symptoms. Holidays are stressful times for many people and a little extra TLC from you may make the difference in your residents’ lives. Patience is a gift for residents suffering with depression all year, but especially during the holidays.
For additional information on senior depression and SAD, refer to www.psych.org. For additional training opportunities for your caregivers, go to www.HealthCapUSA.com. Thanks and happy holidays!
