Depression and anxiety disorders in older people Depression is more ...

Depression and anxiety disorders in older people Fact sheet 17

What is depression? Depression is more than just a low mood – it’s a serious illness. People with depression find it hard to function every day. Depression can have serious effects on physical and mental health.

What is anxiety? An anxiety disorder is more than just feeling stressed or worried. For a person experiencing an anxiety disorder, anxious feelings cannot be brought under control easily. An anxiety disorder can be a serious condition that makes it hard for a person to cope with daily life. Depression and anxiety are common in Australia. In any one year, around one million Australian adults have depression, and over two million have an anxiety disorder.1

An older person may be depressed if, for more than two weeks, they have: 1. Felt sad, down or miserable most of the time, OR 2. Lost interest or pleasure in most of their usual activities. AND experienced a number of the following symptoms:

Behaviours • General slowing down or restlessness • Neglect of responsibilities and self-care • Withdrawing from family and friends • Decline in day-to-day ability to function, with confusion, worry and agitation • Inability to find pleasure in any activity

How do you know if an older person is depressed and not just sad? Depression in older people is common and may occur for different reasons. The onset of a physical illness or personal loss and sadness can be common, but depression is different and is not a normal part of ageing.

• Difficulty getting motivated in the morning • Behaviour which is out of character • Denial of depressive feelings – This can be used as a defence mechanism.

Thoughts • Indecisiveness • Loss of self-esteem • Persistent suicidal thoughts • Negative comments – e.g. “I’m a failure”, “It’s my fault”, “Life is not worth living” • Excessive concerns about financial situation • Perceived change of status within the family

1 Australian Bureau of Statistics (2008) 2007 National Survey of Mental Health and Wellbeing: Summary of Results (4326.0). Canberra: ABS.

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Feelings • Moodiness or irritability – may present as angry or aggressive • Sadness, hopelessness or emptiness • Overwhelmed • Worthless, guilty

Physical symptoms • Sleeping more or less than usual • Feeling tired all the time • Slowed movement • Memory problems • Unexplained headaches, backache, pain or similar complaints

What makes an older person more at risk of depression? • An increase in physical health problems or chronic conditions e.g. heart disease, stroke, Alzheimer’s disease • Chronic pain • Side-effects from medications • Losses – e.g. relationships, independence, work and income, self-worth, mobility and flexibility • Social isolation • Significant change in living arrangements – e.g. moving from an independent to a care setting • Admission to hospital

• Digestive upsets, nausea, changes in bowel habits

• Grief and loss, including particular anniversaries and the memories they evoke

• Agitation, hand wringing, pacing

Early detection and treatment may help to keep depression from becoming severe. Depression is treatable and effective treatments are available.

• Loss or change of appetite • Significant weight loss (or gain) It’s important to note, everyone experiences some of these symptoms from time to time – it may not necessarily mean a person is depressed. Equally, not every person who is experiencing depression will have all of these symptoms. Additionally, older people may use different language to refer to their depression. Instead of describing ‘sadness’, for example, they may talk about ‘their nerves’. Dementia can also co-exist and mask depression and a thorough assessment is recommended.


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How do you know if an older person has anxiety?

How common is depression and anxiety?

The symptoms of anxiety disorders can often develop gradually over time. Given that we all experience some anxiety, it can sometimes be hard to know how much is too much. To be diagnosed with an anxiety disorder, the anxiety must have a disabling impact on the person’s life.

While the precise rates of depression and anxiety in older people are not yet known, it is thought that between 10 per cent and 15 per cent of older people experience depression and approximately 10 per cent experience anxiety. Rates of depression among people living in residential aged-care facilities are believed to be much higher than the general population – around 35 per cent.2

There are many types of anxiety disorders. While the symptoms for each disorder are different, some general signs and symptoms include: • feeling very worried or anxious most of the time • finding it difficult to calm down • feeling overwhelmed or frightened by sudden feelings of intense panic/anxiety • experiencing recurring thoughts that cause anxiety, but may seem silly to others • avoiding situations or things which cause anxiety (e.g. social events or crowded places) • experiencing ongoing difficulties (e.g. nightmares/flashbacks) after a traumatic event. To date, there has been little research into anxiety disorders in older people. While depression and anxiety are different conditions, they share many causes and some symptoms and it is not uncommon for depression and anxiety to occur together. Anxiety disorders are treatable and effective treatments are available. The earlier a person seeks help and gets the right treatment, the sooner he or she can recover.

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What are the treatments? The encouraging news is that there is a range of treatments, health professionals and services available to help with depression and anxiety, and there are many things that people with depression or anxiety can do to help themselves. Different types of depression – and different types of anxiety disorders – require different types of treatment. This may include lifestyle changes (such as diet and physical exercise) for preventing and treating mild symptoms of depression or anxiety, through to psychological treatment and drug treatments for moderate to severe levels of depression and/or anxiety. Depression and anxiety must be recognised in order to be treated. The key to successful treatment is an appropriate assessment by a doctor or other health professional. Both personal and professional carers are an invaluable source of information about personality or cognitive changes in the person and should be included in discussions where possible. 2 beyondblue depression in older age: a scoping study. Final Report – National Ageing Research Institute (NARI), September 2009


Psychological treatments Psychological treatments (also known as talking therapies) help to improve people’s coping skills so they feel more able to deal with life’s stresses and conflicts.

• Like any other medication, some people who take antidepressants also experience some side-effects. The prescribing health professional should discuss differences in effects and possible side-effects of medications.

• Interpersonal Therapy (IPT) helps to improve relationships and/or cope with grief.

• The decision to start taking antidepressant medication is one that should be carefully considered and supervised by a doctor. This should also be the case when going off medication.

Medications

Every person needs to find the treatment that’s right for them.

• Cognitive Behaviour Therapy (CBT) helps to correct negative thought patterns.

People who are depressed often feel physically unwell, with resulting sleep and appetite changes. Antidepressant medication may be prescribed, along with psychological treatments, when a person experiences a moderate to severe episode of depression (or anxiety). • Antidepressant drug treatments can help to relieve the physical symptoms of moderate and severe depression (and some anxiety disorders). • Antidepressants can make people feel better, but antidepressants will not change their personality or make them feel happy all the time. • Medication can take between two and four weeks to begin to work and it may also take some time for the doctor to find the medication and dose that is most effective.

How much does treatment cost? Mental health assessment and treatment services geared towards older people are available free of charge through the public health system. Services are also available through private health professionals and treatment costs vary. Subsidised psychological treatments are available through several government initiatives. This means that part or all of the cost to see a health professional for depression or anxiety is covered – usually by a rebate. It is important to recognise that psychological treatment doesn’t have to cost very much and can have many benefits. If you are unsure if you are eligible for subsidised treatment, check with your GP.


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Helpful tips

Advice for partners and carers

• Find out about depression and anxiety. These are common illnesses, they are not a sign of weakness and there is no shame in seeking help.

• Encourage and support the person to seek help from a doctor or other health professional.

• Don’t ignore the symptoms. If you think you may have depression or anxiety, speak to your doctor. Effective treatments are available. • Keep in touch with family and friends – for those who feel isolated there are many groups for older people in both cities and regional centres offering social opportunities. (Contact your local council or the Council on the Ageing in your state or territory.) • Try to do some exercise every day and maintain a good diet – both are important in promoting good overall mental and physical health. • Allow yourself time to relax and reduce your stress. Plan and participate in enjoyable activities. • Get enough sleep. Depression and anxiety disrupts sleep patterns. Talk to your doctor if you’re having trouble sleeping. • Remember – depression and anxiety are not a normal part of getting older. Go to www.beyondblue.org.au for fact sheets on keeping active, diet, stress and sleeping well.

• Offer practical support by assisting the person to make an appointment and either provide or arrange transport. • Offer help with daily tasks at the person’s home. • Educate yourself about depression and anxiety so you can understand what the person is experiencing. • Help the person to follow his or her treatment plan — for example, practising the coping techniques and skills learnt during psychological therapy, taking medications as prescribed and adopting recommended lifestyle changes. • If the person complains of side-effects from the medication, encourage them to discuss these with their doctor. • Be supportive — people with depression and/or anxiety can feel alone and isolated, and consistent support and understanding is important to their recovery. • Carers and partners are also at an increased risk of depression and anxiety, so it’s important that you look after your own health. For more tips, order the free beyondblue Guide for Carers booklet and DVD at www.beyondblue.org.au or call 1300 22 4636.


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The beyondblue booklet Older people and depression: Depression is not a normal part of ageing provides information about depression in older people, available treatments and support, tips on keeping active, and stories from beyondblue’s ‘Over Bl**dy Eighty!’ (OBE) campaign. The OBE... Our stories booklet is a marvellous collection of positive personal stories from older Australians.

stories OBE...Our stories OBE...Our stories A marvellous collection of personal stories from older Australians

OLDER PEOPLE AND DEPRESSION Depression is not a normal part of ageing

‘Over Bl**dy Eighty’

For more information

www.beyondblue.org.au or beyondblue info line 1300 22 4636

Both booklets are available free from beyondblue at www.beyondblue.org.au or by calling 1300 22 4636.

MORE INFORMATION beyondblue www.beyondblue.org.au 1300 22 4636 or [email protected] Information on depression and anxiety, available treatments and where to get help

Lifeline 13 11 14 Counselling, information and referral

MensLine Australia 1300 78 99 78 Support for men and their families

Suicide Call Back Service 1300 659 467 Telephone support for those at risk of suicide, their carers and those bereaved by suicide

Carers Australia 1800 242 636 Information, referral and support for carers

Relationships Australia 1300 364 277 Relationship support and counselling

beyondblue Info line 1300 22 4636 or [email protected] www.beyondblue.org.au

www.cotaaustralia.org.au Health and wellbeing programs in each state and territory

© Beyond Blue Ltd

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BL/0063 02/12

Council on the Ageing (COTA)