When people in their 70s or 80s walk into a hospital emergency room with no obvious physical symptoms, medical residents often think their problem must be brain impairment. But that’s “nonsense,” said Ole J. Thienhaus, M.D., of the University of Arizona department of psychiatry, speaking at the “Aging and Mental Health Issues” session at the Interfaith Community Services conference, “Faith, Community and Mental Illness: Mind, Body, Spirit and Community,” which was held April 25 at Catalina United Methodist Church.
Of course, many people do suffer from dimunition of cognitive abilities —and that can contribute to depression. But especially now, with more health-conscious and physically active baby boomers, “an older person should be as little depressed as a younger person,” he said.
That’s not to say that seniors can’t experience the onset of mental illness, particularly depression. But the reasons are more complex than old age.
Seniors may often see a doctor, but “a senior doesn’t come in and say, ‘I’m depressed. I need Prozac.’ A change of behavior is most often noticed by the people around them, perhaps a daughter-in-law,” he said, drawing laughter from the audience.
An ongoing problem for many seniors is that “medications for physical problems can make older people feel worse,” noted the psychiatrist.
“Allergy meds can precipitate major depression,” said Thienhaus. “The Vietnam generation is now of Medicare age. Many have lived with substance abuse. Once the immediate benefit of a nightcap wears off, depression can increase in the aftermath.”
A greater understanding of the mind and body connection can help. For example, if someone has heart disease and exhibits deteriorating behavior, “it’s a very good idea to get treatment for major depression. Otherwise,” he said, “there’s a higher incidence of death from heart disease.”
Another issue can be pseudodementia, a term for cognitive decline, typically overlapping with escalating depression in older people. Major depression “may have a risk of suicide,” said Thienhaus. “The risk rises dramatically in older men. Old people who have suicidal ideation act on it more often than young people who think about it more.”
Many seniors who have recently seen their primary physicians “were never asked if they were suicidal,” he said.
Thienhaus noted that “drug representatives are always walking around hospital hallways. There are a lot of therapies in addition to biological therapies [that can be useful in treating depression], including group therapy and cognitive behavioral therapy.”
Sometimes, he said, “We overrate family networks. We don’t know how much elder abuse” may have gone on in any given situation. On the other hand, if a senior is doing well at home, “even a year of not being in a nursing facility makes a difference and can help longevity.”
At any time, seniors can have “a remission to health, [make] a lasting connection to their full potential, which means they’re reconnecting to life,” affirmed Thienhaus. “We all have our good and bad days.”