Depression is a real and often misdiagnosed condition among Maine’s aging population, according to those who work with the state’s elderly population.
Just over 17 percent of Mainers age 65 years and older have been diagnosed with some form of depression, according to the 2016 American’s Health Rankings’ Senior Report.
“I do think it is most likely underdiagnosed and for a lot of reasons,” said Melissa Stoliker, psychiatric mental health nurse practitioner at Northern Maine Medical Center. “We need to remember that depression is not a sign of normal aging or part of the normal aging process.”
But depression can go hand-in-hand with growing older, according to Dr. Kim Lane, associate professor of mental health and human services at the University of Maine at Augusta.
“A lot of things happen with aging,” Lane said. “There can be the loss of a significant other, the loss of friends and family, the loss of the ability to drive or get out to social events, and the loss of social contact.”
The isolation that comes from the loss of social contact is among the No. 1 factors behind depression among the elderly, according to Lane.
“It’s a huge factor,” she said. “And it can be tough just finding those [depressed] people who are often very stoic and won’t ask for help. Being the ‘stoic Mainer’ can really hurt you.”
Signs of depression, Lane said, include changes in sleeping patterns, a loss of interest in things an individual once enjoyed, changes in eating patterns and trouble with making decisions.
This time of year particularly, as family and friends gather for the holidays, it’s important to keep an eye out for any of those symptoms, according to Sharon Berz, long-term care director at the Aroostook Area Agency on Aging.
“We have a very high rate of depression here in Aroostook [County] because we are considered really isolated, and some areas within the county truly isolated,” Berz said. “Plus this time of year there is very little sunlight and less opportunities for the elderly to get outside and be active.”
All of that, Berz and Lane said, can contribute to feelings of depression among the elderly.
“There really are so many factors affecting it,” Berz said. “It’s hard to pinpoint one thing.”
But pinpointing the condition is the first step in getting a senior citizen the help they need, Berz said.
More and more physicians and health care professionals are automatically using the “PHQ-9,” or “Patient Health Questionnaire” depression screening tool to identify those in need, Berz said.
“This is a tool recognized by health care professionals,” she said. “It is being used for people receiving meals in their home, in long-term care and in doctor’s offices or clinics.”
Berz said she has personally seen individuals who scored high — those showing strong signs of depression — referred to primary care givers and getting the help they needed within 24 hours.
“I was really impressed,” she said. “Physicians take these scores very seriously, [and] these tests are being given automatically now more and more.”
And that’s important, according to Stoliker.
“I find with my elderly patients you have to ask the right questions [because] as a generation they are so stoic and often will not bring up what is really troubling them,” she said. “The [PHQ-9] screening is a great way to catch them if those questions are not asked.”
While there are medications that can help with depression, health care professionals such as Lane say they are not always the best solution.
“Often times the elderly are on medications already that have the side effects of causing depression like cardiac drugs or beta blockers,” she said. “Do you really want to give an aging person a litany of medical antidepressants on top of that?”
Societal options also are as important as chemical solutions, Lane said.
“We need to make connections with these people,” she said. “Years ago, we would sit on our stoops and have conversations with our neighbors, [and] now we don’t see that, we need to reach out and be friends with our neighbors.”
Lane is a fan of community-based initiatives that create what she called “aging-friendly” environments.
“It’s really grass-roots activity in an individual community,” she said. “There are lots of communities around the country working to resolve social isolation by looking at ways to provide transportation for the elderly and to help them age in their own homes while maintaining social contacts.”
There also is a risk, according to Stoliker, that elderly suffering from depression get misdiagnosed as having some form of dementia.
“Depression and anxiety can be accompanied by something we call ‘pseudo dementia,’ [where] the individual has a hard time concentrating and difficulty with memory,” she said. “There can be so much going on [with depression] that their mind is not working at full capacity, and those little details get lost [and] that can happen to anyone at any age, but with the elderly, it tends to get chalked up as part of ‘normal’ aging.”
Other medical issues such as dehydration, poor diet and urinary tract infections can not only contribute to depression, but they also present as dementia, Lane said, leading to misdiagnosis.
“Maine is doing a really good job in training people in geriatric care,” she said. “Maine has been growing older for years, and there has been a recognition we need to start effectively treating the aging population.”
With an average age of 43.5, Maine is the second oldest state in the country — behind Florida — with those over the age of 65 making up 18.24 percent of the population.
For elderly living alone and who are able to do so, Berz recommends going out to interact with friends, or if that is not possible, call someone to chat.
“All of us need to recognize who in our communities are living alone,” she said. “Either befriend them, bring them meals or try to find ways to involve them so they aren’t left in isolation.”
The most important thing, Stoliker said, is speaking up, and this time of year — with family holiday gatherings — is a good opportunity to do so.
“Don’t be afraid to have the conversation about emotions and feelings if you observe an elderly person you think may be feeling depressed,” she said. “As a person grows older and friends and family pass away, they may not have that regular support system, and they also find themselves facing their own mortality.”
In some cases those conversations may indicate an individual is in need of immediate, crisis prevention help, and in others, connecting the individual with a therapist is the best solution.
“Either way, help is there,” Stoliker said. “There are things that can be done that make a big difference, and that will return that quality of life to them.”
