Signs and Symptoms of Depression and Anxiety Older Adults
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When asked, what are the most important things to know about anxiety and depression for older adults. Here's what I would say. First is that while anxiety and depression are some of the most common mental health conditions among older adults, anxiety and depression are not normal with aging and really deserve to be investigated if, if older adults are demonstrating signs of anxiety and depression.

We know that there are actually very good treatments for anxiety and depression. It can include a combination of medications like antidepressant medications and psychotherapies. And so it's really important if you're Noticing signs and symptoms of anxiety and depression among older adults that you encourage the older adult to get checked out, and we'll talk about that in a minute. Another important thing I would say about anxiety and depression is that when mental health conditions go unrecognized and untreated in older adults, it actually can have a huge impact on the health and wellbeing of the older adult and not just psychological health and wellbeing. But physical health and wellbeing as well.

We know that when mental health conditions go unrecognized and untreated among older adults, this can result in worsening of medical problems, the need for more medications for their medical problems, longer hospital stays when somebody's medically hospitalized for a medical condition, more family strain because the caregiving needs are higher.

more functional impairments, meaning that the person needs assistance with ADLs and IADLs, like dressing and toileting or transportation, and then needless suffering and caregiver stress and strain, finally increased risk for suicide. So it's really important that if you suspect the person might be experiencing anxiety or depression, that you Encourage them to get an evaluation with their primary care provider.

Sometimes symptoms of anxiety and depression, especially in older adults, can be a symptom of a medical problem, can be a symptom of a medication side effect, can be a symptom of a medication interaction. So when you're taking multiple medications, how those medications interact, and so many other things that might actually be treated with medical intervention alone.

If you're noticing changes in your older clients, encourage the older person to start with their primary care provider to make sure all of their healthcare, medical healthcare needs are addressed.

Okay, so what are the signs and symptoms of depression? I like to use an acronym. The acronym is called SIGECAPS, S I G E C A P S. And so what does this stand for? The first is sleep. Are there changes to the person's sleep? Are they sleeping too much or too little? Has their sleep changed significantly in recent months?

I is interest. Has the person lost interest in activities they used to enjoy? Have they stopped going to the senior center? Have they stopped participating in their book club or volunteer organizations? Are they not having as many phone calls with beloved family members?

Those are signs that the person has lost interest in things that they used to enjoy. G. G stands for guilt, but in older adults, I interpret this as despair. So despair can mean the complete loss or absence of hope, that there's sort of a sense of doom and no purpose to go on living. So instead of guilt, I look for despair. Then E is energy. Have they lost the energy that they used to have? Are they taking more naps than usual?

This gets a little tricky among older adults because sometimes as people, especially much later in their older adulthood, like 90s and 100s, might need more rest time.

C is concentration. Are they noticing changes to their memory where in recent weeks or months they felt masterful.

A is appetite. Are they eating more or less than they had been a couple of weeks ago? P are changes to their bodily movements. So it's psychomotor agitation. Like are they restless? and can't sit still, and maybe even they're fidgeting when they're talking with you, and it's not a result of Parkinsonism or Parkinson's disease or another movement disorder, or are they unusually still, so the opposite?

So are they blunted? Are they really flat? Are they not moving at all? And then, S is, are they isolating socially? And so are they withdrawing from social relationships and family relationships that they used to really enjoy? So all of those symptoms are something to be mindful of.

Another ingredient of depression to be mindful of among older adults is that sometimes, The person might describe more physical sensations and changes in their body than they will in their psyche. Like, instead of saying, I'm in despair, people don't tend to use that word, they might say, I just don't feel good. I'm fatigued. I'm tired. I don't have energy. I just don't feel good in my body. I feel really uncomfortable. I feel like something bad is going to happen. I don't feel like myself. I'm having a lot of GI upset or stomach upset or more chronic pain. And so this is why, as I mentioned earlier, it's really helpful to encourage the person to get checked out with their medical provider, their primary care provider first because we want to be sure we're addressing all the physical health needs in addition to the mental health needs, but it will help us to clarify it.

where the mental health needs are coming from. Is it coming from a medical condition that needs care or vitamin deficiency or a medication or a medication interaction that can be changed? Or is it coming from a depression disorder? The good news about depressive disorders among older adults is that they're as treatable in older adults as they are in other age groups.

So it's really helpful and important to encourage them to get checked out and then treated.

Okay, so what are the signs of anxiety in older adults?

The first is excessive worry or fear, sense of doom, a sense of what's going to happen. I don't know what's going to happen. What if it doesn't happen? Another is refusing to do daily routines or being very rigid and preoccupied with routines. As you're noticing in these conditions, people can fall on either pole, either they're eating too much or too little, sleeping too much or too little, being rigid or avoidant altogether.

Another is avoiding social situations or being preoccupied with safety. I work with many older adults who use assistive devices like a wheelchair or a cane. And there can be fear like, what if I fall? Who will help me? And so there's a fear about what will happen and needing to maintain safety and integrity of self. Like you don't want to fall and get hurt. And so then. Avoid the situation and stay inside to avoid going out with the possibility of falling and then being stuck . Racing heart, shallow breathing, trembling, being revved up inside, feeling a little restless.

Those can also be signs of anxiety. Here, again, the tricky thing is, they could be signs of a medical condition as well. So, again, with anxiety, we start with the primary care provider. More symptoms include poor sleep, as you can imagine if you've ever been anxious and you have those racing thoughts all night long,

and things like muscle tension or feeling tense and rigid and, unwell or, focus on pain and GI upset. Again, those physical symptoms especially the person's experiencing racing heart or shallow breathing and it's due to anxiety that can get very scary if they also have a health condition or a lung condition, or a pain condition. And so, it's really important that you're encouraging them to connect with their primary care provider and then hopefully from there, also a mental health provider because anxiety is also treatable among older adults. When anxiety goes untreated among older adults, This can actually increase risk for dementia disorders, so we really want to encourage older adults to get connected to primary care provider and to mental health care when they're demonstrating mental health concerns.

The tricky thing with older adults is that as we age, our bodies become more vulnerable to medical problems and conditions.

And we know that when people are diagnosed with a medical condition, the rates of depression, And anxiety go up. We also know that when people experience functional impairments, like they need assistance with transportation or bathing and grooming and eating, rates of depression and anxiety go up.

So what's really important to know here is that a person often can experience both. They can experience a medical problem and a depression and anxiety or anxiety, their medical problem and the depression and anxiety each deserve attention and care.

Here's another strategy I want to give you when working with older adults who may be depressed. It's called the five D's of suicide risk. This was developed by Dr. Yates Conwell out of University of Rochester. He and colleagues came up with this five D's of suicide risk. So the five D's are depression, disability. So disability includes functional impairment, like needing assistance with transportation, bathing, dressing. grooming, toileting, preparing meals, disconnectedness, so are they not connecting with friends or family or a community disease. So disease including conditions like dementia disorders. So a new diagnosis of a dementia disorder, Parkinson's disease, and other health conditions also can increase the risk of suicide. And finally, deadly means like stockpiling medications or weapons, et cetera. Those are the five D's of suicide risk.

If older adults are endorsing each one of those, their risk for suicide is higher. And why this is so important is that white men, 85 and older, have the highest rate of suicide more than any other age group.

The other reason it's important to know these five D's is that we can intervene in each of these areas to lower the risk of suicide. So we can intervene with depression, it's treatable. We can intervene with disability. We can provide supports in the home to help the person function and maintain independence as long as possible.

We can intervene with disconnectedness. Meaning that we can encourage social participation, home based primary care programs can be helpful with that, senior communities can be very helpful with that. We can intervene with disease, so we can be sure that we're encouraging the older adult to optimize their medical care so that their health is as optimized as possible.

And then finally, we can intervene with deadly means, meaning that we can remove guns from the home, talk with family and friends to help, with disseminating medication so that the person's not stockpiling it, et cetera. So knowing these risk factors is really, really helpful. So that we know where we can intervene.

Of course, there are additional risk factors like substance use and chronic pain that also increase the risk. So those need to be attended to as well. But these five D's of suicide risk are really key. Knowing these five D's and that we can intervene to improve the quality of life of the older person can possibly help to inspire hope for that person

what helps to protect people from depression and anxiety and suicide in the first place. Social engagement is really important. Making sure that the person has optimal health care is also very important. Making sure that the person understands their medical condition to the extent that they want to. And that their mental health care is taken seriously.

I've worked with many people who may be bed bound or, have other limitations and are not able to go out into the community in terms of being as social as they would like to be. And so we work together on identifying what else brings the person a sense of meaning and purpose in their life. Another protective factor is helping the older person to

think back over the course of their life when they moved through hardship. And what about them? What did they use internally that got them through previous hardships in their life in the past? And so those are three things that could be helpful in helping to foster some protective factors for older adults.

So one is social connection. Two is developing and cultivating a sense of meaning and purpose in your life. And three is reflecting on other times in your life that you moved through hardship and how you got through them.

So how can we have better conversations that de stigmatize mental health for older adults and encourage care? When it comes to having better conversations that de stigmatize mental health and substance use treatment for older adults, I first start with the spirit with which I'm approaching this conversation and this work. So inside of myself, I truly believe in my core that every person at every age with every ability is worthy. Of healing and transformation and love, and that there is no expiration date on this process. And so when I'm having conversations with people about mental health I approach the conversation with that spirit and that spirit, which comes from inside of myself holds that we are human and that we are in this together and that you don't have to do it alone.

And that there is hope for a more peaceful tomorrow. You might not be able to remove medical illness. But we can help people to find a greater sense of peace and belonging and hope for a better tomorrow for themselves. And so that's sort of how I approach these, the spirit with which I approach these conversations.

The other is to really. Respect the person's autonomy. What do they really want? I think often with older adults, we project our wish onto them and it sometimes doesn't match what they want for their life. And so to really be curious. about what the person wants for their own health? What are they actually seeking in terms of what they need for addressing their mental health concerns?

Do they need more information about their medical condition? Do they need more support in the home? Do they need mental health care and to speak with a doctor? And so, really to get curious about what the person needs and wants, and what they want their life to look like, and what they want their their life to include.

It is a beautiful thing to be on the journey with anybody. You have to do that in a way that doesn't infantilize, that doesn't condescend, that supports, that is curious and is a supportive presence and guide.