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Content warning: This article discusses topics such as suicide and depression which may be sensitive for some readers.
On April 30, five-time Grammy winner Naomi Judd died by suicide in her home in Tennessee. Judd's daughters shared the heartbreaking news on social media, revealing that they had lost their "beautiful mother to the disease of mental illness."
“When we’re talking about mental illness, it’s very important to be clear and to make the distinction between our loved ones and the disease,” she said. “It’s very real […] it lies, it’s savage.”
Judd’s death is now sparking an important conversation about how mental illness can affect people of all ages, including seniors.
While not all older adults will ask for help when they experience symptoms of depression, mental health experts in Canada say it’s important for family members to be aware of the warning signs and how to get help when their loved ones need it.
Depression can be challenging to diagnose in seniors, experts say
The Centre for Addiction and Mental Health defines depression as a biological illness caused by a chemical imbalance in the brain that can affect someone’s thoughts, feelings, behaviour and physical health.
The mental illness should not be confused as feeling sad or experiencing grief, but it can be triggered by sad events in someone’s life, like losing a loved one or loss of independence. Depression can also be caused by some medical conditions, including chronic pain, stroke and even certain medications.
Dr. Suparna Madan, a geriatric psychiatrist in Calgary, says it can be challenging to diagnose depression in seniors because healthcare professionals and older adults may see it as a “natural reaction to loss, negative life events or physical [health] decline.”
“There can also be a lot of overlap between depressive symptoms, including symptoms such as sleep, energy, concentration and appetite and other co-morbid medical conditions, which makes depression difficult to recognize,” Madan tells Yahoo Canada.
The psychiatrist also notes that depression can be overlooked in older patients because sadness is a common feature of depression and many seniors may not appear sad, but present "irritability or physical symptoms like headaches or upset stomachs.”
Who is at risk of depression?
According to a Canadian in-home health care provider for seniors, Comfort Keepers, 10 to 15 per cent of seniors suffer from depression in Canada.
Seniors are also at a greater risk of suicide than the younger population, men more so than women.
Nitika Rewari, director of prevention and promotion initiatives at the Mental Health Commission of Canada, says there are a number of factors that can put a strain on a senior’s mental health and lead to thoughts of suicide, including major life changes, fewer connections or relationships, feeling like a burden on others and loneliness.
“There are lots of reasons and depression is certainly the most common mental health problem associated with suicide in later life,” Rewari tells Yahoo Canada.
Rewari adds that COVID-19 has also “disproportionately impacted older adults.”
“With COVID-19 what came about was loneliness and not being able to engage," she notes. "It’s a sense of belonging, and a sense of community."
What are the warning signs of depression in older adults?
The Centers for Disease Control and Prevention (CDC) says older adults are often “misdiagnosed and under-treated” when it comes to depression.
Madan says that could be "due to the stigma of mental illness, bias in recognizing symptoms, and factors such as cognitive impairment limiting an individual’s ability to articulate their symptoms."
The Mental Health Commission of Canada highlights that any significant change in behaviour or mood may be a warning sign of depression. Those changes may include losing interest in a previously enjoyed hobby or activity, disconnecting from friends and family, higher levels of irritability, and increases in alcohol or drug use.
People with depression may display acute warning signs of suicide such as:
Threatening or talking about hurting or killing him/herself
Looking for ways to kill him/herself
Talking or writing about death, dying or suicide
“That’s when you need to call 911 right away or local crisis centre,” Rewari says. “Even those longer-term warning signs, you want to reach out for help, you want to get them to seek help through a family physician or emergency, depending on what the situation is about.”
Reducing the risk of depression and suicide
Not all cases of depression can be prevented, but experts say the risk can be lessened for some older adults by keeping them engaged in activities and giving them a sense of purpose.
Certain lifestyle changes that may help include:
Physical activity and eating a healthy, balanced diet
Getting seven to nine hours of sleep
Keeping in touch with friends and family
Taking part in activities they enjoy, being active in the community
Talking to friends, family, and a doctor if they are struggling and start experiencing symptoms of depression
How do you treat depression in older adults?
There are various treatment options available to help someone who is diagnosed with depression.
Madan says the illness is treatable with medications, psychotherapy and/or neuro-stimulation options.
“Access to treatment is crucial for those who have mental illness,” Madan advises. “For seniors, this may entail the availability of home visits and integrated services.”
Therapy and supportive activities, like social groups, can also be important in a person’s recovery.
Support your loved ones by starting a conversation about their mental health
People suffering from depression may not recognize it at first or may be too ashamed to bring it up with their families and friends.
That’s why it’s important to keep an eye on your older family members or friends so you can quickly notice any changes in behaviour.
If you are concerned about suicide in an older adult, experts recommend having a conversation with them about any changes that you are seeing.
If you're unsure what you should be watching out for, educating yourself on mental illness is a good first step. There are a number of resources online that can be accessed at any time.
Rewari says with the size of the aging baby boom population, there will soon be an even higher demand for services for seniors.
With time she hopes to see more awareness about suicide and a reduction of stigma when it comes to mental illness.
“Mental health problems are not an inevitable part of aging, so we all need to do our collective part,” she says. “Be open to having a conversation, be open to noticing if someone’s behaviour is changing, be open to asking 'are you ok?'”