Geriatric Depression

In her book, The Age of Miracles: Embracing the New Midlife, Marianne Williams suggests that midlife is a time of transition “for one part of ourselves to die and for something new to be born.”  This seems to be particularly true for Americans over the age of sixty-five and is a reality that leads to geriatric depression if not traversed successfully. In previous posts, I discussed reasons why older people might become depressed and ways to help them overcome it. If those basic techniques have proven insufficient, you can always take a more focused approach.

A more focused approach involves five steps: evaluating, brainstorming, planning, scheduling, and re-evaluating.  Evaluating helps you clearly understand the person’s strengths and challenges while providing a baseline from which to work. Brainstorming provides a venue for looking at possibilities and choices, and it generates a list of possibilities that will inspire your loved one to get involved in life again. Planning has a two-fold purpose because you want the person to not only  “buy in” but also agree which ideas to pursue. Scheduling acts as a reminder and motivator. Finally, the fifth step relies on Re-evaluating to ensure you have a successful plan. So, let’s look at each of the steps closely.

Evaluating

Before you can truly help a loved one, you must understand the person’s situation. Evaluation is key to your success, and it is also step one. Evaluating includes asking questions about a variety of issues: health and medications, capabilities, self-care and self- talk, interests, and finances, as well as, support systems and self-sabotage. Once you have this information, you’ll also be prepared to move to step two.

  • Health.  You must clearly understand the person’s health issues because it would be unwise to suggest an exercise program for someone with a heart problem or mobility issues. Important information you need to ask includes what illnesses or ailments the person is experiencing; how these diseases affect the person’s mood and mobility; and, what limitations the person experiences, if any. After you’ve acquired this information accompany the person to his or her health care practitioner and use the acquired knowledge to establish a baseline.  
  • Medications.  It is important to know what medications and doses are being used because this can affect how a person feels. Questions to ask include: Do the meds interfere with any activities? Are they used properly? Are they compatible or do they interact with each other?  Does the person need medications for depression? or, Is the person currently seeing a therapist?
  • Capabilities.  It’s important to know what the person can realistically do because you don’t want to suggest something potentially harmful or get the person’s hopes up only to realize he or she can’t handle it.  Questions to explore include: How well can the person get around?  Can the person go outside? and, Can the person handle a job or volunteer position?
  • Self-care.  If a person can’t take care of him or herself, it can affect your decisions and suggestions. Begin by checking out the person’s living conditions, and then ask: Is the environment clean? Is the person’s hygiene good? Is the person getting out of bed in the morning? Is the person sleeping too much or too little?  and, Is the person getting fresh air?
  • Self-talk.  What a person says to him or herself and others is indicative of the person’s mood and underlying beliefs about life. Aging has numerous challenges, and, so, it is imperative to have a positive attitude. Listen closely to what the person says. What is the person’s attitude? What do they say to others? Are they self-deprecating? Negative? Does the person have hope for the future?
  • Interests.  Explore what activities or suggestions gives your loved one a spark and a reason to step out of depression. What sounds interesting to the person? What would the person be willing to try? and, What makes the person curious? Once you’ve acquired this information you can rule out activities the person’s hates, things the person’s tried, or things the person no longer wants to do. In other words, you want to seek activities that are meaningful enough for the person to want to get up in the morning.
  • Financial.  Know what the person can realistically afford and understand the person’s financial situation. You don’t want to suggest taking a trip and find out your loved one can’t afford it. That could cause further depression. Questions to pursue include: What is the person’s monthly income? Are they on a fixed income? Do they spend their money wisely?  or, What is the person’s total wealth?
  • Support system.  Part of geriatric depression is caused by loneliness or being home alone too much. Therefore, you want to know who the person communicates with regularly or who the person may be able to add to the communication list. Also, find out if the person uses a computer and who the person sees regularly.
  • Self-Sabotage.  Explore what might get in the way of a plan so your endeavors will be successful. Questions to ask include: What is depressing to the person? What is the person saying about life and living? Would the person be willing to work on a plan for a happier life? and, What has made the person happy in the past?

Brainstorming

Brainstorming is step two. You and your loved one will make a list of possible actions without ruling anything out. For example, on a blank piece of paper at the top of the page you will write, “Things to do right now.” Then, together you and your loved one will write down everything that comes to mind, such as bake a cake, climb a mountain, visit my brother, take up painting, go for a walk, do the dishes, wash the car, and so forth. The idea is to generate as many options as possible without rejecting any. Brainstorming expands horizons and lowers barriers; however, follow through is up to the individual because people can choose to make the most of their situations or they can choose to be victims of it. In the planning step, the activities generated during brainstorming can be looked at, updated, and used as future reference sources.

Planning

To help overcome geriatric depression, the third step involves planning, and that can occur given the outcome of the evaluation and the list of possibilities. The chosen activities will be based on what the person is willing to try, what the person thinks he or she can do, and what activities they find interesting. Another part of the plan should include determining what will excite your loved one about life and how you can get the person started on the plan.

Make a list of all the chosen possibilities, and, include in this list, how you plan to move forward. A plan provides structure and acts as a motivating force. For example, if the person has decided to join a bowling team, a plan would include such things as where to buy bowling shoes and a ball, how to find a team, how to get a team shirt, how many times a week the person will bowl, and how the person will get there.

After you have completed the plan, make a written agreement because sometimes, no matter how exciting an activity may seem, doing it alone is just too difficult. In the agreement promise that you will provide support and have your loved one promise he or she will follow through. A contract adds weight to the commitment. Additionally, because you both sign, it increases the commitment, shows your commitment, and encourages your loved one to participate fully.

Scheduling

To make scheduling easy, buy a calendar and plan a month’s worth of activities. Assign amounts of time for each activity, and create a schedule. Include a check off column, and then encourage your loved one to check off daily accomplishments. Also, use the schedule as a motivator for doing, and, then, periodically check on the person’s progress.

You should also have certain tasks that MUST be completed daily. Suggestions may include:

  • Get dressed, put on make-up, shave, and so forth. Getting dressed and cleaning up improves people’s moods and helps them feel better.
  • Read motivational material. Authors that come to mind are Wayne Dyer, Marcie Shimoff, Louise Hay, and Cheryl Richardson. This type of reading is inspirational and provides hope.
  • Go outdoors, when possible. Fresh air is always refreshing, and there’s nothing better to cheer someone up than a glimpse outdoors.
  • Exercise daily for health. Most everything you read praises the merits of exercise. That’s because it improves moods, increases mobility, and aids health.
  • Maintain a clean and cheerful environment. If living quarters are dark and dirty, it’s depressing. Make sure your loved one does daily chores that keep his or her living quarters clean. Additionally, one way you can brighten a home is to add plants and flowers. These small additions create positive attitudes and help bring the outdoors inside.
  • Eat at least three nutritious meals. Sometimes older people forget to eat, or, if they are alone, they may be too lazy to fix it. So, make sure this is on the list.

Remember to include emotional, physical, spiritual, and mental aspects in your plan. If you need help to know what kind of emotional, physical, spiritual, and mental things to suggest, read How to Take Action Against Elderly Depression because you want to give your loved one the optimal chance to achieve total health and wellness.

Re-evaluating Regularly

The final step for geriatric depression is continued and ongoing re-evaluation of the plan and schedule you have established. You will find some things will work and some things won’t work. Sometimes things may need minor tweaking or even major changes. You won’t know what’s working and what’s not if you don’t re-evaluate. Until the plan is smooth and suitable, you may need to meet weekly, if only by phone, to accomplish this step.

Conclusion

Geriatric depression is a serious issue. There are many things, you can do support your loved one, and there are many things you can implement to help your loved one find happiness in spite of life’s transitions. However, if what I have suggested doesn’t seem to be as successful as you would like or if the person seems to not improve and stays depressed, I recommend you seek the help of a health care practitioner or a therapist, and, when doing so, ensure they have expertise in working with the elderly.

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