I think she was right. If we’re physically healthy and financially stable, this can be one of the most fulfilling and exhilarating phases of our lives. And if we’re lucky, it can last for several years.
But the reality is, the clock is ticking, and as we age, we begin to experience a series of losses. Our mental processes slow down. We lose physical strength and flexibility. We develop diseases and conditions for which there are no cures. Chronic pain often becomes a constant companion. We grieve the deaths of friends, family members and spouses, and we mourn the life we are no longer living.
Is it any wonder that depression is the number one mental illness experienced by older people?
In 2010, according to the American Foundation for Suicide Prevention, the second highest rate of suicide (17.6%) was among people 85 years of age and older. (Just one percent lower than the highest ranked group (18.6%), which was people between the ages of 45 and 64.)
How can we encourage people in this age group to seek help with depression? And how can we recognize when someone is at risk for suicide?
Perhaps we should start with a reality check.
Debunk the Myth of the “Golden Years”
If we want to help older people understand and cope with their depression, anxiety, and other mental disorders, we must first acknowledge that there is nothing golden about experiencing ongoing losses and physical or mental decline.
Regardless of what we are called upon to overcome in our youth or middle years, no challenge we take on will ever demand more courage than facing the loss of our ability to care for ourselves and the reality of our own impending death.
So let’s be real in our conversations with older people and acknowledge that this is not an easy time. Ditch the sugar coating and address their concerns, fears and ongoing losses with genuine empathy and compassion.
Older People Don’t Talk About Mental Illness
In an effort to understand the attitude of older adults toward mental illness, I took my 87-year-old Aunt Jean out to dinner recently. I said, “Jean, I’d like to know your thoughts about depression and suicide in older people.”
She shook her head and said, “We don’t talk about it.”
When I asked why, she said, “It just isn’t something you talk about with other people.”
That was a big “Ah-ha!” moment for me. Aunt Jean is a member of the “Silent Generation” – people born between 1925 and 1945.
I asked if she’d ever heard her parents (my grandparents) express concern about the emotional well-being of their friends or other family members. Her answer was, “Never!”
She thought for a minute, and then she said, “When I was a senior in high school we lived in Ellenwood, Kansas. One week in 1942, three women committed suicide.”
“Three women!” I exclaimed. “Why? What happened? What was going on in that tiny community or in their individual lives that would have caused all three of them to commit suicide in the same week?”
She said, “I don’t know. No one ever talked about it.”
We need to recognize that members of the Silent Generation didn’t grow up with reality TV, Facebook or Twitter. They don’t reveal information about their sex lives or finances — and they don’t talk about their feelings, let alone post them on social media websites.
Respect Their Culture and Values
People who are now between the ages of 68 and 88 were raised during a time of national crisis. Many of them were children during The Great Depression when the focus was on survival, not self-actualization.
When Pearl Harbor was bombed in 1941, all of America went to war. Every man, woman and child was expected to make personal sacrifices and contribute to the good of the country as a whole.
The slogan, “Loose lips sink ships” became a part of the popular vernacular. Everyone knew that keeping secrets meant saving lives.
The culture in which they were raised made them pragmatic, stoic people who respected hard work and commitment. They were ambitious and goal oriented. They valued strength, integrity, and independence.
We must understand that, from their perspective, people who couldn’t manage their emotions were weak. Weakness signaled a lack of character, which was shameful and unacceptable.
Recognize the Signs of Depression
Based on their experiences and the culture in which they grew up, it’s unlikely that most members of the Silent Generation would admit to being depressed. Even if they acknowledged feeling “down,” it’s likely that they would dismiss their feelings by saying, “I’m just feeling sorry for myself.”
With that in mind, it may be up to us to recognize the behaviors that signal depression:
- Negative attitude
- Difficulty sleeping
- Refusing to eat
- Lack of concentration and difficulty making decisions
- Various body complaints, including headaches, backaches and various digestive disorders
- Sense of hopelessness
- Negative outlook for the future and a sense of “What’s the use of going on?”
According to geropsychologist Joseph M Casciani, President and Owner of Concept Healthcare, depression is often brought on by the diagnosis of a chronic, progressive or debilitating disease.
Dr. Casciani says in order to support an older person in managing their disease and their emotional reaction to it, we must strive to understand what their life was like before they got sick. What had they expected their life to be like at this point in time? What is their reality now? How do they explain what happened to them? Did they have any role in creating this situation? How do they feel about it?
A psychologist trained in geriatric issues will know how to ask questions and help an older person cope with the multiple losses and challenges that come with illness and aging. Medicare and Medicaid pay for psychological counseling, so depression is not something that has to be suffered alone in silence.
Help is available . . . The challenge is getting an older person to accept it
Perhaps the place to start de-stigmatizing mental health issues with elderly people is with recognizing their generational uniqueness. We need to be sensitive to their deeply ingrained attitudes toward depression, anxiety, and other mental disorders. We must respect their dignity, their privacy, and their need to feel independent and in control.
We cannot storm into their lives and make a diagnosis or pronounce a treatment. But we can ask questions and listen carefully. We can let them know that we care. And then, if we can make them feel safe, perhaps they will open the door a crack and let us in. If they know they can trust us, we’ll be in a better position to help them access the kind of medical and psychological support they need.
We may not be able to help them recapture their “Golden Years”, but with the right approach and appropriate care, we can help them come to a place of peace in their hearts and minds as they negotiate the challenges of their final years.
This video is based on an excerpt from my book, Letters from Madelyn, Chronicles of a Caregiver. My mother was in very poor health and had very little money when my dad suffered a debilitating stroke and she became his full time caregiver. As a member of the “Silent Generation” she put on a courageous public front. However, when she went to her computer to write letters to me, she disengaged her emotional monitor and wrote about everything she was experiencing and exactly how she felt about it. Her letters were always unflinchingly honest and sometimes uproariously funny.
“Madelyn Gets Depressed” is one of the many real-life caregiver stories you will find in CaregiverHelp.com, our new online, video-based caregiver support program. During the month of November we are offering free one-year memberships. If you could use a little help coping with your caregiver anger, guilt, depression and grief, go to CaregiverHelp.com, click on the “Join Now” tab at the top right-hand side of the page. Fill in the form, and in the box labeled “Coupon Code” enter this code: GriswoldFree.
About Elaine K. Sanchez
For more information, please review our Mental Health Symptoms & Treatment Resources.