Aging, with its usual accompaniment of medical conditions and personal losses, often brings about sadness, grief, frustration and temporary periods of feeling blue. These normal emotional experiences can often lead to depression.
Listen as Dr. Peter Betz explores the world of Geriatric Psychiatry and why the elderly population is in most need of our extra help for their mental health needs.
Depression in the Elderly, There is Hope
Featured Speaker:
Peter Betz, MD
Peter Betz, M.D., is a board-certified geriatric psychiatrist with Centra's Piedmont Psychiatric Center, where he has practiced since 2001. He also consults with nursing homes and assisted living facilities throughout the region. He is a sought-after speaker for his knowledge and expertise of mental health conditions in the older population. For the past several years, Dr. Betz has been instrumental in initiating and planning Centra's new senior psychiatric program and now serves as its medical director. The 12-bed inpatient acute unit opened last October in the former pediatric wing at Centra Virginia Baptist Hospital. Dr. Betz received his bachelor's degree from the Georgia Institute of Technology in Atlanta and his medical degree from the Medical College of Georgia. He completed his internship and fellowship in geriatric psychiatry at Johns Hopkins Hospital. Transcription:
Depression in the Elderly, There is Hope
Bill Klaproth (Host): As anyone with aging parents can attest, it’s not easy watching them navigate through their final years. Medical conditions, personal loss, grief, frustration can all add up to depression. Here with us is Dr. Peter Betz, medical director of geriatric psychiatry, Piedmont Psychiatric Center at Centra Health. Today, we’re going to be talking about depression in the elderly. Peter, thank you so much for your time today. My first question is: is it easy to overlook depression in the elderly? Because we want to associate sadness and feeling blue sometimes as maybe just a normal part of getting old. But there’s more to it than that, correct?
Dr. Peter Betz (Guest): Absolutely. I think you hit on an important topic. One of the things that I like to say is that it’s not okay to be old and depressed. Sadness is a normal experience of our emotional life. It’s one of the things that give us the full color of our existence. It’s a good and wonderful thing for us to have, as humans, as interactive beings. But when we become depressed, it’s not just a sadness or a sense of feeling blue or grief, but it is a fundamental change in our whole demeanor, our emotional state that is beyond what you might expect given the stresses that we all feel in life. As we get older, we are confronted with different kinds of stressors, particularly losses, whether it’s because of independence or we’ve lost our friends, or because of loss of function in one form or another or health. In that setting, losses are something that elders do need to learn how to cope with in some ways. When that becomes a problem where it effects our person beyond what we would normally think of the day-to-day sadness you might experience, it becomes concerning. Depression can be best defined by really having two of three main criteria. One is if you have a persistent, pervasive low mood. For example, if you get bad news, let’s say the IRS says, “You owe me more money than you think you owed me,” you feel unhappy, but you can still go out with your friends and have a great time. You can still enjoy the usual activities, whether it’s bowling or tennis or golf or reading books and those kinds of activities. When you start losing your interest and your vitality in your normal life and it’s a pervasive problem, that’s a real big issue that identifies depression. Depression can probably be best defined not so much as sadness but as the loss of enjoyment, the loss of the happiness, the loss of the yah out of life. Depression often also affects our sense of self. We start devaluing ourselves, like I’m just a burden to others, I’m not worth being around, I’ve been a bad husband or a bad father, bad mother, bad spouse. Those kinds of feelings are not usual. It is appropriate for us to go back in life and say, “Gosh, I could have spent more time doing this,” or, “I could have spent more effort in that circumstance,” and that’s how we grow and learn from our experiences. But to fundamentally think that we’re a second-rate individual or we’re less important than somebody else, that really may imply that we have a serious depression.
Bill: My dad is in his early 90s, and I can relate to everything you’re saying. I see the grief, the frustration, the sadness, the medical issues all taking their toll. It’s heartbreaking, and it’s almost to the point of hopelessness where you see this man, he knows that he’s entering the final years of his life and all this is adding up in that overwhelming hopelessness that I think he feels.
Dr. Betz: Absolutely. Hopelessness is one of the great predictors of someone potentially even choosing to harm themselves. When there is no sense that there is a chance of enjoyment or betterment or a future of fun and a quality of life, that is a great worry to a psychiatrist. If there is truly a sense that there is no chance of having a good quality of life, we need to pay very special attention to those individuals, which again of course is somewhat a little bit different than simply saying I’m not happy with my circumstance or my surroundings or my ailments where there’s arthritis or high blood pressure. Hopelessness is a key issue in evaluating depression versus the sense of sadness, which of course we described as sort of a normal part of life, which should not be more common in the elderly. The elders do in fact have some limitations, but in fact, they also have great opportunities. They have wisdom beyond their younger years. They have the ability to develop and understand relationships and engaging with people. They have time to spend in a whole variety of different ways that we don’t often have earlier in our life. There are many great things to rejoice and to be happy about. That doesn’t mean that we don’t struggle with certain things, but certainly, there should be the sense of enjoyment and a quality of life throughout our years.
Bill: How do you diagnose an elderly person then with depression? You talked about low mood, we talked about a sense of hopelessness. What are some of the other warning signs that would say something’s not right here, this isn’t a normal sadness?
Dr. Betz: Well, we’ve also talked about the low sense of self-attitude, when you start devaluing yourself. There’s a whole set of symptoms. There’s a fancy word called “neurovegetative symptoms.” When your body changes and there’s not a good reason for it and it seems to be related to your vitality in life, those are great concerns. For example, appetite changes. You’re not interested in food anymore. You have low energy and you’re always chronically fatigued. You have no interest in getting out and doing things. The activities you normally would enjoy just don’t seem to excite you as much as they did. You have a decreased interest in all cadre of things, whether they’re a sensitive personal issue like, for example, sex drive, or your interest in going out with your friends to have your Sunday lunch or go to church activities. All of those things are very sensitive findings that would suggest that there may be a depression beyond simply the sadness of life.
Bill: For an older person diagnosed with depression, what are the treatment options?
Dr. Betz: Well, there’s a whole litany of different ways you can approach treatment of depression. If there, for example, is a mild depression, one may be able to intervene with simply encouragement and support of therapy. Sometimes, when it becomes more moderate or severe, there needs to be the thought of using medications, which nowadays can be, a) generic and inexpensive, b) sort of have minimal drug-drug interactions, and c) have very few complicating side effects, and d) actually work to help folks feel better. There is no such thing as a happy pill, but there are medicines that treat the abnormal state of depression. That can be helpful. Chronic therapies where you have an ongoing interaction with somebody to teach you how to cope with negative life experiences and how to manage your negative emotions so that we can change a perspective on quality of life can often be very helpful. Getting involved in activities. Being physically active, where you’re getting out and doing as much as you can—perhaps not as much as we used to—but those kinds of activities are very important for our own vitality and mental health.
Bill: Maintaining some level of social contact, getting out of the house, staying physically active, all those things can help alleviate the depression. Let me ask you about caregivers though. Is there a tip you can give someone who has a mom or a dad or uncle or aunt that’s elderly as far as interacting with them if they are depressed? Are there any tips you can give to that person?
Dr. Betz: Absolutely. How much time do you have? In short, there are a couple of things that are important. One is that as a caregiver, it is a very stressful and difficult role to play. One of the things that one need to be careful about is making sure that you take care of yourself. If you get overwhelmed and depressed and affected by those around you who are struggling and whom you love so much and care for, because they can affect you, you end up losing some of that ability to be a caregiver. But essentially, trying to be as much of a cheerleader as you can. Cheerleaders, as we know them, if the team is doing well, they cheer for the team. If the team is not doing well, they don’t say, “You butterfingers of a receiver.” They cheer for the team. They’re really always positive and upbeat and being gregarious and warm and engaging and never really showing that negative side that we have. When someone is fundamentally depressed, they need that sense of persistent cheerfulness, persistent upbeat energy, that activity. You take folks who are depressed and you don’t say, “Do you want to go have lunch?” You say, “We’re gonna go have lunch. What kind of lunch do you want?” If they don’t come up with a good idea, you say, “Well, we’re having Mexican today. Mexican is gonna be a great thing to have for lunch.” You get out and you do stuff. You be active. That’s probably the best role of a caregiver. Certainly, that’s not perfect in all circumstances, but it probably is a good place to start.
Bill: That is a great tip. Because as I can attest, as I said, my father is in his early 90s, and I will suggest things and he’ll, “No, I don’t wanna do that. No, I just wanna stay in. No, I…” but how you just put it, “We’re going to lunch. Get your coat. We’re going.” I think that’s a great tip and not saying, “Okay, well, fine. Just stay home again inside, shut out from the world.” I think that’s an excellent tip, because I was going to ask, sometimes that cheerleader can fall on deaf ears sometimes. “Come on, we’re gonna do this.” “No, I don’t wanna do that.” As a caregiver, don’t take no for an answer. We’re going. We’re having this. You’re coming with.
Dr. Betz: Absolutely.
Bill: Excellent tips. Very good tips. Is there anything else, Dr. Betz, that we haven’t touched on that we should know about in the care of an elderly person with depression?
Dr. Betz: I think the one thing that is important to highlight is that there is a very high rate of suicide in the elderly relative to patients that are depressed throughout the entire rest of the life span. That is of great concern. Patients that contemplate suicide don’t walk around and tell their doctor, “I’m thinking about killing myself.” They are silent. We have to oftentimes pry that information. That’s why the word of hopelessness speaks so importantly when you’re assessing folks that have depression. Because when patients lose hope is when they start thinking that taking their own life is a reasonable solution. And that’s not okay. That’s a very desperate place to be. I would really encourage folks to think about the sense of hopelessness and that people that are elderly, that are withdrawn, that are not engaging, that are profoundly depressed, have a high risk of prematurely ending their own life, which is a very, very difficult thing for everyone else, including their loving caregivers who have done everything they could to avoid such a thing. That’s the one thing I would like to add to what we’ve talked about.
Bill: Thank you. If that person withdrawn, not engaging, totally reversing themselves from society and becoming even more of a shut-in, those are the warning signs we should look for?
Dr. Betz: Absolutely.
Bill: Dr. Betz, tell us why people should come to Centra for their geriatric health needs.
Dr. Betz: Centra is a leading organization in really putting together a whole spectrum of care that is aimed or focused not just on providing an individual with good care at the point of service, which is what we are really driven to do on some level. But we’re working very hard to create a coordinated system of care so someone can come within the Centra family and get provided coherent care across the spectrum so that we’re able to integrate all of the expertise in one office to another specialist to another type of procedure and be able to unify that. And so with the focus of Centra developing that level of care, it provides an opportunity, not just a single good service but a whole spectrum of care for the entire person.
Bill: That sounds great, Dr. Betz. Thank you so much again for your time. We really appreciate it. For more information, please visit centrahealth.com. That’s centrahealth.com. This is Centra Healthy Radio. I’m Bill Klaproth. Thanks for listening.
Depression in the Elderly, There is Hope
Bill Klaproth (Host): As anyone with aging parents can attest, it’s not easy watching them navigate through their final years. Medical conditions, personal loss, grief, frustration can all add up to depression. Here with us is Dr. Peter Betz, medical director of geriatric psychiatry, Piedmont Psychiatric Center at Centra Health. Today, we’re going to be talking about depression in the elderly. Peter, thank you so much for your time today. My first question is: is it easy to overlook depression in the elderly? Because we want to associate sadness and feeling blue sometimes as maybe just a normal part of getting old. But there’s more to it than that, correct?
Dr. Peter Betz (Guest): Absolutely. I think you hit on an important topic. One of the things that I like to say is that it’s not okay to be old and depressed. Sadness is a normal experience of our emotional life. It’s one of the things that give us the full color of our existence. It’s a good and wonderful thing for us to have, as humans, as interactive beings. But when we become depressed, it’s not just a sadness or a sense of feeling blue or grief, but it is a fundamental change in our whole demeanor, our emotional state that is beyond what you might expect given the stresses that we all feel in life. As we get older, we are confronted with different kinds of stressors, particularly losses, whether it’s because of independence or we’ve lost our friends, or because of loss of function in one form or another or health. In that setting, losses are something that elders do need to learn how to cope with in some ways. When that becomes a problem where it effects our person beyond what we would normally think of the day-to-day sadness you might experience, it becomes concerning. Depression can be best defined by really having two of three main criteria. One is if you have a persistent, pervasive low mood. For example, if you get bad news, let’s say the IRS says, “You owe me more money than you think you owed me,” you feel unhappy, but you can still go out with your friends and have a great time. You can still enjoy the usual activities, whether it’s bowling or tennis or golf or reading books and those kinds of activities. When you start losing your interest and your vitality in your normal life and it’s a pervasive problem, that’s a real big issue that identifies depression. Depression can probably be best defined not so much as sadness but as the loss of enjoyment, the loss of the happiness, the loss of the yah out of life. Depression often also affects our sense of self. We start devaluing ourselves, like I’m just a burden to others, I’m not worth being around, I’ve been a bad husband or a bad father, bad mother, bad spouse. Those kinds of feelings are not usual. It is appropriate for us to go back in life and say, “Gosh, I could have spent more time doing this,” or, “I could have spent more effort in that circumstance,” and that’s how we grow and learn from our experiences. But to fundamentally think that we’re a second-rate individual or we’re less important than somebody else, that really may imply that we have a serious depression.
Bill: My dad is in his early 90s, and I can relate to everything you’re saying. I see the grief, the frustration, the sadness, the medical issues all taking their toll. It’s heartbreaking, and it’s almost to the point of hopelessness where you see this man, he knows that he’s entering the final years of his life and all this is adding up in that overwhelming hopelessness that I think he feels.
Dr. Betz: Absolutely. Hopelessness is one of the great predictors of someone potentially even choosing to harm themselves. When there is no sense that there is a chance of enjoyment or betterment or a future of fun and a quality of life, that is a great worry to a psychiatrist. If there is truly a sense that there is no chance of having a good quality of life, we need to pay very special attention to those individuals, which again of course is somewhat a little bit different than simply saying I’m not happy with my circumstance or my surroundings or my ailments where there’s arthritis or high blood pressure. Hopelessness is a key issue in evaluating depression versus the sense of sadness, which of course we described as sort of a normal part of life, which should not be more common in the elderly. The elders do in fact have some limitations, but in fact, they also have great opportunities. They have wisdom beyond their younger years. They have the ability to develop and understand relationships and engaging with people. They have time to spend in a whole variety of different ways that we don’t often have earlier in our life. There are many great things to rejoice and to be happy about. That doesn’t mean that we don’t struggle with certain things, but certainly, there should be the sense of enjoyment and a quality of life throughout our years.
Bill: How do you diagnose an elderly person then with depression? You talked about low mood, we talked about a sense of hopelessness. What are some of the other warning signs that would say something’s not right here, this isn’t a normal sadness?
Dr. Betz: Well, we’ve also talked about the low sense of self-attitude, when you start devaluing yourself. There’s a whole set of symptoms. There’s a fancy word called “neurovegetative symptoms.” When your body changes and there’s not a good reason for it and it seems to be related to your vitality in life, those are great concerns. For example, appetite changes. You’re not interested in food anymore. You have low energy and you’re always chronically fatigued. You have no interest in getting out and doing things. The activities you normally would enjoy just don’t seem to excite you as much as they did. You have a decreased interest in all cadre of things, whether they’re a sensitive personal issue like, for example, sex drive, or your interest in going out with your friends to have your Sunday lunch or go to church activities. All of those things are very sensitive findings that would suggest that there may be a depression beyond simply the sadness of life.
Bill: For an older person diagnosed with depression, what are the treatment options?
Dr. Betz: Well, there’s a whole litany of different ways you can approach treatment of depression. If there, for example, is a mild depression, one may be able to intervene with simply encouragement and support of therapy. Sometimes, when it becomes more moderate or severe, there needs to be the thought of using medications, which nowadays can be, a) generic and inexpensive, b) sort of have minimal drug-drug interactions, and c) have very few complicating side effects, and d) actually work to help folks feel better. There is no such thing as a happy pill, but there are medicines that treat the abnormal state of depression. That can be helpful. Chronic therapies where you have an ongoing interaction with somebody to teach you how to cope with negative life experiences and how to manage your negative emotions so that we can change a perspective on quality of life can often be very helpful. Getting involved in activities. Being physically active, where you’re getting out and doing as much as you can—perhaps not as much as we used to—but those kinds of activities are very important for our own vitality and mental health.
Bill: Maintaining some level of social contact, getting out of the house, staying physically active, all those things can help alleviate the depression. Let me ask you about caregivers though. Is there a tip you can give someone who has a mom or a dad or uncle or aunt that’s elderly as far as interacting with them if they are depressed? Are there any tips you can give to that person?
Dr. Betz: Absolutely. How much time do you have? In short, there are a couple of things that are important. One is that as a caregiver, it is a very stressful and difficult role to play. One of the things that one need to be careful about is making sure that you take care of yourself. If you get overwhelmed and depressed and affected by those around you who are struggling and whom you love so much and care for, because they can affect you, you end up losing some of that ability to be a caregiver. But essentially, trying to be as much of a cheerleader as you can. Cheerleaders, as we know them, if the team is doing well, they cheer for the team. If the team is not doing well, they don’t say, “You butterfingers of a receiver.” They cheer for the team. They’re really always positive and upbeat and being gregarious and warm and engaging and never really showing that negative side that we have. When someone is fundamentally depressed, they need that sense of persistent cheerfulness, persistent upbeat energy, that activity. You take folks who are depressed and you don’t say, “Do you want to go have lunch?” You say, “We’re gonna go have lunch. What kind of lunch do you want?” If they don’t come up with a good idea, you say, “Well, we’re having Mexican today. Mexican is gonna be a great thing to have for lunch.” You get out and you do stuff. You be active. That’s probably the best role of a caregiver. Certainly, that’s not perfect in all circumstances, but it probably is a good place to start.
Bill: That is a great tip. Because as I can attest, as I said, my father is in his early 90s, and I will suggest things and he’ll, “No, I don’t wanna do that. No, I just wanna stay in. No, I…” but how you just put it, “We’re going to lunch. Get your coat. We’re going.” I think that’s a great tip and not saying, “Okay, well, fine. Just stay home again inside, shut out from the world.” I think that’s an excellent tip, because I was going to ask, sometimes that cheerleader can fall on deaf ears sometimes. “Come on, we’re gonna do this.” “No, I don’t wanna do that.” As a caregiver, don’t take no for an answer. We’re going. We’re having this. You’re coming with.
Dr. Betz: Absolutely.
Bill: Excellent tips. Very good tips. Is there anything else, Dr. Betz, that we haven’t touched on that we should know about in the care of an elderly person with depression?
Dr. Betz: I think the one thing that is important to highlight is that there is a very high rate of suicide in the elderly relative to patients that are depressed throughout the entire rest of the life span. That is of great concern. Patients that contemplate suicide don’t walk around and tell their doctor, “I’m thinking about killing myself.” They are silent. We have to oftentimes pry that information. That’s why the word of hopelessness speaks so importantly when you’re assessing folks that have depression. Because when patients lose hope is when they start thinking that taking their own life is a reasonable solution. And that’s not okay. That’s a very desperate place to be. I would really encourage folks to think about the sense of hopelessness and that people that are elderly, that are withdrawn, that are not engaging, that are profoundly depressed, have a high risk of prematurely ending their own life, which is a very, very difficult thing for everyone else, including their loving caregivers who have done everything they could to avoid such a thing. That’s the one thing I would like to add to what we’ve talked about.
Bill: Thank you. If that person withdrawn, not engaging, totally reversing themselves from society and becoming even more of a shut-in, those are the warning signs we should look for?
Dr. Betz: Absolutely.
Bill: Dr. Betz, tell us why people should come to Centra for their geriatric health needs.
Dr. Betz: Centra is a leading organization in really putting together a whole spectrum of care that is aimed or focused not just on providing an individual with good care at the point of service, which is what we are really driven to do on some level. But we’re working very hard to create a coordinated system of care so someone can come within the Centra family and get provided coherent care across the spectrum so that we’re able to integrate all of the expertise in one office to another specialist to another type of procedure and be able to unify that. And so with the focus of Centra developing that level of care, it provides an opportunity, not just a single good service but a whole spectrum of care for the entire person.
Bill: That sounds great, Dr. Betz. Thank you so much again for your time. We really appreciate it. For more information, please visit centrahealth.com. That’s centrahealth.com. This is Centra Healthy Radio. I’m Bill Klaproth. Thanks for listening.