Depression and Older Adults Part 3

by Emily Carton, LISW

The issues surrounding depression in elderly people are complicated, often quite serious, and even more often, misunderstood. As a result, older adults and the elderly can be unfairly treated by loving family members who just don't understand that their loved one needs something different. This is the first of the three-part series examining various aspects of these concerns.

Once upon a time when I was a child, my parents were all powerful and nothing could convince me that they could not conquer the world and make it safe. Although I am now a grown woman, a mother with children of my own, I am still their daughter, frozen in time within our family structure. My parents were of the generation who tended to their parent's needs in old age, who had a profound sense of responsibility and duty, and who never questioned their prescribed roles.

I, only a generation later, have moved to another city and cannot care for my parents on a daily basis, as they once did for theirs. This does not mean that I care any less. For better or for worse my life, the pressures, and roles that I must fulfill are different. Our society has changed and the family structure is still in the process of redefinition.

Yet with all that my parents did for their parents, they would never have openly suggested, even if they knew, that something might be wrong -- that one of them might seem depressed. While I, not being in the position of helping on a daily basis might try to address the issues by telling them what I see and how I feel. Talking at this level would be difficult, uncomfortable, and would bring up feelings that I don't necessarily look forward to addressing, but it would be something that I would feel the necessity to do.

Although every family is different and relationships between parents and children are unique and varied, whether you have had an open relationship with your parents or one that is more remote, confronting a difficult situation, regardless of where you stand, is never easy.

When one sees a parent who is depressed, there can be a sense of helplessness and anger, sadness and pain, followed by the desire either to pack one's bag and run, or to find a way to confront the situation at whatever cost.

How one chooses to respond to a depressed parent depends on family history and whatever emotional issues might come into play.

Stepping Back

What Your Parents Might be Going Through the later years are a time of many changes. Work patterns change. There can be retirement issues, loss of family and friends, and a change in self-image. Over the years everyone develops coping skills to deal with the disappointments, the losses, and the changes that come as a natural part of life.

As we grow older the losses and changes can be more frequent and the consequences more devastating. There is simply less time and fewer resources in our bodies and in our minds to always see us through. A parent may develop a depression in response to events that are occurring. Or a parent may have a recurrence of an earlier depression. Perhaps, through our adult eyes, we recognize a depression we were never able to identify before.

Preparing to Help

It is important to remember that previous generations were not raised to think in psychological terms. It may not be a part of their history or a part of their vocabulary. Mental illness was an embarrassment and something to be ashamed of. A great stigma was attached to any behavior that someone might label as "crazy."

For the adult child, perhaps this is the first time he or she is in a position of being the person who needs to guide and support a parent. A parent, regardless of the situation, might find that accepting the suggestions of a child is a difficult proposition. Regardless of the strength or weakness of the family bond, confronting anyone about depression is bound to be difficult and uncomfortable and met with skepticism and anger.

Possible Approaches

Try offering your parents the facts. Tell them how you see them. Are they less active then they once were. Are they ignoring their appearance? Are they less responsive? Are they complaining more about physical ailments? Describe to them exactly what you see. Try to demystify mental illness.

You might begin by explaining that depression is now believed to have a strong biological component just like other diseases of the body. Reassure them that there are doctors and therapists who deal specifically with the issues that they are facing.

Explain that depression is now talked about openly and that the stigma of brain disorders is disappearing. Make the analogy that just a short time ago people refused to talk about cancer and felt ashamed if they or anyone else in their family had the disease. Becoming educated helps destroy old myths. Make it as easy for your parents as possible. Offer to find help for them. Accompany them to the doctors if you can.

Try approaching the issue from many different angles. Sometimes it helps to put psychotherapy into a different perspective. The word psychotherapy comes from two Greek words: psyche and logos, which means soul and study. Therapist originally meant servant. Psychotherapy can be a way of healing something deep inside. Find words and images that speak to who they are.

Ask yourself if you are the best person to confront the problem. Are there other trusted relatives or friends whom they might listen to more readily? Are there several close friends and relatives that could meet together and confront the issue as a team? Alcoholics Anonymous has used the confrontational approach very successfully and it often works well in other situations.

Don't let your need or wish to be the one who is able to help get in the way of finding the right person to bring up the issue with your parents. Situations like this bring up a wealth of emotion. Sometimes past pains and disappointments about the relationship we have had with our parents can rise to the surface. Your feelings are very important and need to be addressed.

But in terms of the immediate crisis of securing support for your parents, you have to decide who in their lives would have the most likelihood of success. Make this decision based on what you know about them, what your relationship with them has been, and not what you wish your relationship could be.

Accept that we cannot always help the people we care about. Ultimately, we all make our own decisions. All we can do is to confront the situation with genuine concern, offer information and support, and remember that they will make their own decisions.

Taking Matters in Your Own Hands

If you believe that your parent's depression is life threatening, then you might need to act. This is not an easy thing to do, but might be necessary if a parent stops eating, cannot function, or exhibits other potentially dangerous behavior.

Elicit help from your parent's physician. See if he/she can admit the depressed parent to a hospital for evaluation or find out whom to call to evaluate whether this is a dangerous situation. Your parent's physician should be able to help.

For additional assistance, you can call an agency on aging or a private geriatric care manager to guide you. If you are ever in doubt as to whether a depressive illness is serious enough to warrant action (even if your parent is reluctant or totally resistant), it is best to take the risk of angering them out of love then to not act out of fear.

Resources:

Children of Aging Parents (CAPS), 1609 Woodbourne Road Suite 302A. Levittown PA 19057-1511
800-227-7294. Extensive National information resources files. Telephone counseling. The country's oldest information resource helping adult children understand the needs and concerns of both the children and parents.

National Institute of Mental Health's Depressive Awareness, Recognition and Treatment Program
800-421-4211.

Part 1 Part 2

About the Author:

Emily Carton, LISW is a licensed social worker who works with Elder Options, a private care social service firm in the DC Metropolitan Area. She is also an intern in Bibliotherapy at St. Elizabeth's Hospital in Washington D.C.

Originally published 5/13/98
Revised 9/02/08 by Marlene M. Maheu, Ph.D.

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