Senile depression - how to detect and overcome the disease

Depression is common at any age. But statistics say that among the elderly this percentage is almost 3 times higher. Treatment of depression in the elderly has its own characteristics associated with the physiological state of the body of such patients.

Women suffer from senile depression more often than men, and their clinical symptoms are also more pronounced. The main manifestations of senile depression are reduced physical activity and being constantly in a bad mood. The incidence of such depression increases with age: the older a person is, the more likely he is to develop this disease. Despite the patient’s age and the severity of symptoms, Alcoclinic specialists always achieve positive dynamics in the treatment of depression in the elderly.

Why do older people get depressed?

As people age, they often experience significant life changes that increase their risk of developing depression. These may include:

• chronic diseases;
• isolation from society;
• immobility;
• financial difficulties;
• divorce or widowhood;
• death of friends and loved ones;
• approaching the end of life;
• loss of independence;
• retirement;
• moving.

Alcohol or drug use can accelerate the onset of this condition.

Older adults who are lonely and lack social support are at greatest risk of becoming depressed.

Stages and symptoms of dementia

Typically, dementia progresses over many years and goes through 3 stages of development:

1. Mild dementia is a condition in which the patient loses his professional skills. At the same time, his social activity decreases, interest in the world around him fades away, the person stops communicating with friends, gives up his favorite hobby, etc. With mild dementia, the patient retains all self-care skills and continues to navigate normally within his own home.
2. Moderate dementia. This stage is accompanied by a condition when the patient cannot remain alone for a long time, as he loses the skills to use household appliances: telephone, TV remote control, kitchen stove. An older person may also have difficulty opening locks. It is this stage of dementia that is commonly called senile insanity. With moderate dementia, the patient retains personal hygiene and self-care skills.
3. Severe dementia is senile dementia, characterized by a complete loss of a person’s adaptation to the environment and his constant dependence on outside help even in the simplest activities (dressing, eating, hygiene).

Impact of depression on older people

Suicidal tendencies caused by depression and related deaths are higher in older people compared to other population groups. However, men are at higher risk compared to women. The reasons are mainly related to widowhood and divorce.

Older people with depression are at very high risk of developing cognitive impairment and dementia. Their brain function is noticeably impaired and they are more anxious than other groups of people.

Depression is a problem that needs to be given special attention and help the elderly person improve their quality of life.

What is depression

Depression is a mental illness that affects more than 40% of people over 60 years of age. With increasing age, this figure only grows. Women aged 50-60 years are most often affected. The causes of the disease are numerous, we will consider them below.

Depression in old age is rarely detected: the mentality created over decades in our country has made us think that irritability, constant pain in various organs, and touchiness are a normal state in old age.

Only a relative of an elderly person who knows his personality traits and hobbies can suspect depression. Only he can notice that his parent has lost the pleasure of doing certain things - those that previously pleased him. The patient himself, feeling “inner emptiness,” believes that he is sick with a disease of the heart, digestive system, or oncological pathology. And the fact that during the examination nothing “terrible” is revealed, assures the elderly person of the poor quality of the diagnosis and his own uselessness, aggravating the course of depression.

Prevention is better than cure!

When a person is already depressed, it is quite difficult to find the motivation to do anything. But even small steps taken to stay healthy can make a big difference in reducing symptoms of depression.

Exercises

Research shows that exercise can be as effective as antidepressants. Take a short walk or do some light housework and see how much you feel better.

Even if an older person is sick or disabled, there are many safe exercises they can do to improve their mood—even while sitting in a chair or wheelchair.

Diet

You need to start by minimizing sugar and refined carbohydrates and instead focus on quality protein, complex carbohydrates and healthy fats.

You shouldn't go too long without eating, it will worsen the mood and make the older person tired and irritable, so do your best to eat at least every 3-4 hours.

Quality sleep

Many older adults struggle with sleep problems, especially insomnia. Normal sleep duration is somewhere between 7-9 hours. To get better sleep, you should avoid alcohol and caffeine, go to bed at the same time every night, and keep your bedroom dark, quiet, and cool.

Day walks

Sunlight will increase serotonin levels, improve your mood, and combat seasonal affective disorder. If possible, an older person should go outside during the day and walk for at least 15 minutes.

Communication

It's never too late to build new friendships! Convince your elderly relative to join a group of people with similar interests. This could be a book club, chess club, etc. To overcome depression and stop it from returning, it is important to continue to feel involved and enjoy a new purpose in life.

One solution to problems with lack of communication is a private nursing home for older people: interaction with others facing the same daily problems will reduce feelings of loneliness.

For questions about accommodation in the private boarding house “Blago” in Khabarovsk, please call

Dementia and its symptoms

Dementia is a symptom of old age that is not natural. This pathology cannot be called a disease that is associated with one organ or with a specific problem in the body. In the International Classification of Diseases, dementia (or dementia) is called a syndrome caused by brain damage and manifests itself as follows:

• decreased ability to perceive and assimilate new information (the patient repeats the same questions or topics of conversation, loses personal belongings, forgets events or agreements, gets lost on a familiar route);
• decreased ability to think logically and solve complex problems, impaired critical thinking (the patient incorrectly assesses the threatening danger, cannot manage money, loses the ability to make decisions, as well as to plan complex or sequential actions);
• decreased visuospatial functions (the patient is unable to find and recognize faces or familiar objects, he loses the ability to use simple tools and items of clothing);
• speech disorders (the patient finds it difficult to remember simple words, makes long pauses during a conversation, makes various mistakes);
• the patient's personality, behavior or demeanor changes. An elderly person experiences sudden mood swings, unreasonable anxiety, apathy, loss of sense of purpose, social self-isolation, weakening interest in previously preferred activities, loss of ability to empathize, and socially unacceptable behavior.

Senile dementia is accompanied by a complete or partial loss of independence and can be caused by a wide variety of diseases and conditions. Moreover, some diseases affect the brain directly. The most common cause of dementia is Alzheimer's disease, which causes toxic deposits to form in the brain and destroy brain cells. Some diseases have an indirect effect on the activity of the brain: they impair the functioning of any body system, as a result of which the brain suffers. This can happen, for example, with liver failure, thyroid dysfunction, deficiency conditions (lack of vitamin B, etc.).

The clinical features of endogenous depression in elderly patients have been studied incomparably better than in children. Even E. Kraepelin (1904) noted that its distinctive feature is the presence of anxiety. When comparing two large groups of patients with depression (over 55 years old and under 35 years old), V. L. Efimenko (1975) found anxiety in 71% of elderly patients and only 30% of young ones. Expressed fear was noted in 25% of the older age group and only 2.7% in the younger. In elderly patients, irritability, emotional lability, gloominess were more often observed, and melancholy was less common. They are characterized by ideas of damage and impoverishment; less often than young people, ideas of self-blame and low value arise, but more often they are hypochondriacal. Much more often in old age, depression occurs with agitation and, accordingly, psychomotor retardation is observed less often. Nevertheless, we met MDP patients aged 70 years and above, in whom the depressive phase proceeded with a fairly typical melancholic syndrome. Depressive phases in old age tend to be protracted and usually less responsive to treatment.

The question of why endogenous depression in old age acquires its characteristic features has long been discussed in the literature. As rightly noted by G.L. Voronkov et al. (1983), a combination of a number of factors plays a role here (premorbid personality traits that increase with age and sometimes become exaggerated, increased vulnerability, the great influence of environmental factors, vascular pathology, etc.). This is why the classification of depressive states in late life is so difficult. Obviously, it is anxiety, combined with the feeling of powerlessness, helplessness and hopelessness characteristic of depression and the consciousness of the limitations of one’s strength, dependence on others, and uncertainty in the future inherent in old age, that gives rise to delirium of impoverishment. Memory impairments caused by atherosclerosis create the basis for ideas of damage, theft; increased vulnerability and response to minor external factors determine the “small scope” and everyday nature of delusional ideas. Intense delusional symptoms can develop in patients with relatively mild depression. With severe anxiety in elderly patients, Cotard's delusion often develops.

In elderly people with organic brain changes caused by atherosclerosis, depression occurs with a picture of typical vascular dementia. Severe impairments of memory and intelligence make productive contact with the patient impossible, which makes it difficult to identify depressive symptoms themselves and assess their role in the structure of the syndrome. Only after the spontaneous end of the depressive phase or the use of antidepressants is it discovered that the dementia is reversible. However, with prolonged depression or frequent repeated phases in subsequent light intervals, personality changes of the vascular type become increasingly apparent. To assess the role of depression in the clinical picture of vascular dementia, R. A. Alimova (1983) used pharmacological tests: administration of imizin (imipramine) and diazepam. The data obtained allow us to predict the choice and effectiveness of therapy.

Very rarely, depression is masked by the clinical picture of dementia in young patients. We observed a 26-year-old patient in whom extremely severe memory impairments made us think about the acute onset of some gross organic process. However, after the end of the depression, it was not possible to identify any intellectual-mnestic deviations. Subsequently, the patient experienced several more typical depressive phases, in which mental retardation was disproportionately pronounced compared to other manifestations of depression. Obviously, such severe inhibition, combined with anxiety, which was more intense in the first phase than in subsequent ones, led to gross disorganization of thinking. In elderly patients with vascular changes in the brain, there is no need for such deep depression and anxiety to disorganize thinking, since affective disorders in these patients only manifest an already existing defect.

The debate is still ongoing about whether involutional melancholia is an independent disease or a phase of MDP that began at involutional age. Highlighting involutional melancholia, E. Kraepelin proceeded from the late onset and features of the clinical picture (intense anxiety, often heterogeneous for classical depression delusions of persecution, relationships, etc., hallucinations and, most importantly, a more unfavorable course and poor prognosis). However, after in 1907 G. Dreyfus re-examined 85 patients classified by E. Kraepelin as involutional melancholia, it was found that more than half of them had depressive episodes in the past, and in 2/3 depression was replaced by a full-fledged light period . These data forced E. Kraepelin to combine involutional melancholia with MDP in the subsequent edition of the manual on psychiatry.

Thus, there are two polar points of view: according to the first, involutional melancholia is an independent nosological form of affective psychosis, which has distinct criteria (late onset, intense anxiety, prolonged course, poor outcome), peculiar personality traits in the premorbid state: rigidity, anxiety, poor adaptability, etc., as well as less hereditary burden. According to another, this is a late attack of unipolar endogenous depression, colored by the anxiety characteristic of the involutionary period. This is evidenced by data on the frequency of subclinical depressive episodes in the past and the fact that in the involutionary period, due to the addition of anxiety, the symptoms of depressive phases change in patients with a long history of the disease and previously typical depression.

It is likely that these discrepancies are largely due to the heterogeneity of groups of patients selected only according to clinical criteria. Data from dexamethasone and diazepam tests and the results of therapy with anxiolytics and antidepressants show that among patients who meet the clinical characteristics of involutional melancholia, two groups are distinguished: 1. Patients in whom the dexamethasone test was pathological, the diazepam test was of a depressive or, more often, intermediate type, and antidepressants had a positive therapeutic effect of varying degrees. In some of these patients, careful questioning revealed minor depressive states in the past. 2. Patients in whom the dexamethasone test was more often normal or questionable, and the diazepam test was of an alarming type; the therapeutic effect was achieved by using anxiolytics (usually phenazepam). They often exhibit the premorbid personality traits described above, heredity in most cases is not burdened, and if there are mentally ill people in the family, then these are most often involutional, somatogenic and exogenous psychoses. These patients, as a rule, had premenstrual tension syndrome. Thus, the disease of the first group of patients can be attributed to endogenous depression, occurring with intense anxiety, and the second group - to anxiety states of a psychotic level. The question of the relationship between these clinical forms is discussed in more detail in Chap. 10.

Summarizing the above, we can conclude that endogenous depression is quite complex in its structure. This complexity does not manifest itself in the large number and variety of symptoms, but in the complexity of each individual symptom, which is determined by several factors. The most important of them is the affective structure of the syndrome, that is, the relationship between melancholy and anxiety. Anxiety, along with melancholy, is involved in the formation of many symptoms of endogenous depression: ideas of guilt and low value, hypochondriacal ideas, suicidal tendencies, agitation and psychomotor retardation, and plays a dominant role in the genesis of a number of somatic symptoms and manifestations of depersonalization. The presence and nature of depressive ideas are largely determined by the premorbid personality characteristics of the patient and cultural factors. The manifestations of depressive symptoms largely depend on age characteristics. At the same time, a clear inverse relationship appears between the depth of the “biological” affective pathology and the influence of personal, situational and age factors, as well as cultural factors: the deeper the depression, the less they affect the clinical picture, and, conversely, with mild depression they can even mask its manifestations.

In this regard, the question arises what place in the structure of depression is occupied by symptoms such as a decrease in the level of motivation, inertia of thinking, and a decrease in the ability to exert volition: they can be considered as a manifestation of the affect of apathy, as O. P. Vertogradova and V. M. do. Voloshin (1983), or, in our opinion, they are manifestations of a general decrease in mental tone, the level of mental activity, which probably underlies endogenous depression, being its primary, basic component.