How to identify early depression in the elderly? These phenomena cannot be ignored

As of 2023, the number of elderly people over 60 years old in China is about 300 million, accounting for more than 20% of the total population. According to relevant statistics, the population in this age group is increasing year by year. The incidence of depression among the elderly is usually between 10% and 20%. Some studies have shown that about 15% of the elderly in the community may experience depressive symptoms, and this proportion is even higher among the elderly who are hospitalized or in medical and nursing institutions and nursing homes, reaching 30% to 50%. How to identify early depression in the elderly, intervene in time, and achieve ideal treatment effects. The following introduces the causes and early clinical manifestations, treatment and intervention measures of depression in the elderly.

1. What is depression in the elderly?

It refers to a mood disorder that occurs in the elderly (age ≥ 60 years old), manifested by symptoms such as persistent low mood, loss of interest and happiness, and physical discomfort, which seriously affect the quality of life and social function. The consequences are extremely serious and may even be life-threatening.

(I) Causes of the disease: The causes of depression in the elderly may involve multiple factors, including biological factors (such as genetics, neurotransmitter imbalance), social and psychological factors (such as bereavement, changes in social roles, children not getting married for a long time, living alone, lack of social support, etc.) and other factors (such as multiple physical diseases, multiple medications).

(ii) Clinical manifestations: The clinical manifestations of geriatric depression are similar to those of other types of depression, but may present special manifestations in the elderly, such as decreased cognitive function, intense physical discomfort, sleep disorders, decreased ability to live, etc.

(III) Diagnostic criteria: According to internationally accepted diagnostic criteria (such as DSM-5), doctors usually determine whether the diagnostic criteria for depression are met by asking questions and observing symptoms.

(IV) Treatment methods: Treatments for depression in the elderly include medication (such as antidepressants), psychotherapy (such as cognitive behavioral therapy), social support, and lifestyle interventions.

(V) To identify early depression in the elderly, we need to pay attention to the following important phenomena and symptoms:

1. Emotional changes in the elderly: often feel sad, empty or helpless. Loss of interest in activities that were previously interesting.

2. Cognitive manifestations: slow thinking, poor concentration, memory loss, often forgetting things, things that could be done before, now seem to be unable to be done.

3. Energy: Feeling tired, persistent feeling of powerlessness, lack of energy and motivation for daily activities.

4. Social behavior: gradually reduce interactions with family and friends, avoid social activities, and show loneliness.

5. Self-evaluation: Having negative views of oneself, such as self-blame or loss of self-confidence. Sometimes expressing thoughts of death or self-harm.

6. Physiological changes: Sleep problems, such as insomnia or hypersomnia. Appetite changes, eating less, and significant weight loss.

(6) If the elderly in your family show the following symptoms, you should pay attention to whether they are early signs of depression and should not ignore them.

1. Sudden changes: If the elderly person’s personality, mood or behavior changes significantly, it should be taken seriously.

2. They move slowly, speak less, speak in a low tone, speak slowly, and don't want to do anything. They lose their enthusiasm for life and even cannot take care of themselves. They are unwilling to interact with others and even live alone and alienate their relatives and friends.

3. Impact on physical health: Depressive symptoms may lead to worsening of physical health problems, such as worsening of chronic diseases.

4. Repeatedly complain of various physical discomforts, such as headache, dizziness, loss of appetite, weight loss, chest tightness, fatigue, urgency and frequent urination, etc.

5. Family members should be alert to anxiety, hypochondriasis, physical symptoms, hallucinations or delusions. Anxiety and hypochondriasis are particularly common. Give more guidance and seek medical treatment in time.

6. There are major changes in life, or events that you usually pay attention to cannot be realized, such as: the sudden death of a relative in life, the son is older and the family hopes he will get married, but the son does not want to get married at all, others are always concerned about whether the son is married, etc. In addition, physical illness, etc., cause mental stimulation to the patient, resulting in psychological stress and inducing a series of symptoms of depression.

(VII) Recommendations

If you find the above symptoms, you should seek help from a professional doctor in time to provide objective assessment and support. Early identification and intervention are crucial to improving the quality of life of the elderly. Home care for elderly patients with depression requires comprehensive consideration of their physical and mental health. The following are some home care suggestions:

1. Establish a support system to ensure that patients have social support, can stay in touch with relatives and friends, and provide companionship and psychological counseling when needed.

2. Encourage appropriate exercise: Help patients develop appropriate exercise habits, such as walking, Tai Chi, or simple stretching exercises. Appropriate physical activity can improve mood and sleep quality.

3. Balanced nutrition: Diversify the family diet to increase appetite and ensure that the patient has a balanced diet and adequate intake of nutrients. If conditions permit, ask professionals to design a diet plan to ensure nutritional intake.

4. Monitor medication: Take medication as directed by the doctor, do not increase or decrease medication at will, pay attention to possible adverse reactions, and report any adverse reactions to the doctor at any time.

5. Pay attention to risk factors: In life, family members should pay more attention to the patient's feelings, understand his inner thoughts, provide timely psychological counseling, encourage patients to express their discomfort, provide symptomatic treatment, pay close attention to risk factors such as suicidal thoughts and behaviors, and report any abnormal signs to professional doctors in a timely manner for symptomatic treatment and care.

6. Psychological care: Family members’ companionship and care for patients are helpful for the recovery of elderly depression. They should communicate with the elderly more often, respect and listen to their inner feelings, avoid excessive intervention, and give necessary comfort and encouragement. If conditions permit, they can receive counseling services from social workers, psychological counselors and other professionals.

7. Promote social participation: Help elderly patients with depression participate in some social activities. Some group activities can also be organized at home to promote their active participation in life.

8. Regular follow-up examinations: Take elderly patients with depression to the hospital for regular follow-up examinations and evaluation of treatment effects.

9. Preventive measures: Family members should pay more attention to and accompany the elderly in their daily lives, and do not put too much pressure on them. When encountering accidents or major traumas, they need to provide timely psychological counseling for the elderly, and do not keep it in their minds; for the elderly with personality defects, they should be given more psychological counseling and psychological intervention to avoid deterioration.

Summary: Pay attention to the early manifestations of depression in the elderly, identify it early, diagnose it early, intervene early, and treat it early. The prognosis of depression in the elderly is good after timely and effective treatment. It can generally be cured, does not affect the natural life span, and has no sequelae. In addition, let the patient maintain a relaxed and happy mood, and exercise regularly and moderately every day, which will help improve the body's immunity and improve the quality of life.

Author: Yang Lijuan, Lunjiao Hospital, Shunde District, Foshan City