Recognizing Late-Life Depression Dora spent much of her day in bed - in a heavy gray fog.  Many days, she let the phone and doorbell ring without answering them.  In the kitchen, dishes, mail, and trash piled up, but she was too weak to clean or care. Excessive sleep and a lack of energy are warning signs of a serious but treatable disease called depression.Older adults face increased risks for depression. Surprisingly this common illness frequently goes undetected and untreated in late life.  Recognizing Depression Coexisting medical conditions, complicated medication regimes, and painful losses sometimes mask the symptoms of depression in late life, says Janet Linton, M.D, medical director of Senior Behavioral Health at Mobile Infirmary, located in Mobile, and North Baldwin Infirmary, located in Bay Minette. Some of the most visible signs of depression, Dr. Linton says, are significant changes in appetite, sleep, and energy level. These symptoms should always be reported to your physician. A checklist of other warning signs of depression follows. If someone experiences a number of these symptoms for more than two weeks in a row, it is time to see a doctor. Many people - especially those who grew up in times or places where mental health problems were viewed as personal, religious, or moral failingshave difficulty talking about the emotional symptoms of depression. You can start by talking to your doctor about your physical symptoms, says Dr. Linton then move on to changes in moods or thoughts. Getting Help Many people first see their family doctors for help with depression. There are, however, many mental health specialists who also treat depression: PsychiatristsPsychologistsCounselors and therapists To find a mental health specialist, contact your local hospital, community mental health center, or senior center. A little preparation can make that first visit to the doctor or therapist go smoother:Make a list of your symptoms.Write down your questions.Take a list of the medications you take and their dosages. If you feel anxious about the appointment, ask someone to go with you. If possible, take notes during your visit. That way it will be easier to recall your doctors recommendations. Treating Depression Depression can be successfully treated at any age. The most effective treatments are medication and psychotherapy. Medications for depression are safe and effective, with very few side effects. They help improve mood, sleep, appetite, energy, and concentration. Psychotherapy is private counseling with a trained professional. It helps you overcome the effects depression has on your moods, thought, and relationships. These treatments may be used separately or in combination. With proper treatment, says Linton, most people experience relief from the symptoms of depression within a few weeks. Warning Signs of Late-Life Depression Physical ChangesSleeping too much or too littleEating too much or too littleFeeling tired or slowed downRestlessness, pacing, fidgetingPersistent headaches, stomachaches, or chronic pain Mood ChangesSadnessHopelessnessHelplessnessTearfulnessIrritability Thought ChangesExcessive worriesDifficulty concentrating, remembering, or making decisionsLoss of interest in hobbiesPreoccupation with death or dyingThis article was submitted by Janet Linton, M.D., Medical Director Senior Behavioral Health at Mobile Infirmary and North Baldwin Infirmary.  For more information contact North Baldwin Infirmary at Infirmaryhealth.org or 251-580-1770

Mental Health in an Aging PopulationThe American Psychiatric Association defines mental illness as health conditions involving changes in emotion, thinking, and behaviors. Mental illnesses can be associated with distress and/or functioning in social, work or family activities. It is estimated that 20% of those age 55 or over will experience some sort of mental health issue. Those numbers are expected to double by 2030 due to the approximately 75 million Americans being over the age of 65. The most common disorders include dementia, cognitive impairment, anxiety, and mood disorders (depression or bipolar disorder). A little known but disturbing fact is that people aged 85 or older have the highest rates of suicide of any age group.https://www.cdc.gov/suicide/suicide-data-statistics.html.Older adults can often feel overlooked and unheard when it comes to receiving mental health treatment. Douglas Lane, a clinical psychologist in geriatric psychology spoke about the implicit biases medical providers may carry when dealing with older adults. Ageism often plays in one of three ways: They may be infantilized by providers. Providers can also be dismissive, assuming that older people cant be suicidal or have intimate relationships. Other times, issues among older people get normalized as a so-called routine part of aging. He went on to say, Well of course theyre frail. Of course theyre depressed. Of course they dont remember things as well as they used to. Aging stereotypes are pervasive in the culture but can also reside in ourselves. Older adults as well as their medical providers tend to normalize the physical and mental conditions that come along with getting older but it doesnt have to be that way. Being sad and depressed doesnt need to be a normal aspect of aging. Medical providers need to reinforce hope and remind their patients that once they get help, they can overcome those negative feelings and emotions.There are two main subgroups of the aging population who deal with the issues of ageism and health stigma. The first group includes those who have suffered with mental illness throughout their lives. The National Association of State Mental Health Program Directors conducted a study in 2006 that demonstrated that people with serious mental illnesses lived 25 years less than those without. The majority of deaths were caused by heart disease, respiratory disease, and diabetes which are largely preventable. The second group consists of elderly persons who are newly diagnosed with mental illness/es. They are at risk of being misdiagnosed with dementia when they are actually dealing with substance abuse issues and depression. Physical complaints, irritability, and cognitive impairment can present as depression in this population as opposed to more common signs such as sadness and crying. Treatment options can vary between the groups and traditional community health programs should provide multiple options ranging from therapy to supported employment.Aside from stigma and ageism, older adults face many other issues that result in care not being sought. Insurance companies play a major role in coming between an elderly patient and the care they need. Doctors appointments times have been minimized to increase volume, much needed prescriptions are not covered, and pre-authorizations are denied based on not meeting narrowing criteria. Primary Care Physicians (PCP) have also become the gatekeepers to care for many managed and private plans. The PCP may miss signs and symptoms of a mental illness or attribute them to a physical ailment due to a lack of time to adequately explore all of the patients complaints.Older adults deserve the same level of care and respect as their younger counterparts. They deserve happiness and to feel like their mental health needs are being met. It is the responsibility of the providers to work with these patients collaboratively and to choose the least invasive treatment options with minimal side effects. Society needs to address the stigmas associated with aging and mental health in order to create a culture where seeking treatment is accepted and encouraged. We should all remember that we will someday grow old and may face these challenges ourselves. Author Jacqueline Woodson put it best, Time comes to us softly, slowly. It sits beside us for a while. Then, long before we are ready, it moves on.Article submitted by By: Brandon M Osborn, MHAContact North Baldwin Infirmary Senior Behavioral Health.  Call 251-937-5521 for more information.  Free consultations provided.