Depression impacts 14% of seniors in Colorado. The symptoms of depression in older adults can range from fatigue and poor appetite to hopelessness and thoughts of suicide. Most elders living with depression do not develop symptoms until later in life and are often unfamiliar with treatment options. In addition, many may be reluctant to share details about their experience due to a perceived social bias against mental illness. Acupuncture, because of its unique ability to simultaneously address both the physical and emotional aspects of health, is an ideal treatment for senior depression.
The factors leading to depression in seniors are different from those of younger adults. Many of these factors are linked to physiological changes that may appear with age. Patients with advancing stages of certain diseases, such as Alzheimer’s and dementia, often develop depression due to organic changes in the brain. Other seniors are impacted more by the social implications of aging, including a loss of freedom, autonomy, purpose, and meaningful identity.
In this article we will first become familiar with physical and mental considerations in identifying senior depression. We will then look at when acupuncture is an ideal choice for an elder living with this condition. Because of the far-reaching, and potentially devastating, effects of depression, we must understand how to offer the right assistance at the right time.
Physical Symptoms in Senior Depression
Particular diseases are linked to depression in older adults. Patients with Alzheimer’s disease, Parkinson’s, dementia and those recovering from stroke carry a greater risk of developing depression due to physical changes in the brain. Elders with cardiovascular disease, hypo- and hyper-thyroidism, and Type II diabetes also show a propensity for depression. Often patients are treated for mood changes in the context of managing these chronic illnesses.
When identifying depression in a senior, it is imperative to determine if mood changes are due to the progression of a disease, either previously diagnosed or currently unidentified. Mental health shifts can point to hidden physiological changes that must not be overlooked. Always consider whether a change in mood is coming from physical illness before starting treatment for depression.
Even with this screening in place though, many seniors my not articulate their feelings of sadness, hopelessness, or anxiety openly to family or caregivers. The signs of depression in seniors can be difficult to identify and are sometimes dismissed as being part of “old age”—even by the patient herself. While aging does bring unique life challenges, certain physical changes should not be ignored.
Possible Physical Indications of Depression in Seniors
Insomnia: Insomnia and depression are closely linked in elders. Patients with lifelong sleep problems have a higher risk of developing depression. A recent onset of insomnia may also indicate a senior is having a mood shift. Correcting the insomnia is important, as poor sleep lowers immunity, clouds cognition, and can lead to accidents and falls.
Fatigue: Daytime exhaustion may be a sign of poor sleep, but this is not always the case. Fatigue can point to a variety of issues, including physical complications from hypotension or hypothyroidism. Fatigue can also be a sign of mental disengagement and avoidance. Both fatigue and depression can create a sensation of being physically “dragged down,” leaving the patient feeling helpless to complete the basic Activities of Daily Living (ADLs) or engage socially with friends and family.
Lack of Appetite: Disinterest in food can also be a sign of depression in seniors, a condition we see more in women than men. The implications of poor nutrition are numerous, including blood sugar instability, increased frailty and risk of falls, and dehydration. Diseases of the digestive tract should be ruled out, including constipation.
Physical symptoms are sometimes the only clues we have to helping seniors with mental health concerns. If you notice changes in sleep, appetite, or energy levels, see a medical doctor to rule out infection or disease. Often shifts in mental outlook are directly related to changes in physical health, especially in patients managing complex diseases. A clear diagnosis is always the first course of action.
Mental Symptoms in Senior Depression
Depression can be tied to a number of triggers in older adults. For some, the losses of aging—including diminished physical vigor, reduced mental clarity, changing social roles, and grief over losing a spouse—can be overwhelming. Lack of control over the processes of illness and death may cause some seniors to feel regret, sorrow, and fear. Caregivers should be able to offer solace and companionship to elders who are navigating this difficult terrain.
Life changes that may trigger depression in a senior include:
- Death of a spouse
- Moving to assisted living, a memory care unit, or a skilled nursing facility
- Deterioration of physical health
- Memory loss, especially in the early stages of Alzheimer’s
- Change in financial status
- Sudden isolation
- Loss of a social role, either in the family or community
Seniors may also experience a state of “depression without sadness,” meaning they can be depressed even in the absence of an emotional trigger. They may say they have nothing to feel sad about, and yet, as caregivers, we may observe physical or emotional changes that suggest there is something deeper going on. The following indicators may help us identify hidden symptoms of depression.
Possible Mental Indications of Depression in Seniors
Anxiety: Seniors who are anxious are more likely to develop symptoms of depression if triggered by a life-changing event. Also, elders who live with both anxiety and depression may not respond as quickly to conventional treatment (medication and psychotherapy). Helping seniors feel less anxious may lead to emotional resiliency and feelings of self-empowerment and stability in the face of difficult life transitions.
Lack of Interest in Life: Engagement, purpose, and connection are important during every phase of life. Some elders see the last phase of life as an opportunity to let go of relationships, roles, or obligations they no longer need or enjoy. For some, self-reflection becomes their main focus. Others use this time to create relationships, travel, or learn new hobbies. A lack of interest in life, including hopelessness about the future, could be a sign of depression in an older adult and should be taken seriously.
Grief: Grief, or bereavement, is differentiated from depression. At the same time, untended grief can turn into depression, especially if the loss of a loved one coincides with another trigger, such as a move to an assisted living facility. Some elders may feel they need to “get over it” but are unable to transform their grief in a timeframe that feels reasonable to them. It is important to tap into a network of care for elders working through loss of a loved one. Luckily, hospices across the country offer grief counseling and support groups for the bereaved. These services are often free and can make an enormous difference in an elder’s recovery.
Mental and physical symptoms often mix to present a complicated health picture in older adults. The combination of emotional loss and changes in physical wellbeing can initiate feelings of despair in elders who have lived long lives of independence and vitality. Attending to both physical and emotional needs is crucial for maintaining a positive mental outlook in seniors and offering the best care possible.
Acupuncture for Depression in Seniors
Acupuncture is a unique drug-free alternative that treats a spectrum of body-mind concerns in older adults. Treatments are automatically designed to address physical issues, as well as mental discomfort. In fact, acupuncture theory is built on an inherent relationship between physical wellbeing and mental health.
Acupuncture is particularly powerful in treating seniors because we begin by addressing physical discomfort. Older adults usually feel safe talking about pain or the progression of diseases, such as hypertension and COPD, with an acupuncturist. Patients understand that acupuncture helps with physical ailments, and they can measure changes in physical health after seeing a practitioner.
The benefit of having an acupuncturist on your caregiving team is that patients receive emotional support in the context of physical care. This mimics the Western medical model of going to the doctor for physical pain and being asked about mood. I find patients respond well to this approach and are grateful that I ask about their mental wellbeing.
When I treat older adults, I always ask about mood. Some patients talk openly with me about their feelings; others are more private with their answers. I work to create a relationship of trust so that patients understand I am committed to helping them both physically and emotionally. Each of my treatments addresses the body-mind spectrum.
If patients wish to share how they’re feeling, acupuncture treatments almost always allow time for connecting. While clients are resting with needles inserted, I offer to talk if they feel inclined. This combination of authentic listening, attention to physical care, and gentle touch make a noticeable difference in an elder’s life.
At Boulder Acupuncture and Herbs, senior mental health is important to us. We are connected to social workers, psychotherapists, geriatric medical doctors, and other alternative medical practitioners who can help. If acupuncture is not the ideal treatment for you or a loved one, we will refer you to the right provider.
Emotional wellbeing is an important part of healthy aging. Our mission is to provide full-spectrum care for every senior we see in our clinic. When you work with us, you can be confident we will always consider your mental health concerns in the context of treating your physical condition.
Carnarius, Megan (2015). A Deeper Perspective on Alzheimer’s and Other Dementias: Practical Tools with Spiritual Insights. Findhorn Press (Scotland, UK).
Colorado Department of Public Health and Environment. 2016. The health of Colorado’s older adult population data infographic. http://www.chd.dphe.state.co.us/Age/Healthy-Aging-in-Colorado-Infographic.html.
Fiske, Amy, et al. (2009). “Depression in Older Adults.” Annual Review of Clinical Psychology. Accessed via National Institutes of Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852580/.