Acupuncture: An Ideal Treatment for Senior Depression

senior alone on bench

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.

 

Works Referenced

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/.

Hibernation Season: Using Deep Winter to Rest and Restore

Chinese medicine developed based on observation of the natural world. In diagnosing and preventing illness, we always consider the role of natural forces, including seasonal influences. Even though we live in climate-controlled environments, we are still impacted by the winter weather outside our front doors, just like the plants and animals with which we share this beautiful planet.

Winter is the time of year when yang energy—warmth from the sun—is at its weakest. Many animals hibernate, plants go dormant, and water freezes. The kinetic energy of our environment is much slower than it is in high summer. Food and fuel both become scarce—and precious.

Your body has its own energetic sun, housed in the Kidneys. Being attuned to climate, your body naturally regards winter with caution. During the coldest months of the year, this energy is conserved as a means of survival. Sleep becomes a priority. We may also eat more, padding our bodies with a little extra energy. Many of our winter tendencies toward comfort—warm blankets, wool socks, cinnamon tea—are unconscious gestures of self-protection. Biologically we understand that cold is dangerous.

When pathological cold enters the body, it paralyses normal function. Cold can damage the joints, the digestive system, and the skin, causing frostbite. Blood flow slows in cases of excess cold, creating poor circulation in the hands, feet, lower back, buttocks, and abdomen. This deficiency in blood circulation causes poor nutrient perfusion and slows the body’s ability to heal, warm, and detoxify itself.

Cold has always been a serious threat to human survival. One of the most famous Chinese herbal texts, the Shang Han Lun, or Treatise on Cold Damage Disorders, describes treatments for diseases that have their origins in pathogenic cold. This 1,800-year-old text describes how cold penetrates the body and becomes lodged, weakening the organs. Many formulas we use in the clinic today come from this insightful text, written by Zhang Zhongjing, centuries before the discovery of bacteria or viruses. It seems cold weather and weakened immunity were linked in the minds of Chinese herbalists nearly 2,000 years ago.

This winter help your body stay healthy by applying these preventive measures to ward off illness and make the most of the darkest season.

 

Avoid getting cold

This seems like the simplest advice, but many people do not understand the depleting quality of cold. Dress warm, especially protecting your hands, feet, and neck. In Chinese medicine, cold easily enters the neck, hands, and feet, causing sinus problems, joint stiffness, increased urination, headache, and loose stools.

Gentle exercise, warm showers, footbaths, and adequate clothing can all reduce the danger of penetrating cold. Be cautious of drafts, wear socks to bed, and avoid walking on tile floors without slippers. If you do catch a chill, address it immediately by adding clothing, turning up the heat, or getting in the tub or shower. People with colder constitutions are most susceptible to cold damage, though “hot-blooded” people are vulnerable as well. Dress appropriately to avoid taking on an environmental chill.

 

Eat for warmth

Culturally, winter can bring a lot of excess—rich food, alcohol, and sugar being the most common indulgences. The tendency to overeat during November and December can inspire dramatic shifts in diet and exercise plans on January 1.

Reducing holiday indulgencies is a great New Year’s goal, but winter is the worst time of year to go on a detoxification diet or shift to a raw food plan. Your body is already fighting to keep you warm, and eating uncooked food takes energy away from critical organs, including the digestive and waste elimination systems. This is energy you need to keep your immune system strong.

If you want to improve your diet during the winter months, switch to cooked meat, vegetables, and grains. Soups, stews, and slow-cooked foods offer the most nourishment and will not tax your body. Smoothies, salads, and raw fruit are the hardest foods to digest during winter and should be saved for spring, when the yang energy of the sun is returning.

 

Rest, relax, and sleep

Many animals spend the majority of winter in a state of hibernation, conserving their energy for basic daily tasks. Modern humans, of course, rarely adjust their seasonal schedules to accommodate a need for more rest. In fact, winter can be just as hectic as summer, especially around the holidays.

Shorter days are a natural cue to your body to grab a few more hours of rest. Think of a good night’s sleep as a kind of mini-hibernation. Even adding an extra half-hour of sleep to your night can make a difference in you daytime energy levels, cognition, and productivity—not to mention your immunity.

Winter is a great time of year to work on sleep issues. If sleep is challenging for you, consider acupuncture and Chinese herbs. Our clinic can help you rest and relax with treatments designed to address your constitution. In fact, skip the smoothies and make a good night’s sleep your New Year’s resolution this year.

Have a happy, healthy 2017!

Acupuncture for Urinary Tract Infections

women

Urinary tract infections, also called UTIs, are a common occurrence in older adults, especially women. In Western medicine UTIs are caused by the presence of bacteria, often E. coli, in the bladder. These bacteria travel up the urethra, and if left untreated, can also affect the kidneys. Managing a urinary tract infection quickly is important. If left untreated, these infections may spread, causing damage to the bladder, kidney, urethra, and genital tissue.

The symptoms of a UTI include burning on urination, the sensation of needing to urinate and being unable to void, itching in the genitals, or pain in the lower abdomen. Patients may also have an overall feeling of being unwell, including fever, irritability, or insomnia.

Healthy urine should pass easily, be straw-colored and free of cloudiness. In the case of a UTI, the urine may be dark in color, cloudy, milky, or even streaked with blood. The presence of blood in the urine indicates the infection is severely irritating the lining of the kidneys, bladder, or urethra.

Women are more likely to contract UTIs because of the short length of their urethras, or the passage between the bladder and the outside. Many women who suffer from UTIs show a chronic recurrence of these symptoms. For women who wear padded protection against accidents, a lack of breathability in the vaginal area can create an environment for bacteria. Also, patients who are unable to bathe regularly present a higher risk for developing a urinary tract infection.

Western medicine treats UTIs with antibiotics. Depending on the severity of the infection, the duration, and the patient’s history of naturally managing UTIs, alternative treatments are available.

We will focus on acupuncture, Chinese herbs, and dietary medicines, though there are other resources for UTIs in Western herbalism and homeopathy. My experience is that women often discover the best combination of alternative treatments for their particular body; no “one way” is right for every patient.

Chinese medicine treats the cause of UTI in many different ways, depending on the patient’s age, constitution, symptoms, and overall health picture. UTIs come about due to a variety of factors, including environmental, biological, and emotional. Certain types of UTIs are initiated by psychological upset and can be traced back to stress or anxiety. In Chinese medicine these infections are treated differently than UTIs caused by tight-fitting clothing, hygiene issues, or eating the wrong foods.

UTI symptoms fall on a spectrum. Some women experience intense burning with urination. Other women feel bloated and swollen, as if their urine cannot pass through the urethra because the passage is narrower than usual. Still others may feel no pain at all but notice their urine is cloudy. I have also known of women who simply felt like they had the flu but could not point to the bladder being the cause of their discomfort.

Once I have determined the cause of the problem, I develop an acupuncture plan and may prescribe a Chinese herbal formula designed to address the infection. Most UTIs can be cleared up with a few treatments and a week of herbs. If your symptoms are recurring though, we need to determine what is triggering the infection and eliminate the irritant.

The vagina and opening of the urethra are sensitive to changes in temperature and the presence of chemicals. I recommend all women wear cotton underwear, which is the most breathable fabric available, to keep the vaginal area cool and dry. If you wear pads or panty liners to manage incontinence, choose products that are made of organic cotton and a minimal amount of plastic. Organic cotton cloth diapers are a good solution for patients who need round-the-clock protection. Currently, there are no organic cotton disposable adult diapers on the market. I am hopeful these become available soon. Above all, make sure the underwear, pads, or diapers are changed regularly to minimize the risk of bacteria from the colon entering the urethra.

Drinking plenty of water will help your body flush the bacteria out of the bladder. You may also add 100% cranberry juice to your diet. Just make sure your juice does not contain any added sugar or high-fructose corn syrup. All bacterial infections are “fed” by the simple sugars found in sweet fruits and refined sweeteners. The best dietary change you can make to make the body inhospitable to bacterial infections is to cut refined sugars and alcohol.

A simple, effective home remedy for UTI is drinking corn silk tea. Corn silk is the “hair” that grows around the corn ear and is sloughed off before eating the kernels. This “silk” is soothing to the urinary tract and also has a mild taste. You can make a tea from the silk or buy encapsulated corn silk to be taken as a pill. This remedy is not for patients who are taking blood thinners (Coumadin, Plavix, etc.) or diuretics for high blood pressure or edema. If you are not taking these contraindicated medications and are experiencing recurring UTIs, consider buying a bottle of corn silk pills to keep on hand for future infections.

It is critical to remember that some urinary tract infections are best managed with antibiotics. Longstanding infections, or infections in patients who have compromised immune systems, should be addressed through Western medicine. If you are unsure whether your symptoms should be treated with antibiotics, make an appointment with your doctor. For mild infections, acupuncture, herbs, and dietary therapy may offer relief.

We are happy to talk with you about your symptoms and your health history to determine if Chinese medicine is the right choice for you.

Acupuncture and Surgical Recovery

According to the article “Common Surgical Procedures in the Elderly”[*] published by the American Geriatrics Society, older adults receive 20% of all surgeries conducted in the United States. Comprising only 13% of the population, the patient-to-procedure ratio for older adults undergoing surgery is quite high.

Surgery is an important part of modern healthcare. Many life-threatening and painful conditions are helped by surgical intervention, including cardiac events and broken bones. Older adults may undergo many surgeries to address a variety of health problems as they age.

Whether you have a procedure planned or are recouping from surgery, consider adding acupuncture to your rehabilitation program to shorten and ease your recovery time.

Acupuncture works by stimulating the body to initiate its own healing capabilities. Inserting needles in the skin at specific points reduces inflammation, releases endorphins, stimulates the immune system, and promotes blood flow to compromised areas. Recovering from surgery stresses the body’s natural repair and defense systems, especially in older patients with weakened immune and metabolic responses. Acupuncture provides gentle, supportive treatment during those vulnerable weeks after surgery when the body is asked to do significant self-healing. It stimulates the appetite, promotes elimination, and can reduce dependence on pain medication, all of which speed recovery and improve quality of life through the rehabilitation process.

Post-surgical acupuncture can be done in a variety of settings. Patients may be treated in bed, in a wheelchair, on a massage table, or in a recliner. Our clinic specializes in elder care, which means we can treat older adults with mobility restrictions and special needs, including hip, knee, and back surgeries. 

A series of acupuncture treatments can also help you prepare before receiving a medical procedure. Acupuncture boosts your immunity, calms your nervous system, and helps you sleep, which are important to recovery. Plan to see your acupuncturist once a week for three weeks before your surgery, and aim to schedule your last appointment a day or two before your procedure. Once you’ve had your surgery, schedule a series of follow-up appointments to help you through rehabilitation.

After surgery, it is important to closely manage your post-surgical pain. As pain levels rise, so do instances of insomnia, high blood pressure, and anxiety. By combining acupuncture with traditional pain management, many patients find they are able to reduce their pain medications, helping them feel more alert and avoiding side effects like constipation. Remember, pain is best managed through treatment before it becomes unbearable. Schedule appointments with your acupuncturist prior to going in for surgery to insure you are able to get in after your procedure.

Surgery can be worrisome, especially in older patients, and particularly if the recovery process is long. At Boulder Acupuncture and Herbs, we see patients in their homes or in rehabilitation facilities, like Frasier Meadows Healthcare Center, so that you can start treatment right away. If you have a surgery planned, call us to schedule a series of appointments aimed at helping you recovery quickly, safely, and with fewer complications.

[*] http://www.americangeriatrics.org/gsr/anesthesiology/common_surgical_procedures.pdf