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07 July 2019 at 5am |
Kelly Kenoyer, Veronica Mohesky, Hannah Musick and Renae Whissel
Tom Rote, 70, lives alone on his property in Harrisburg. Many of his friends and family members have died in recent years and he can no longer do some of the things he used to like, like flying hot air balloons now that he was older.
Rote's circumstances tick each box for risk factors for depression.
He is a white man, over 65, who lives alone in a life full of losses. While these factors may increase the risk of depression in all people, they pose a greater threat to older adults: silent suicide.
In older adults, the prevalence of suicide is already high – and significantly underreported
Adults 65 years and older represent only 12% of the population but account for 18% of all suicides, according to the American Association of Marriage and Family Therapies.
In Missouri, the suicide rate among adults over age 85 is almost 50% higher than the national average. This statistic may be higher because suicide can be difficult to identify in the elderly.
It is not always clear if people have forgotten their medication or have deliberately ignored it, if they were too sick to eat and drink or simply did not want to.
Shirk
"Silent suicide is the intention, often masked, to kill oneself by non-violent means by depriving oneself of food or not conforming to essential medical treatment," according to forensic psychiatrist and author Robert I. Simon , who taught at Georgetown University and led one of the published studies on silent suicide in the elderly.
David Fleming, a specialist in geriatric medicine at MU Health, said that an intervention can be difficult. If patients stop caring for themselves, doctors can not do more.
If he notices that a patient is deliberately and intentionally eating, for example, he can not force him to use a diet probe ethically if this patient has the ability to make decisions.
"Sometimes we have to say," OK, we'll support you in that way. "And we let them go," said Fleming.
Samantha McCay, life specialist, said she saw many older people become depressed because they felt they were useless or just "old and annoying," as Rote himself describes it. For people who have experienced substance abuse problems in the past, such as Rote, this feeling can trigger a relapse.
"Silent suicide is definitely a problem because … some people, if they were alcoholics, might be able to start drinking again at some point," McCay said. "There is just a lack of care for themselves."
Solitary wrestling
Rote fought against alcoholism after his wife was injured in a car accident while he was returning home after his honeymoon decades ago.
"She was in a coma for nine months and I had two DWIs trying to drown my grief and I went to a mental health center," Rote said.
His wife woke up from coma, but she had no memory of him. They finally divorced and, even though he has had a few friends since, he has never remarried.
He now lives in a small house surrounded by photographs and memories of his adventurous past. Rote said he liked going to Columbia's bars and cafes, but it was a 20-minute drive from his home.
During the snowy winter months, it can be difficult to get out of its long gravel driveway. He has never had children and spends most of his time alone watching old pictures or cutting firewood.
This type of community isolation is another risk factor for depression. Rote enjoys spending time in a seniors' center, but even there he often sits alone. The grief caused by the loss of parents, combined with little or no interaction with others, further increases the risk of depression.
Signs
In addition to isolation, there are many early warning signs of depression in the elderly, such as withdrawal of activities and changes in sleep and appetite. However, they are not always easy to recognize for doctors.
In fact, 70% of seniors who commit suicide go to their main health care provider within a month of their death, according to the American Association of Marriage and Family Therapy.
Peter Koopman is an badociate professor of family and community clinical medicine at MU. He has been teaching geriatric depression for over ten years. One of the reasons it can be difficult to diagnose depression in older people is that they often describe their emotions better.
Younger patients are much more likely to come in and say that they feel depressed, he said, but older adults usually do not. In addition, the majority of patients over 65 years of age have at least one chronic disease and physicians consider these diseases as the highest priority of older patients.
"It's easier for depression to go unnoticed because you have high blood pressure, diabetes, and often as doctors, we want to treat their chronic physical illness and make it part of our program," he said. Koopman.
The best way for doctors and family members to check for depression is to ask what happens if there is a change in behavior, even though it may be uncomfortable, he added.
"Most of the medical literature would say that you have to be direct if you want to ask questions about it," Koopman said. "And you have to ask about it if you are worried about depression."
Treatment options
Once diagnosed with depression, treatment may be a little more complicated for the elderly population as well, as some antidepressants interact negatively with other drugs. Cynthia Baker, a Certified Clinical Socialist Specialist in Gerontology at The Bluffs, a senior living center in Columbia, said a combined approach that includes cognitive-behavioral therapy was the best option.
"What we're seeing is what the research supports is the combination of counseling or psychotherapy with an anti-depressant or mood-related medication that reduces depressive symptoms," said Baker.
Although aging often requires adapting to a different lifestyle, depression is not a normal aspect of aging, according to the Center for Disease Control and Prevention. Depression is highly treatable and older people with depressive symptoms are encouraged to contact family members and their health care providers for appropriate treatment.
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