Grief vs. Depression in the Elderly: What’s Really Going On?

It can often be difficult to distinguish between grief and depression in an individual. This distinction is made even more difficult when working with the elderly, given that there are typically many other changes taking place at the time of diagnosis. Living in an ageist society stimulates anxiety around the natural process of growing older. This, coupled with the challenges and changes that come with growing older, can make grief and depression in the elderly close bedfellows.

Although change and loss can be very painful, they are a cornerstone of our existence as humans. As individuals age, one of the most common changes they face is loss. Whether it’s loss of our work, loved ones, independence, or our health, we are destined to grieve at some point. It’s important to remember that grieving is a normal and healthy response to these transitions and changes. Although it can be difficult, there is incredible value in facing and working through these emotions.

It’s extremely important to understand the differences between grief and depression in the elderly. Although both grief and depression are often treated similarly, the course of action is not the same for both. If an individual is experiencing both grief and depression simultaneously, it needs to be addressed in treatment, and this can only occur if they are properly identified.

Many of us believe that becoming complacent or sad as we age is just a part of life. It’s easy to overlook depression in the elderly or chalk it up to a natural flow of events. But the truth is that depression is as much of a disease as diabetes and can be treated if properly diagnosed. Our bodies’ natural production of “happy” neurotransmitters, such as norepinephrine, serotonin, and dopamine, decreases as we age. When produced at the right levels, these neurotransmitters help us feel good emotionally and physically, but as we age, their levels drop.

How do we experience grief and depression differently? To put it simply, grief often rides like a wave: A grieving person can usually find moments of levity inside the darkness, something to spur a smile or a moment of joy. Depression, however, often feels like being buried in a dark hole where no light comes through for extended periods of time. According to the Centers for Disease Control and Prevention, depression in the elderly affects about 7 million Americans age 65 and older. Caucasian men over 85 years old have the highest suicide rate in the nation. It’s important for depression to be properly diagnosed so that treatment can begin as soon as possible, but it all too often goes undiagnosed.

Issues That May Hinder a Proper Diagnosis of Depression in the Elderly

  • The use of multiple medications may either mask or create symptoms.
  • The individual may hide his symptoms for fear of social stigmas.
  • The symptoms coincide with other diagnoses, such as dementia or heart disease.
  • Depression could be misdiagnosed as bereavement or grief.

Depression in the elderly may be first diagnosed upon admittance into an assisted living or nursing home environment. Often the diagnosis of depression is accompanied by a prescription for antidepressant medication(s). Although this introduces yet another change for the individual, medication can often help with the physical symptoms and chemical imbalances that affect daily living in seniors. Coupled with appropriate social measures, antidepressants can assist elderly individuals in managing the difficult aspects of depression.

Even though the use of antidepressants can be helpful in treating depression, the importance of differential diagnosis between depression and grief shines bright. If an elderly individual is not actually depressed, but rather grieving the many losses that accompany moving to a nursing home, the antidepressants could have an adverse affect and take away from a healthy grieving process. This makes a proper diagnosis and treatment plan that much more significant, and it’s important to be able to distinguish between the symptoms of both.

Signs of Depression in the Elderly (Symptoms Present for at Least Two Weeks)

  • Fantasizing or speaking of suicide, known as suicidal ideation
  • Frequent anxiety and irritability
  • Constant feelings of emptiness
  • Feeling hopeless or helpless
  • Concentration or memory problems
  • Social withdrawal
  • Vague complaints of physical pain
  • Significant shifts in:
    • Sleep habits
    • Mood
    • Energy
    • Food consumption
    • Interaction with hobbies that previously brought joy

Signs of Grief in the Elderly

  • Recent or upcoming loss
  • Sadness about changes/loss
  • Moments of pleasure and happiness amid the grief

Each individual grieves differently, and an individual will have a different experience with the grief process for different losses throughout her life.

Ways to Help Decrease Symptoms of Depression in the Elderly

Increasing physical activity can help produce more of those “happy” chemicals in our brains. Many forms of exercise have been proven to help with both the physical and emotional aspects of depression, according to a recent study from the Duke University Medical Center. The New York Times outlines the findings that even a few tai chi classes can help decrease the symptoms of depression in the elderly. If physical limitations prohibit standing or walking for exercise, there are alternatives — like Sit and Be Fit — that allow for muscle movement and healthy aging while remaining seated.

Making sure to include all aspects of the individual’s support system, especially face-to-face contact with friends and family, can help decrease his symptoms and effectively treat his depression. With the increase in the use of technology to connect with others comes the opportunity to widen the support network for elderly individuals who live far away from their support network. Bridging the gap between generations can also be beneficial to people experiencing depression. This intergenerational connection can come in many forms, including between family members or between community members who aren’t part of the family. They can also utilize newer technologies to connect over the Internet if their location does not easily lend itself to face-to-face contact.

Helping your patients find balance in areas that feel overwhelming can also help lessen their depression. This may include increasing support, bringing in additional help, or encouraging them to participate in psychotherapy. With or without antidepressants, psychotherapy can help a person process the feelings of depression, create structure, and allow for a safe space to discuss the difficult aspects of depression. Having a balanced diet and getting enough restful sleep are also essential in treating both the physical and emotional aspects of depression. Additionally, seniors can experience many benefits from becoming involved in their communities. Most local senior centers, assisted living facilities, and nursing homes have daily or weekly social events that are free. These create an opportunity for seniors to meet new people, participate in an engaging activity, and potentially find other people who may be experiencing similar struggles.

Incorporating arts into a daily or weekly routine can have many benefits for a senior dealing with depression. This can be an especially good option for someone who is not able to do physical exercise. There are multiple ways to use art to help treat symptoms of depression, ranging from simple art projects to more involved art therapy.

Here are just a few of the artistic pursuits and hobbies you can encourage seniors to try out:

  • Music
  • Painting
  • Knitting or crocheting
  • Drawing
  • Watching movies
  • Going to live performances (dance, music, theater)
  • Clay projects, pottery, or sculpting
  • Games
  • Photography or scrapbooking

If, in fact, an elderly individual isn’t clinically depressed and is instead grieving the loss of one or several things in her life, it’s imperative to allow space for the grieving process. Growing older means being faced with many changes, and as we grow older these changes are often losses. Older adults experience loss at an accelerated rate due to changes in physical ability, health, living situation, and the deaths of close friends and loved ones. These losses are unbelievably hard to cope with, especially when more than one is experienced at a time. Many people overlook that losses other than death can bring a grieving process very similar to that of losing a loved one. Grief has been described as a process of letting go of something we are attached to. This means we could experience grief at any time for many reasons and suggests that grief should be treated equally, regardless of the precipitating event.

Ways to Support the Grief Process in Elderly Patients

Referring your patient to a therapist or grief counselor can help give him a space to process his grief. In addition, getting the senior’s loved ones involved can help ease the stress of everyday life while he is grieving. Here are just a few of the ways you can encourage families or neighbors to help:

  • Creating space for acknowledging that a loss has occurred.
  • Helping with daily living tasks (meals, laundry, etc.).
  • Suggesting activities the individual typically enjoys.

Knowing the difference between grief and depression in the elderly is essential when creating a treatment plan that can enhance their lives. Although there are many similar aspects of grief and depression, they are not the same and should not be treated as if they are. Allowing someone to appropriately grieve their losses is an important part of healing. Recognizing the signs of depression and getting appropriate treatment for it is vital in helping the senior recover. Being able to recognize the often subtle differences between symptoms of grief and depression can help you decide the best way to give your senior patients the best care possible.

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