As we get older, it’s expected that our bodies won’t act the same as they used to. We may experience a decrease in stamina, bone and joint problems, increased recovery time from activities, among other things.
However, there are some symptoms typically associated with old age that are actually worth paying more attention to in elderly individuals. Memory loss, decreased appetite, or a decline in activities’ participation could just be side effects of elderly conditions, but significant changes could signal other underlying issues as well. Depending on the symptoms and their severity, certain changes could suggest depression or possibly the onset of dementia as well.
The presentation of dementia and depression can appear similar in elderly residents. ALE discusses the distinguishing features and the differences in these conditions.
Depression Vs. Dementia
Depression in the Elderly
It’s estimated that over 6 million Americans 65 and older experience late-life depression (National Alliance on Mental Illness, or NAMI). The causes are often related to the shift in purpose, abilities, or other events common in later life, such as a decline in physical health as well as loss of family, friends, or a spouse. People are often eager to retire, but sometimes lose a sense of purpose without the structured schedule of working life. This can be especially hard on people who either don’t have children, have children and grandkids who live far, or don’t have hobbies or a regular social life to keep them occupied. In some cases, retirement can be stressful with a reduced income but increased medical care costs. Specific medical conditions that may take away an individual’s independence can also trigger depression as well.
In assisted living, depression is noted as one of the top five ranked health concerns, according to the CDC. In addition to the aforementioned triggers, feelings of despair and loss of independence may be heightened, especially if families and friends fail to make regular visits, or the resident no longer has any social connections. A resident realizing they are no longer capable of living independently in their own home anymore can be crushing to their self-image as well.
Symptoms of depression in the elderly are similar to general symptoms of depression and can include:
- Persistent feelings of unhappiness, anxiousness, hopelessness, pessimism
- Feelings of guilt or worthlessness
- Increased irritability or restlessness
- Insomnia, early-morning wakefulness, or excessive sleeping
- Fatigue and decreased energy
- Unexplained aches, pains, headaches, or digestive problems that do not resolve with treatment
- Difficulty concentrating, remembering details, or making decisions
- Appetite loss or overeating
- Loss of interest in activities that were previous enjoyable
Source: Geriatric Nursing Journal
Medical conditions that tend to induce depression or make depression worse are typically chronic conditions (Parkinson’s, cancer, diabetes, etc.) or acute medical events such as a stroke, heart attack, and even hip fracture. Despite the advances in medical technologies and therapies to aid in an individual’s recovery, there can be complications and setbacks. Even the prospect of dealing with these life-changing events in later life can be overwhelming and core-shaking for an individual.
Certain medications can also cause or exacerbate symptoms of depression, some of which include medications for blood pressure, tranquilizers, beta-blockers, steroids, estrogens, and more. Elderly adults are also more susceptible to the side effects of particular medications. Check out our previous blogs, Effects of Medications on the Senior Body Part I, and also Part II.
Dementia and How it Differs from Depression
The symptoms of depression and dementia sometimes appear similarly, and it’s important to distinguish the two in order to find the right treatment or accommodations for the individual.
Additionally, just because an individual is beginning to show some form of memory loss, it is inappropriate to immediately conclude they have dementia. There are other aspects of cognitive function that enter in a dementia diagnosis.
Common Dementia Symptoms
- Subtle short-term memory changes
- Struggling to find the right words
- Changes in mood / Sundowner’s Syndrome
- Change in sleep pattern
- Difficulty completing normal tasks
- Difficulty following story lines or completing stories
Distinguishing the Differences Between Dementia & Depression
Memory: Memory issues are a common problem in old age, dementia, and depression. However, the distinguishing features are the kinds of memory loss or lapses we see in individuals.
Old age – Includes occasional forgetfulness or trouble remembering specific information right away, but can still continue their thought processes, finish sentences, and are able to carry on with their daily schedule and tasks independently.
Depression – Individuals with depression have trouble focusing or concentrating, and can experience some lapses in memory. Coupled with any anxiety or preoccupation in thought, this can distract the mind from properly recalling information.
Dementia – Memory loss starts slowly, but as the condition advances, the loss is consistent and apparent. Individuals with dementia frequently struggle to pull up the right words or phrases in conversation and can have trouble finishing sentences. Learning new tasks can become increasingly difficult as short-term memory deteriorates. They may not remember what they did during the day, what they ate for breakfast, etc. Tasks they’ve done most of their life, such as writing a check or completing basic math problems can become confusing.
Orientation: Generally, elderly individuals with or without medical conditions not affecting cognitive function are aware of the day, year, where they are, and so on. Likewise with elderly residents with depression. Individuals with dementia lose their sense of time and place and may not be able to answer correctly if asked. They may not be able to answer what year it is, in which city they live, etc.
Language: An average elderly individual with normal cognitive function (barring individuals who have had a stroke affecting the language area of the brain) and an elderly individual with depression should be able to properly use their native language, even if it may be at a slower pace. Those with dementia have increased problems with language, either forgetting common words (cat, window, desk), misusing or making up words. Sentences may be incomplete or not appropriate for the context. They may also have difficulty following multiple-step directions, complex or abstract thoughts. Advanced dementia residents may have trouble expressing their needs (e.g., hunger, tiredness, restroom needs).
Those with vascular dementia, the second most prevalent form of dementia after Alzheimer’s, may even resemble someone affected by a stroke because the condition is a result of reduced blood flow to the brain. In fact, vascular dementia can develop after a stroke.
Mood: The average elderly individual presents with their normal affect. Elderly residents with depression have a persistent ‘blue,’ sad, or empty mood all day most days, which doesn’t change much with interactions, activity, or environment.
Individuals with dementia tend to present normally, but can be hypersensitive or reactive at times. Feelings of frustration and agitation can come easily as well.
In the evening and night, some dementia residents experience Sundowner’s Syndrome, an increase in agitation, anxiety, restlessness, fear, crying, or even physical outbursts. Some may experience hallucinations or paranoia, or wander, pace or rock back and forth. There is no solid explanation yet for what specifically causes Sundowner’s but doctors and researchers surmise it might be due to hormone changes, or even fatigue.
Elderly dementia and depression are common in assisted living facilities. This is why it’s important to know your resident and note any change in behavior, disposition, and even physical changes. The elderly body is more sensitive to change and any deviation from the norm can have a cumulative effect on their health and well-being.
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