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Depression in Seniors is Often Unnoticed

depression uptown dallas counseling

Family members and even primary healthcare providers often mistake an older adult’s symptoms of depression as just a natural reaction to illness or an unavoidable part of the aging process. Older adults themselves often share this belief and suffer unnecessarily because they don’t understand that they could feel better with appropriate treatment.

Statistics on Mental Health and Seniors

Recent data indicate that an estimated 20.4 percent of adults aged 65 and older met criteria for a mental disorder. (Karel, Gatz & Smyer, 2012). The CDC’s 2013 report on The State of Aging and Health in America identified “addressing mental distress among older adults” as one of its primary Calls To Action needed to improve the health and well-being of older adults.  The CDC estimates:  About 25% of adults aged 65 years or older have some type of mental health problem, such as a mood disorder not associated with normal aging. Mental distress is a problem by itself, and it has been associated with unhealthy behaviors than can interfere with self-management and inhibit recovery from an illness.  

How Can we Help Change these Statistics?

Talking to seniors about their mental health can be challenging. Family members, caregivers, and even many medical professionals are not trained to assess mental disorders.  Conversations can be awkward.  Seniors are often reluctant to talk about their symptoms.  

The most common mental disorder among older adults is depression.  Depression, once diagnosed, often responds quickly to treatment.  Most older adults with depression improve when they receive treatment with an antidepressant, psychotherapy, or a combination of both. If left untreated, however, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life. 

If you suspect an older adult has depression, there is an easy, direct way to talk with them about their symptoms.  The Geriatric Depression Scale (GDS) is a reliable 15-question assessment that anyone can use.  Ask the senior to answer the following questions:

Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO

Answers in bold indicate depression. Score 1 point for each bolded answer.
A score > 5 points is suggestive of depression.
A score ≥ 10 points is almost always indicative of depression.

Source: http://www.stanford.edu/~yesavage/GDS.html
This scale is in the public domain.

Any score greater than 5  warrants a follow-up assessment by a medical professional. If your senior scores higher than 5, help them schedule an appointment to discuss the results and form a treatment plan with a healthcare provider.

If you or someone you care about is in crisis, please seek help immediately using one of the following methods:

  • Call 911
  • Visit a nearby emergency department or your health care provider’s office
  • Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Sources: 

Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013.

Karel, M. J., Gatz, M. & Smyer, M. A. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67, 184-198.

Lyness JM, Noel T, Cox C, King DA, Conwell Y, Caine ED. Screening for Depression in Elderly Primary Care Patients: A Comparison of the Center for Epidemiologic Studies—Depression Scale and the Geriatric Depression Scale. Arch Intern Med. 1997;157(4):449-454. doi:10.1001/archinte.1997.00440250107012.

U.S. Department of Health and Human Services, National
Institutes of Health, National Institute of Mental Health. (2015).
Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S.
Government Printing Office.

 

 

Depression Therapy Treatment with Cognitive Therapy

Aaron Beck Cognitive Therapy

Dr. Judith Beck with her father, Dr. Aaron Beck

At a fundraiser on November 11, 2013, Aaron Beck talked with an audience about Depression Therapy.  While treating patients for depression in the 1960’s, he recognized a repeated pattern.  When he helped patients change their current thoughts about themselves, the patients’ moods would improve.  For example, a patient would stop thinking “I am useless” because he lost a job, to “I am talented, I will find a new job.”  Dr. Beck began to change his focus of therapy from analyzing childhood events, to challenging patients to change their negative thoughts.  Additionally, he began encouraging them to recognize and remember the many positive aspects of their lives.  He went into academia at the University of Pennsylvania where he expanded, researched, and taught his ideas to others in the field of psychology,

Dr. Beck, 92, is known as the father of Cognitive Behavioral Therapy (CBT), and is internationally respected for his views on psychotherapy.  Dr. Beck has written dozens of books detailing effective ways to treat different disorders by using his “thought changing” techniques.  The November 11 event was a fundraiser for his Beck Institute of Cognitive Therapy.  The money raised will be used to defray the costs of teaching CBT to practitioners and allow low-income clients to receive CBT treatment at the Institute.

Stacy Burling’s article published in the Inquirer on November 11, 2014 describes the details of the event:

Judith Beck, a formidable psychologist in her own right, describes her father, the psychiatrist Aaron Beck, with a mixture of amusement and veneration, as a “rock star.”

The Becks were the attractions at a fund-raising event last week for their Beck Institute in Bala Cynwyd. But it was clear that the elder Beck, known as the father of cognitive behavior therapy and one of the world’s most influential therapists, was the main draw.

Before they took the stage at WHYY in Center City to discuss their form of treatment – aimed at changing self-defeating thinking – they met with 70 “patrons” who had paid $250 a ticket for one-on-one access.

Aaron Beck, known as Tim to friends, is 92 and seriously stooped, but he was engaging and congenial as well-wishers waited in line for a chance to bend down to talk with him.

He seemed to relish the job of selling the institute, which he and Judith Beck founded 20 years ago. After the remaining 90 ticket-holders ($150 and $75) were within earshot, he joked that he and she had kept news of the center quiet until now.

“This is sort of a coming-out party for the Beck Institute,” he said.

The institute provides training in cognitive therapy as well as treatment. It recently expanded both and was raising money to help defray costs for students and patients who cannot afford the fees. This was its first fund-raiser.

“We decided the time was right to get the word out more about what we do,” Judith Beck said.

Many people think all psychotherapy is the same and equally effective, she said. “You need someone with a kind ear and the expertise to get you over what you’re suffering.”

Aaron Beck was an early advocate of measuring the effectiveness of his therapeutic approach and says cognitive therapy is now well-positioned because the Affordable Care Act encourages the use of “evidence-based” treatments.

Under the benevolent questioning of WHYY host Marty Moss-Coane, the Becks talked about their past and future with a very supportive audience.

Before Aaron Beck described how he happened on the new approach in the 1960s, he warned, “I’ve told this story before, so those who’ve heard it before can turn off their hearing aids.”

He was doing traditional psychotherapy when a patient revealed that she worried during their sessions that she was boring him. Her tales of her sexual escapades were not boring. Beck started asking other patients what they were thinking, and a theme emerged. As they went about their lives, they were telling themselves, “I am a loser.”

No wonder they were unhappy.

Beck thought it might be more fruitful to worry less about how patients felt about their mothers and work instead on changing their thinking. In each case, he’d ask them “What is the evidence?” for the negative thoughts, and challenge them to consider another explanation. He also urged them to focus more on positive things that happened, since his depressed patients seemed to selectively remember the bad.

Patients started feeling better, he said, and after 10 or 12 sessions, they told him they longer needed him.

“Until then, I was able to fill my schedule up,” Beck said drily.

This newfound efficiency, he said, led to his academic career at the University of Pennsylvania.

While new therapists get training in cognitive therapy, and many say they do it, Judith Beck said most are not doing what she recognizes as cognitive behavior therapy.

In a true CBT session, she said, the therapist assesses the patient’s mood, asks about changes since their last meeting, including positive events, and works with the patient to set an agenda for the hour. They talk about distorted automatic thoughts and how to change them.

At the end, the therapist asks the patient to summarize what happened and write down what was important. They talk about the patient’s homework for the next session, and the therapist asks for feedback and ideas on how to do better next time. That sets a “collaborative” tone.

As for the future, Aaron Beck said he thinks that evidence eventually will lead to a single approach. Cognitive therapy will be a big component of it, but it will be “fleshed out and modified in many ways.”

Aaron Beck, who uses an iPhone, iPad, and Skype, also thinks technology will bring better treatment to rural residents.

Judith Beck said her highly accomplished family – her mother is retired Superior Court Judge Phyllis Beck – gets along well.

“My father would say, ‘Problems are meant to be solved,’ ” she said.

“Have you thought about working with Congress?” Moss-Coane quipped at one point.

Aaron Beck said his publisher considered sending copies of his book, Prisoners of Hate, to lawmakers when it came out in 1999, but never did. 

http://articles.philly.com/2013-11-14/news/44033725_1_cognitive-therapy-beck-institute-aaron-beck