Dr. Mauk’s Boomer Blog

In the wake of the sad news about the suicide death of beloved actor Robin Williams, discussions about depression, its recognition and treatment seem appropriate. Depression is common in American society, with 10% of men and 18% of women over the age of 65 in the United States reporting current symptoms associated with clinically significant depression. These statistics have been relatively stable since about 1998. Severe depression is one of the major causes for suicide attempts.
Sometimes it is hard to understand why a person would become so depressed that suicide seems like the only option. There are many reasons that depression occurs. These may include losses of various types such as outliving a spouse, friends, or loved ones. There may have been loss of health, financial difficulties, loss of a job, or a drastic unwanted change in living situation. Maybe the person has experienced a trauma that was life-changing. For some people, these losses can be overwhelmingly painful and persons may lack the support or coping mechanisms to successfully deal with their extreme feelings.
Men and women may display depression differently. Men express depression in the form of irritability, anger, agitation, controlling behavior, blaming others, or expressions of despair. In contrast, women may appear anxious, scared, apathetic, and express feelings of worthlessness.
Other common signs of depression include:

• No interest or pleasure in enjoyable activities
• No interest in sexual activities
• Feeling sad or numb
• Crying easily or for no reason
• Feeling slowed down
• Feeling worthless or guilty
• Change in appetite; unintended change in weight
• Trouble recalling things, concentrating, or making decisions
• Problems sleeping, or wanting to sleep all of the time
• Feeling tired all of the time
• Thoughts about death or suicide

While depression can be associated with suicide, persons with depression may not actually want to die. They simply feel they cannot live with the pain they feel and may express wanting that pain to end. This pain can be physical or emotional or both. In the United States, the highest rate of suicide is among white males over the age of 85. These men often visit their doctors within the month prior to their suicide, and give few other signs of their suicidal thoughts. They most often use lethal means to carry out suicide such as hanging or firearms. In women, suicide attempts are more often by nonlethal means such as taking pills, and should be considered a cry for help. If you have a loved who is at high risk for depression or suicide, be sure to take special note of the warning signs listed here.
The good news is that depression can be successfully managed and treated with the right help. Early recognition and treatment of depression is important and generally includes medication therapy and counseling. Talk to your doctor if you or your loved one is feeling depressed. Your primary care provider can assist you in diagnosing depression and can refer you to a reliable mental health professional to help address your symptoms and promote a better quality of life.

Tips for helping your loved one who is experiencing depression are provided on SCC’s care page that can be found at https://senior-care-central.com/category/dr-mauks-boomer-blog/

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Background

Hypothyroidism results from lack of sufficient thyroid hormone being produced by the thyroid gland. Older adults may have subclinical hypothyroidism, in which the TSH (thyroid-stimulating hormone) is elevated and the T4 (thyroxine or thyroid hormone) is normal; 4.3–9.5% of the general population has this problem (Woolever & Beutler, 2007). In this condition, the body is trying to stimulate production of more thyroid hormone. Some older adults with this condition will progress to have primary or overt hypothyroidism. This is when the TSH is elevated and T4 is decreased. Hashimoto’s disease is the most common cause and represents 90% of all patients with hypothyroidism (American Association of Clinical Endocrinologists [AACE], 2005; Woolever & Beutler, 2007), though certain pituitary disorders, medications, and other hormonal imbalances may be causal factors.

Warning Signs

Older adults may present an atypical picture, but the most common presenting complaints are fatigue and weakness.

Diagnosis

Diagnosis should include a thorough history and physical. Bradycardia and heart failure are often associated factors. Lab tests should include thyroid and thyroid antibody levels (common to Hashimoto’s), and lipids, because hyperlipidemia is also associated with this disorder.

Treatment

Treatment centers on returning the thyroid ¬hormone level to normal. This is done through oral thyroid replacement medication, usually L-thyroxine. In older adults with coexisting cardiovascular disease, starting with the usual doses may exacerbate angina and worsen the underlying heart disease, so it is important to start low and go slow. Titration should be done cautiously, with close monitoring of the older adult’s response to the medication. The does should be adjusted on 6- week intervals until normal levels of thyroid hormone are achieved. Once the TSH is within normal limits, then checking the TSH should be done every 6 to 12 months to monitor effectiveness and blood levels, because hyperthyroidism is a side effect of this therapy and can have serious implications on the older person’s health.

Patients need to learn the importance of taking thyroid medication at the same time each day without missing doses. Sometimes older adults have other problems associated with hypothyroidism, such as bowel dysfunction and depression. Any signs of complicating factors should be reported to the physician, and doctors’ appointments for monitoring should be religiously kept. Strategies for managing fatigue and weakness should also be addressed, because some lifestyle modifications may need to be made as treatment is initiated.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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