● Do not be defined as old; be defined as a person. Focusing on age often makes people think they are too old for various activities. ● Avoid maladaptive coping, such as alcohol consumption, recreational drugs, and reckless behavior. ● Vent feelings. It is okay to feel angry, hurt, or upset but try not to keep it inside. Talk to a friend, loved one, or other trusted person. ● Join a support group. Interacting with others who have similar concerns provides support and possibly friendship. ● Seek professional counseling if depression or unresolved grief is suspected. ● Find sources of humor. This is a form of distraction and provides an emotional break. ● Learn about the illness and implement healthy habits to prevent or slow the progression. ● Take control of a problem to gain empowerment. Avoiding problems or denying problems are maladaptive coping mechanisms. ● Find an effective relaxation technique. Examples are meditation, guided imagery, tai chi, progressive muscle relaxation, and soothing music. ● Spend time with enjoyable people. If unable to be with them in person, call, write, or email. ● Consider journaling and writing your family history for your grandchildren. Or, perhaps organize and label old photographs to give them a sense of their family history. ● Find enjoyable activities. If unable to do them anymore, find adaptive ways of getting pleasure from them. Perhaps your enjoyment of horseback riding can be replaced by watching horse shows on television. ● Try to look at change as a challenge – not as a threat. ● Do not worry about things that cannot be controlled, such as the weather or problems in other parts of the world. ● Exercise is a stress reliever. Find something enjoyable to do, such as walking, swimming, or yard work. ● Go outside into the fresh air and enjoy nature. ● If animals are a source of pleasure, adopt a pet or request pet visits through Pet Partners. ● Get enough rest. It is more difficult to cope when fatigued.
Very few older adults navigate through the aging process without encountering a chronic illness. The Corbin and Strauss Trajectory Model (Corbin & Strauss, 1991) is based on the premise that the course of a chronic illness can be shaped and managed over time, even if the course of the disease cannot be modified. This model defines chronic illness as the irreversible presence and accumulation of disease states or impairments that require supportive care and self-care to maintain function and prevent further disability. “Trajectory” implies that the course of the chronic condition profoundly affects an individual and those around him or her in all aspects of life. Chronic conditions and illnesses and their symptoms influence a person’s life. In addition, other aspects of life influence a person’s ability to manage his or her illness. This model details various stages that occur with a chronic illness. The management of all phases of most chronic illnesses, except for acute and deteriorating phases, takes place in the home. The model explains that an illness is not just coped with as part of life; rather, it must be managed and requires work. Healthcare professionals, family, friends, or the older adult can do this work. This can include managing and arranging medical appointments, diet, medications, and health behaviors. This management and arrangement is continually revised in accordance with changes in illness phases, addition of new diagnoses, and fluctuations in support systems. The major focus for older adults is not merely managing an illness, but maintaining quality of life, as defined specifically by them, despite the illness. The goal of healthcare professionals within this model is to provide older adults with the assistance needed to manage their illness course while maintaining their quality of life. Examples of assistance are education, transportation arrangements, financial support availability, assistive device procurement, community referrals, and support groups. The following are tips that the healthcare professional can share with older adults to cope with illnesses and losses: ● Keep busy. Plan something to do every day. It might be as simple as writing a letter to a friend, going to the grocery store, or doing volunteer work. People who feel they do nothing all day tend to focus on the negative aspects of life. ● Focus on what can be done, not on what cannot be done. An older adult who no longer can go dancing might now enjoy reading the classics he or she always wanted to read. Not a normal part of aging Depression is the most frequent mental health problem among adults. Estimates of major depression in older adults living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home health care and to 11.5% in those who are hospitalized (Centers for Disease Control and Prevention [CDC], 2015). Depression often goes undiagnosed and therefore untreated, especially in older adults (Tanner, Martinez, & Harris, 2014). It is often missed in older adults because they may exhibit nonspecific somatic complaints rather than the symptoms of depressed mood classified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition ( DSM‑5 ; American Psychiatric Association [APA], 2013). Coping with chronic illness, disabilities, and losses often results in minor depression, which may in itself become chronic (National Institute of Mental Health [NIMH], 2016a). Depression, however, is not a normal consequence of aging (Tanner et al., 2014). Depression may be associated with adverse effects of medications or even certain medical diagnoses. Refer to Table 1 for factors related to depression. Depression may also be caused by psychological conditions, such as coping with chronic illness, pain, gloomy environments, and an assortment of losses, including function, independence, social roles, friends and relatives, and past leisure activities (NIMH, 2016a). Nonspecific somatic complaints that might indicate depression include
DEPRESSION
increased fatigue, heaviness, grumpiness, a churning feeling, difficulty digesting food, and even pain. There may be a change in appetite or sleeping patterns (NIMH, 2016a). Some older adults with depression may appear to have dementia, and may show signs of confusion, inattention, and memory difficulties. For some, there may be a family or past personal history of depression. Others may become depressed after losing a loved one, having a serious illness or someone they love having a serious illness, or from the stress of being a caregiver. Some become depressed for no clear reason. It is important to recognize and treat depression because it is associated with functional decline and excess mortality (Tanner et al., 2014). Depression is also associated with increased falls (Gimm & Kitsantas, 2016) and has been demonstrated to spread from one person to another in a phenomenon known as emotional contagion (Kiuru, Burk, Laursen, Nurmi, & Salmela-Aro, 2012). For a healthcare professional to diagnose and treat depression, an older adult needs to inform the healthcare professional of the signs and symptoms he or she is experiencing. The Geriatric Depression Scale-Short Form is the recommended screening tool when working with older adults who may have depression (Sheikh & Yesavage, 1986). This screening takes approximately 5 minutes to administer, has been validated and extensively
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