On Healing 5/17/2004: Elderly suffer depression in silence

Many are afflicted, and sadly few seek treatment. Yet nearly 80 percent could be helped.

My father was always a worrier. I don’t know if it was his genetics or the times he lived in, but he had more than his share of anxiety. As he aged, it got much worse. After my mother died, I would frequently find him in his easy chair in front of the television staring down at the floor with furrowed brow, looking as though the world was on his shoulders.

As a psychologist, I knew that worry could be a symptom of an anxiety disorder or clinical depression. And like most people with significant anxiety or depression, my father suffered terribly.

According to the National Institute of Mental Health, one of every five older Americans has a diagnosable mental illness. Most suffer with anxiety, depression or dementia. And very few get help.

The reasons so few get help are complex, but a recent study by the National Mental Health Association revealed that most Americans think depression is a normal part of aging. “I would be depressed too if I were older” was a too-typical response.

According to Tom Volkert, director of advocacy at the Mental Health Association of Southeast Pennsylvania, many older people experience depression for the first time as they age, and most suffer in silence.

“Seventy percent of people in nursing homes experience clinical depression but only one-third are receiving adequate treatment,” Volkert said. “And there are many reasons why older people don’t get the treatment they need, but one of them is because the majority of physicians who see older people don’t screen regularly for depression, and when they do, they often under-prescribe.”

Stigma is also a major inhibitor. Today’s seniors grew up in a time when anxiety and depression were considered signs of weakness and only extremely disturbed people sought help.

Last year, a Philadelphia city agency sent brochures listing the Mental Health Association as a resource to older Philadelphians on medical assistance. Within days, Volkert said, his office was deluged with phone calls from angry seniors offended that such a brochure would be sent to them, and two people even threatened to sue for defamation of character.

Public policy also contributes to the problem. When an older person goes to a doctor for treatment of a physical problem, Medicare pays 80 percent. Medicare pays only 50 percent of mental health services. To make matters worse, in 2002, Congress allocated $5 million to investigate effective mental-health treatment for seniors. But this year’s budget cut that out completely.

The real tragedy is that seniors suffer unnecessarily: Nearly 80 percent of people with anxiety or depression improve with treatment.

Hikmah Gardiner knows this from experience. She is a senior advocate with the Mental Health Association of Southeastern Pennsylvania and just celebrated her 75th birthday. Although she describes her life as “getting better with age,” it hasn’t always been good for her.

When she was 10 years old, she experienced her first symptoms of depression and was taken for psychiatric help. After struggling with depression for many years, Gardiner describes what she sarcastically calls the cure: “I found that alcohol made my demons go away. But when I got sober, they seemed to multiply. So I drank more and they went away again.”

In the midst of her battles with alcoholism and depression, her mother died, and Gardiner was left destitute and on the streets. After years there, she was helped by a kind doctor to get into a 12-step program. The doctor also put her on medication. With the combination of medication, alcoholism treatment and psychotherapy, she has done very well, though her old demons still return on occasion.

One can hear laughter in her voice when Gardiner says: “I realize every day is a blessing. I have the usual aches and pains of a 75-year-old person, but that’s part of the dues you have to pay for the good Lord letting you stay here.”

According to the American Association of Suicidology, 75 percent of seniors don’t get the treatment they need. Unfortunately, my father was one of them. At first, he refused all treatment for his “worrying.” Eventually, he agreed to take antidepressant medication, but when he felt no relief after a couple of days (it can take up to a month), he stopped. When I hear the delight in Gardiner’s voice, I wistfully think how nice it would have been to hear the same in my father’s voice.

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