Older adults, particularly those with health problems, are at risk for depression.
However, it is important to note that clinical depression is definitely not a normal part of aging. Most older adults are not depressed. Estimates of clinical depression among older people living in their homes in a community range from about 1% to 5%. These figures increase for elderly hospital patients and adults who require home healthcare, for whom around 11% to 14% experience clinical depression. Furthermore, depression is more common in people who have other illnesses or chronic conditions, and in people whose daily functioning has become limited.
Unfortunately, some healthcare professionals chalk up symptoms of depression to a normal reaction to a chronic illness, or disappointment over the changes in everyday living that can occur alongside aging. And many older adults share these beliefs, and may not seek help because they either consider depression to indicate a lack of character, or are unaware that effective treatments for depression exist.
Depression in Seniors Often Goes Untreated
Stephen Bartels, director of the Centers for Health and Aging at Dartmouth College, tells The Washington Post, “Depression is underrecognized and undertreated in older adults.” Older people who are depressed are more likely to die or have serious complications after a medical event than are non-depressed seniors. And although seniors are actually somewhat less likely to be depressed than the population at large, the sheer size of the aging baby boom generation will stretch mental health resources in coming years.
A 2012 publication by the Institute of Medicine says that nearly one in five older American adults has one or more mental health and / or substance use conditions. The need for helping older people obtain mental health care services will become increasingly apparent as more baby boomers reach retirement age.
Depression Among Vietnam Veterans
One particularly important senior subpopulation is Vietnam Veterans with mental illnesses like depression. Decades after the end of the war, veterans still seek help with mental illnesses including post-traumatic stress disorder. But according to researchers at the Portland Vet Center in Oregon, there are as yet no specific age-related protocols for treating this disorder in older patients. They recently published results of a pilot study in which “life review” counseling was delivered in addition to regular PTSD counseling for a dozen Vietnam vets.
Statistical analysis of the results found that life review prior to PTSD group therapy showed clinical benefit in reducing symptoms of depression and increasing a personal sense of having acquired wisdom from traumatic events. The researchers postulate that there is a relationship between traumatic stress symptoms and the natural reminiscing process for these aging veterans, and hope to be able to gain insights for better methods for age-appropriate mental health treatment for this population.
Telemedicine for Treating Depression in Seniors
As people get older, they’re more likely to experience obstacles to getting help for health problems, such as no longer driving, or having other mobility issues. Dr. Leonard Egede, professor of medicine at the Medical University of South Carolina in Charleston, says that telemedicine may expand seniors’ access to mental health treatment. Egede tells Reuters, “Psychotherapy works for depression whether you deliver it by face-to-face or the telemedicine approach.”
Egede says that depression is also a problem for older veterans, who are at much greater risk than the general population, and with many veterans disabled or home-bound, getting to a clinic for care can be a challenge. While telemedicine has been found effective in treating PTSD, it hadn’t been studied for depression in veterans, according to Egede. His study of 204 veterans over age 58 with major depressive disorder found that after one year of treatment, there was no statistically significant difference in outcomes between participants who received treatment in person and those who received identical treatment via telemedicine.
Having an Emergency Plan Is Critical
Psychiatrist Charles Hoge of the Walter Reed Army Institute of Research wrote a commentary that accompanied Egede’s study, noting that while in-home therapy can be effective, it’s important that each patient have an emergency plan in place, should he, for example, develop suicidal ideation. Ultimately, Hoge said, he is optimistic about the use of telemedicine in mental health care for older veterans, because it expands options and reduces barriers to seeking treatment for depression.
Other Important Telemedicine Applications for Seniors
Treatment for clinical depression isn’t the only telemedicine application that is being studied in seniors. In fact, telemedicine can be an excellent tool for helping physicians monitor patients who have chronic conditions in their own homes. Conditions like chronic obstructive pulmonary disease (COPD), heart failure, and diabetes can be monitored by patients in the home, with information sent to care monitors on a regular basis. This cuts down on the need to travel to access some care services, making compliance with doctor recommendations easier for seniors with transportation or mobility issues.
Furthermore, new telemedicine tools are being developed to monitor and automatically transmit information like a patient’s vital signs, blood sugar, and weight to clinicians, so potential problems can be assessed early on. The addition of secure video conference technology allows patients and doctors to have “face to face” interactions without the patient having to leave home. If an in-person visit, or a trip to the emergency department is indicated, a healthcare worker can arrange for this right away.
The VA and Medicare: Expanding Telemedicine Access
The Veterans Administration (VA) has been active in expanding telemedicine access to veterans, enacting rules that make it easier for VA doctors to practice medicine via telemedicine across state lines, and generally making it easier for veterans to use telemedicine for a variety of health conditions, including mental health care.
Medicare has used telemedicine for a long time, but it has been very conservative in its approach to expanding reimbursement for telemedicine services. However, this is starting to change. Medicare is adding to the telemedicine services for which it will reimburse doctors, and is no longer limiting telemedicine access to patients in rural areas.
Telemedicine is proving to be a valuable tool in providing mental healthcare services, particularly for older people with mobility or transportation problems. Results of studies comparing telemedicine services with in-person services are encouraging, and as telemedicine expands, seniors (both civilian and veteran) will have easier, faster access to services and monitoring. Depression does not have to be considered a normal part of aging, and telemedicine is helping depressed seniors access the treatment they need to have better quality of life.
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