A neuropsychological evaluation can be an important tool in helping your parent’s doctor diagnose conditions that impact cognitive (mental) functioning. It can be used to help refine the diagnosis of memory problems by distinguishing between normal age-related memory loss and dementia. It also distinguishes between dementia and temporary memory problems caused or affected by emotional disturbance.
Neuropsychological testing can also assist in differentiating between different types of dementia, and is an effective way to monitor progressive decline and to provide important feedback regarding the efficacy of cognitive enhancing medications.
There are many causes of dementia, including degenerative diseases, vascular disease, infections, traumatic brain injury, or combinations of these conditions. Some dementias are progressive, whereas others are not.
A neuropsychological evaluation provides a comprehensive assessment of cognitive (mental) functions including attention and concentration, memory, language, motor functioning, reasoning, and executive functioning. Alzheimer’s disease, strokes and trauma each produce different patterns of dysfunction.
A thorough neuropsychological evaluation provides the necessary information needed to identify the actual cause of the symptoms, or what is referred to as a “differential diagnosis”.
When ordered by a physician, neuropsychological testing is covered by Medicare and paid at 80% and most private insurance companies will cover the 20% copayment. An evaluation with a focus on memory loss and suspected dementia typically involves a one-hour diagnostic interview and approximately 6 hours of testing.
Monday, August 31, 2009
Tuesday, August 25, 2009
Intervening in the Decision Making of your Aging Parent
If you think your parent is making poor choices and that you need to get involved how do you go about doing so? This decision, like the decision about whether to get involved at all, is a very personal one. My thoughts on this are only intended to help you think through the options – not to point you in any particular direction. The choices that you make about how to get involved in your parent’s decision making can have a long-term affect on your relationship so it is vital that you intervene thoughtfully.
Is there abuse?
If you suspect that abuse is occurring your options will likely be narrowed as most states have laws that require reporting of elder abuse that extend to the general public. If you are aware of a situation where an older adult is being abused you may be obligated to report it to the authorities whether you want to or not. The National Center on Elder Abuse has some helpful information about how abuse is defined in each State and the reporting guidelines. Although you may be obligated to report abuse, it can still be done thoughtfully.
If after reading the guidelines available from your State and other available information you are still unsure if a situation constitutes abuse, call your local Adult and Aging Services department and ask them for feedback – you can often do this anonymously.
The less intrusive the better
Intervening in our parent’s lives can be accomplished in various ways. I advocate trying the least intrusive approach first. For example, you might begin by finding out if your parent sees any problem with the situation that makes you uncomfortable. Is your father who suffers from macular degeneration concerned about his own driving ability? Does your mother who is giving a lot of money to charity worry about running out of money? If both parents are living, does the other parent share your concerns?
To begin you might start a conversation with the purpose of gathering more information. There are ways to raise these issues in a non-threatening manner. For example, over dinner you might say “there have been a lot of news reports lately about how bad the economy is …. do you ever worry about things like that?” As much as we may feel compelled to start giving advice, it usually works out better if we do more listening first. Find out more about why the driving or giving to charities is important to your parent’s life before you start talking about changing things.
Getting others involved
Eliciting the help of others who are trusted by your parents can also be useful. If you have siblings try to get the sibling who is most likely to get the desired result to intervene. If your parent has siblings they trust get them to help. In some situations it is appropriate to use an authority figure, like the family doctor. This may be particularly useful in situations where your parent is continuing to drive despite suggestions from you that they should not. It may also be useful to have the doctor be the first line of intervention so that you do not have to risk damaging your relationship by “trying to take the car away.”
When everything else doesn’t work
By soliciting the help of people with the highest level of trust and the greatest amount of credibility you will increase the likelihood of success. However, sometimes despite all of our best efforts we cannot get our parent to alter their behavior voluntarily. The question then becomes is it worth trying to coerce them to change using the law or by pursuing guardianship? I have a lot of empathy for the unfortunate families that find themselves pondering this question. Taking away a parent’s right to make a decision through the appointment of a guardian seems to always result in significant conflict. This is particularly true if there is disagreement among the children about the need to pursue guardianship.
If you find yourself considering this level of intervention I would recommend that you
1- Pursue all other options first,
2- Make sure your reasons for doing so are sound (e.g. for the health and wellbeing of your parent or others who could be harmed if you do not intervene),
3- Get input from professionals about your intentions,
4- Marshal support for the hard feelings and family conflict that will likely follow
As children we are used to our parents telling us that they think we are making mistakes and using various means to influence our decision making, but when we as children are put in the position of having to intervene with our parent’s decision making - this is a type of role reversal that can create internal and external conflict.
As loving children we are not deterred by the prospect of this conflict and we intervene when we need to and gratefully defer when we do not.
Is there abuse?
If you suspect that abuse is occurring your options will likely be narrowed as most states have laws that require reporting of elder abuse that extend to the general public. If you are aware of a situation where an older adult is being abused you may be obligated to report it to the authorities whether you want to or not. The National Center on Elder Abuse has some helpful information about how abuse is defined in each State and the reporting guidelines. Although you may be obligated to report abuse, it can still be done thoughtfully.
If after reading the guidelines available from your State and other available information you are still unsure if a situation constitutes abuse, call your local Adult and Aging Services department and ask them for feedback – you can often do this anonymously.
The less intrusive the better
Intervening in our parent’s lives can be accomplished in various ways. I advocate trying the least intrusive approach first. For example, you might begin by finding out if your parent sees any problem with the situation that makes you uncomfortable. Is your father who suffers from macular degeneration concerned about his own driving ability? Does your mother who is giving a lot of money to charity worry about running out of money? If both parents are living, does the other parent share your concerns?
To begin you might start a conversation with the purpose of gathering more information. There are ways to raise these issues in a non-threatening manner. For example, over dinner you might say “there have been a lot of news reports lately about how bad the economy is …. do you ever worry about things like that?” As much as we may feel compelled to start giving advice, it usually works out better if we do more listening first. Find out more about why the driving or giving to charities is important to your parent’s life before you start talking about changing things.
Getting others involved
Eliciting the help of others who are trusted by your parents can also be useful. If you have siblings try to get the sibling who is most likely to get the desired result to intervene. If your parent has siblings they trust get them to help. In some situations it is appropriate to use an authority figure, like the family doctor. This may be particularly useful in situations where your parent is continuing to drive despite suggestions from you that they should not. It may also be useful to have the doctor be the first line of intervention so that you do not have to risk damaging your relationship by “trying to take the car away.”
When everything else doesn’t work
By soliciting the help of people with the highest level of trust and the greatest amount of credibility you will increase the likelihood of success. However, sometimes despite all of our best efforts we cannot get our parent to alter their behavior voluntarily. The question then becomes is it worth trying to coerce them to change using the law or by pursuing guardianship? I have a lot of empathy for the unfortunate families that find themselves pondering this question. Taking away a parent’s right to make a decision through the appointment of a guardian seems to always result in significant conflict. This is particularly true if there is disagreement among the children about the need to pursue guardianship.
If you find yourself considering this level of intervention I would recommend that you
1- Pursue all other options first,
2- Make sure your reasons for doing so are sound (e.g. for the health and wellbeing of your parent or others who could be harmed if you do not intervene),
3- Get input from professionals about your intentions,
4- Marshal support for the hard feelings and family conflict that will likely follow
As children we are used to our parents telling us that they think we are making mistakes and using various means to influence our decision making, but when we as children are put in the position of having to intervene with our parent’s decision making - this is a type of role reversal that can create internal and external conflict.
As loving children we are not deterred by the prospect of this conflict and we intervene when we need to and gratefully defer when we do not.
Thursday, August 20, 2009
When Good Parents Make Bad Decisions
When you see your aging parent making decisions that you disagree with how do you decide if, when and how to intervene? I’ve encountered this question many times and in a wide variety of situations. I have seen children struggle with how to confront a parent who has demonstrated that he should no longer be driving. I have seen children struggle with a parent who is living in a nursing home and has started a new romantic relationship (that may include sexual contact). There are also the many situations in which seniors are enticed to part with their money (including their home equity through a reverse mortgage).
As we observe our parents making decisions that we don’t agree with we may be tempted, or feel obligated, to get involved. I would argue that in some situations we do have an obligation to our parents and, sometimes to society at large, to get involved. For example, if a parent has dementia that interferes with his decision making, his reaction time, or other faculties that are required for driving, we have an obligation to help prevent him from continuing to drive. However, in other situations it may best to do nothing.
Before getting involved in your parent’s decision making, it may be useful to ask yourself some questions. The first question I would suggest asking is “what is my motivation for getting involved?” If you can truly say to yourself that you have your parent’s, and society’s best interests in mind then you are in a good place to start thinking about getting involved. However, because most of us are good at rationalizing our decisions to ourselves, it may be useful to explain to someone else what you think you should do and why. If you find yourself fumbling over a weak argument or if the person looks askance at you, then you may want to rethink your decision.
Once you are pretty sure your intentions are good, the next question might be “does my parent have a condition that is known to impair decision making abilities?” Some of these conditions, like Alzheimer’s disease, have a permanent and progressive effect on decision making abilities. While others, including delirium, may only temporarily impact decision making. The presence of these conditions, although significant, is sometimes not enough by itself to obviate a person’s ability to make a decision. I have seen situations in residential settings where people with moderate dementia experience an increase in their quality of life through a relationship with another resident that leaves their children shaking their heads. However, I have also seen family members move a person to different facility to get them out of such a relationship.
The next question I would suggest asking is “what are the consequences of intervening versus doing nothing?” Even if the decision made by your parent appears to you as an adult child to be a bad one, ask yourself “what is the harm that will come if I do nothing?” You might also consider the question “what consequences will the decision have on my parent’s life?” It is of course important to think of both the short and long-term when asking these questions.
Consider this example: A woman in her early seventies is talking about taking out a reverse mortgage so she can travel the world with a new companion. For her adult children there is a lot to consider. After they have established that their own motives are “pure” they next consider the conditions that may impact their mother’s decision making ability. Let’s suppose the doctor reports that she has mild dementia, probably Alzheimer’s disease. According to a neuropsychological evaluation, she is believed to have some cognitive impairment, but she can still demonstrate the ability to consider the consequences of her decisions, at least as posed to her in the abstract. The questions that she has a harder time answering involve what happens to her if she lives longer than the money from the reverse mortgage lasts. When it is suggested to her (by the neuropsychologist) that she will likely have to live in a subsidized apartment or, if her health does not hold, go into a nursing home under Medicaid, she does not appear willing, or able, to appreciate the significance of this possibility.
This example illustrates some of the complicated factors that should be considered by adult children as they think about trying to influence, or take over, their aging parent’s decision making.
It is not my intention that this post be a comprehensive treatment of the topic, but only to provide some questions to think about as this very sensitive topic is broached.
If you decide to intervene after diligently considering all other options, the next question is how to go about doing so. In the next few days I will post some ideas on how to go about trying to influence your parent’s decision making, while preserving your relationship with them.
As we observe our parents making decisions that we don’t agree with we may be tempted, or feel obligated, to get involved. I would argue that in some situations we do have an obligation to our parents and, sometimes to society at large, to get involved. For example, if a parent has dementia that interferes with his decision making, his reaction time, or other faculties that are required for driving, we have an obligation to help prevent him from continuing to drive. However, in other situations it may best to do nothing.
Before getting involved in your parent’s decision making, it may be useful to ask yourself some questions. The first question I would suggest asking is “what is my motivation for getting involved?” If you can truly say to yourself that you have your parent’s, and society’s best interests in mind then you are in a good place to start thinking about getting involved. However, because most of us are good at rationalizing our decisions to ourselves, it may be useful to explain to someone else what you think you should do and why. If you find yourself fumbling over a weak argument or if the person looks askance at you, then you may want to rethink your decision.
Once you are pretty sure your intentions are good, the next question might be “does my parent have a condition that is known to impair decision making abilities?” Some of these conditions, like Alzheimer’s disease, have a permanent and progressive effect on decision making abilities. While others, including delirium, may only temporarily impact decision making. The presence of these conditions, although significant, is sometimes not enough by itself to obviate a person’s ability to make a decision. I have seen situations in residential settings where people with moderate dementia experience an increase in their quality of life through a relationship with another resident that leaves their children shaking their heads. However, I have also seen family members move a person to different facility to get them out of such a relationship.
The next question I would suggest asking is “what are the consequences of intervening versus doing nothing?” Even if the decision made by your parent appears to you as an adult child to be a bad one, ask yourself “what is the harm that will come if I do nothing?” You might also consider the question “what consequences will the decision have on my parent’s life?” It is of course important to think of both the short and long-term when asking these questions.
Consider this example: A woman in her early seventies is talking about taking out a reverse mortgage so she can travel the world with a new companion. For her adult children there is a lot to consider. After they have established that their own motives are “pure” they next consider the conditions that may impact their mother’s decision making ability. Let’s suppose the doctor reports that she has mild dementia, probably Alzheimer’s disease. According to a neuropsychological evaluation, she is believed to have some cognitive impairment, but she can still demonstrate the ability to consider the consequences of her decisions, at least as posed to her in the abstract. The questions that she has a harder time answering involve what happens to her if she lives longer than the money from the reverse mortgage lasts. When it is suggested to her (by the neuropsychologist) that she will likely have to live in a subsidized apartment or, if her health does not hold, go into a nursing home under Medicaid, she does not appear willing, or able, to appreciate the significance of this possibility.
This example illustrates some of the complicated factors that should be considered by adult children as they think about trying to influence, or take over, their aging parent’s decision making.
It is not my intention that this post be a comprehensive treatment of the topic, but only to provide some questions to think about as this very sensitive topic is broached.
If you decide to intervene after diligently considering all other options, the next question is how to go about doing so. In the next few days I will post some ideas on how to go about trying to influence your parent’s decision making, while preserving your relationship with them.
Wednesday, August 12, 2009
Could it be Delirium?
I can’t tell you how many unfortunate situations I have seen that could have been avoided if someone had asked “could it be delirium?” I have seen people committed to psychiatric facilities where they were treated for psychosis and I have seen people assigned long-term guardians because of what was a temporary alteration in consciousness caused by an episode of delirium. If you have ever seen people during a delirium it is not hard to understand how this can happen – they are often highly agitated, they may make outlandish statements with no basis in reality and they may even hallucinate. The symptoms may also fluctuate over a relatively short period of time which can add to the confusion. The problem is that a delirium is often a short-term situation resulting from a reversible condition like an infection, dehydration or an unintended response to a medication. There are three basic clues to look for if you think the person is suffering from delirium.
The first clue that it might be delirium is that the onset of the symptoms is fairly rapid. If a person over 55 years with no history of hallucinations starts talking about seeing bugs crawling on the wall it is appropriate to ask “could this be delirium?”
The second clue that it might be a delirium is that the person is not oriented to person, place and/or time – They can’t they tell you basic things about who they are, where they are or they can’t tell you the day, the month and/or the year? During a delirium a person will also have difficulty focusing their attention for sustained periods and will often have to have questions repeated for them – if they can respond at all.
The third clue that it might be delirium is the presence of significant changes in the person’s life. For example, recent onset of physical symptoms (especially those consistent with a Urinary Tract Infection), changes in medications, recent surgeries (deliriums are common after anesthesia), or changes in eating, drinking or sleeping patterns?
It is also important to understand that delirium is not mutually exclusive with any other condition – i.e. a person with any other condition (e.g., dementia, bipolar illness) can still experience delirium. A person with dementia who develops a delirium as the result of a Urinary Tract Infection (UTI) may be overlooked because the symptoms are assumed to be part of the progression of the dementia. The key is the timeframe for the onset of the worsening of symptoms. If there is any question, consult a physician – a test for a UTI is simple and it is usually treatable.
It is not wise, or helpful, to try to diagnose delirium and its primary cause on your own. The diagnosis of delirium is tricky, even for doctors, and that is why so many get overlooked. If the clues mentioned above are present, it is advisable to get the person to a doctor as soon as possible and to ask the doctor “could this be delirium?”
The first clue that it might be delirium is that the onset of the symptoms is fairly rapid. If a person over 55 years with no history of hallucinations starts talking about seeing bugs crawling on the wall it is appropriate to ask “could this be delirium?”
The second clue that it might be a delirium is that the person is not oriented to person, place and/or time – They can’t they tell you basic things about who they are, where they are or they can’t tell you the day, the month and/or the year? During a delirium a person will also have difficulty focusing their attention for sustained periods and will often have to have questions repeated for them – if they can respond at all.
The third clue that it might be delirium is the presence of significant changes in the person’s life. For example, recent onset of physical symptoms (especially those consistent with a Urinary Tract Infection), changes in medications, recent surgeries (deliriums are common after anesthesia), or changes in eating, drinking or sleeping patterns?
It is also important to understand that delirium is not mutually exclusive with any other condition – i.e. a person with any other condition (e.g., dementia, bipolar illness) can still experience delirium. A person with dementia who develops a delirium as the result of a Urinary Tract Infection (UTI) may be overlooked because the symptoms are assumed to be part of the progression of the dementia. The key is the timeframe for the onset of the worsening of symptoms. If there is any question, consult a physician – a test for a UTI is simple and it is usually treatable.
It is not wise, or helpful, to try to diagnose delirium and its primary cause on your own. The diagnosis of delirium is tricky, even for doctors, and that is why so many get overlooked. If the clues mentioned above are present, it is advisable to get the person to a doctor as soon as possible and to ask the doctor “could this be delirium?”
Sunday, August 9, 2009
Combating Helplessness – One Weed at a Time
I recently read the chapter on weeds in Michael Pollan’s book Second Nature and it seemed to me that there are some parallels between weeds and hopelessness, especially for those who live in the country’s nursing homes. I have been counseling nursing home residents for the past 12 years and in that time I have worked with people who have had such a profound sense of hopelessness that it seemed almost tangible. When I first started working with people in this state I would often leave the room feeling exhausted and like some of my own hope had been drained from me.
These experiences got me thinking a lot about hope and about why it is important to keep the flame of hope lit – even if it is just the pilot light. It seems to me that hope is what keeps us going even when we can see no ostensible reason to do so. So we must be vigilant and combat threats as they arise.
This is where the analogy to weeds comes in – if we have one or two weeds in our garden they are easy to ignore and they may even blend in with the other plants so as to be unnoticeable. However, as more weeds appear, they can no longer be ignored and if not dealt with they can easily take control of the garden. So it is with hopelessness – with losses and disappointments comes threats to our hope for the future. For many of us this is a normal part of life - we experience some feelings of hopelessness which we may ignore expecting that they will resolve without much special effort from us. However, if the situational factors support the spread of hopelessness and we continue to do nothing the insidious effect of hopelessness can take over our lives.
The sooner you begin to tackle the weed problem the better the chances of success, so it is with hopelessness. Nevertheless, it is always possible to make progress in the fight, and even when all seems lost improvement can be made. Most gardeners have their preferred tools for tackling a job and psychologists are no different. The choice of tools has a lot to do with how they have worked in the past and how comfortable we using them.
One of the most effective tools I have found in combating hopelessness is to change the subject. How I go out doing this varies based on the person I am working with and my relationship with them. Sometimes I will explain what tool I am using and what I expect it to do, and at other times I will subtly introduce the tool with no mention of its presence.
In nursing homes it is common to hear complaints about everything from family not visiting to the food that is served. I find that these complaints, while usually justified, serve to nourish hopelessness, so I will work to refocus the person to more positive themes. One of my favorite positive themes is gratitude and I will ask the person to tell me about the things that they are grateful for. I have found most people responsive to this intervention, but I have had a few people say that they could not think of anything that they were grateful for. When this happens I encourage them to think about things from the past that they are grateful for and I have not yet come across a person who has failed to find something they are grateful for. The wonderful thing about gratitude is that it is incompatible with hopelessness. You cannot in the same moment feel gratitude and hopelessness, and so in that moment it provides a person with respite and nourishes the seeds of hope (the stuff we want growing in our garden).
There are other great tools to fight hopelessness and so if, like me, you encounter hopelessness in your interactions with those you care for weed assiduously and do not let hope die.
These experiences got me thinking a lot about hope and about why it is important to keep the flame of hope lit – even if it is just the pilot light. It seems to me that hope is what keeps us going even when we can see no ostensible reason to do so. So we must be vigilant and combat threats as they arise.
This is where the analogy to weeds comes in – if we have one or two weeds in our garden they are easy to ignore and they may even blend in with the other plants so as to be unnoticeable. However, as more weeds appear, they can no longer be ignored and if not dealt with they can easily take control of the garden. So it is with hopelessness – with losses and disappointments comes threats to our hope for the future. For many of us this is a normal part of life - we experience some feelings of hopelessness which we may ignore expecting that they will resolve without much special effort from us. However, if the situational factors support the spread of hopelessness and we continue to do nothing the insidious effect of hopelessness can take over our lives.
The sooner you begin to tackle the weed problem the better the chances of success, so it is with hopelessness. Nevertheless, it is always possible to make progress in the fight, and even when all seems lost improvement can be made. Most gardeners have their preferred tools for tackling a job and psychologists are no different. The choice of tools has a lot to do with how they have worked in the past and how comfortable we using them.
One of the most effective tools I have found in combating hopelessness is to change the subject. How I go out doing this varies based on the person I am working with and my relationship with them. Sometimes I will explain what tool I am using and what I expect it to do, and at other times I will subtly introduce the tool with no mention of its presence.
In nursing homes it is common to hear complaints about everything from family not visiting to the food that is served. I find that these complaints, while usually justified, serve to nourish hopelessness, so I will work to refocus the person to more positive themes. One of my favorite positive themes is gratitude and I will ask the person to tell me about the things that they are grateful for. I have found most people responsive to this intervention, but I have had a few people say that they could not think of anything that they were grateful for. When this happens I encourage them to think about things from the past that they are grateful for and I have not yet come across a person who has failed to find something they are grateful for. The wonderful thing about gratitude is that it is incompatible with hopelessness. You cannot in the same moment feel gratitude and hopelessness, and so in that moment it provides a person with respite and nourishes the seeds of hope (the stuff we want growing in our garden).
There are other great tools to fight hopelessness and so if, like me, you encounter hopelessness in your interactions with those you care for weed assiduously and do not let hope die.
Wednesday, August 5, 2009
Is My Dad Depressed?
The question of depression comes up frequently in my conversations with the children of aging parents – especially when there has been a recent significant loss. In answering this question it is important that we understand what depression is, how it is manifested differently among seniors and what are the things that mimic, or look like depression.
I think of depression as an impairment of mood that usually results in subjective distress and interferes with social and/or occupational functioning. It can result from internal factors or a response to external situations. Depression is not a normal part of the aging process. It occurs in 5-9% of women and 2-3% of men in the population at large and in about 5% of healthy elderly people. The prevalence of depression increases dramatically among those who are chronically ill and those living in residential care settings.
The symptoms of depression include: depressed mood (feelings of sadness sometimes accompanied by tearfulness), anhedonia (loss of interest in things that used to be enjoyable), weight loss/gain, insomnia/hypersomnia, fatigue, feelings of worthlessness and/or hopelessness, excessive guilt, problems with attention and decision making, and when severe can include persistent thoughts about death and suicidal ideation and/or intent.
Among seniors anhedonia is usually the primary symptom and depressed mood (the subjective feeling of being depressed) may be denied. The older depressed person is more likely to present with somatic symptoms (physical complaints for which there is no identified illness, or that are in excess of what would be expected for an illness). Cognitive symptoms may also be prominent particularly short-term memory loss and mental slowing.
If you think that your aging loved one may be depressed ask yourself – has there been a notable change in their involvement in the things that used to be enjoyable to them? Are they sleeping and eating well? Does there appear to have been a significant change in their mental capacity or short-term memory? If you answered yes to any of these questions then there your loved one should be evaluated for depression. I recommend starting the evaluation process with a physician who specializes in the treatment of older adults because he/she will know the medical conditions to assess that may be responsible for the symptoms. There are many systemic, neurologic and iatrogenic (caused by treatments – for example medication side-effects) that can cause or exacerbate depressive symptoms.
If the physician believes the person is depressed she/he can prescribe various treatments including counseling and/or medications. Both counseling and the newer anti-depressant medications have been found to be effective in the treatment of depression in older adults.
I think of depression as an impairment of mood that usually results in subjective distress and interferes with social and/or occupational functioning. It can result from internal factors or a response to external situations. Depression is not a normal part of the aging process. It occurs in 5-9% of women and 2-3% of men in the population at large and in about 5% of healthy elderly people. The prevalence of depression increases dramatically among those who are chronically ill and those living in residential care settings.
The symptoms of depression include: depressed mood (feelings of sadness sometimes accompanied by tearfulness), anhedonia (loss of interest in things that used to be enjoyable), weight loss/gain, insomnia/hypersomnia, fatigue, feelings of worthlessness and/or hopelessness, excessive guilt, problems with attention and decision making, and when severe can include persistent thoughts about death and suicidal ideation and/or intent.
Among seniors anhedonia is usually the primary symptom and depressed mood (the subjective feeling of being depressed) may be denied. The older depressed person is more likely to present with somatic symptoms (physical complaints for which there is no identified illness, or that are in excess of what would be expected for an illness). Cognitive symptoms may also be prominent particularly short-term memory loss and mental slowing.
If you think that your aging loved one may be depressed ask yourself – has there been a notable change in their involvement in the things that used to be enjoyable to them? Are they sleeping and eating well? Does there appear to have been a significant change in their mental capacity or short-term memory? If you answered yes to any of these questions then there your loved one should be evaluated for depression. I recommend starting the evaluation process with a physician who specializes in the treatment of older adults because he/she will know the medical conditions to assess that may be responsible for the symptoms. There are many systemic, neurologic and iatrogenic (caused by treatments – for example medication side-effects) that can cause or exacerbate depressive symptoms.
If the physician believes the person is depressed she/he can prescribe various treatments including counseling and/or medications. Both counseling and the newer anti-depressant medications have been found to be effective in the treatment of depression in older adults.
To Blog or Not to Blog
To Blog or not to Blog – that was my question. At 47 (I know - where have the years gone – it seems like only yesterday I was 29) I am among the last of the boomers and, like many of my peers, have an uneasy relationship with advancing technologies. However, the convenience and the expediency of the web and mobile devices have largely won me over, and while I am not ready to tweet (still not sure what that means) I am finally ready to Blog.
To Blog then - allow me to introduce myself - I am Tony Morrison a psychologist who specializes in working with seniors and the founder of http://www.helpwithmyparents.com/ . While my interests are largely around issues of aging and caring for older adults, I will be Blogging about a wide range of topics and events. I plan to Blog on the areas where I have experience including: depression, anxiety, the effect of aging on other mental health conditions, neuropsychological assessment as a tool for the diagnosis of dementia, the management of difficult behaviors and improving the quality of life for older adults and their families. I will also Blog about my observations of the senior care industry – where I see strengths and where I see problems. I will plan to comment on what I read in the news and on other Blogs. If I can summon the nerve, I may even Blog about my own experience of aging and, with children in grade school and parents in their 70’s, about being a part of the Sandwich Generation. I hope that some of you will join me, for at least part of this journey, and that together we learn how to better care for our aging family members and friends.
To Blog then - allow me to introduce myself - I am Tony Morrison a psychologist who specializes in working with seniors and the founder of http://www.helpwithmyparents.com/ . While my interests are largely around issues of aging and caring for older adults, I will be Blogging about a wide range of topics and events. I plan to Blog on the areas where I have experience including: depression, anxiety, the effect of aging on other mental health conditions, neuropsychological assessment as a tool for the diagnosis of dementia, the management of difficult behaviors and improving the quality of life for older adults and their families. I will also Blog about my observations of the senior care industry – where I see strengths and where I see problems. I will plan to comment on what I read in the news and on other Blogs. If I can summon the nerve, I may even Blog about my own experience of aging and, with children in grade school and parents in their 70’s, about being a part of the Sandwich Generation. I hope that some of you will join me, for at least part of this journey, and that together we learn how to better care for our aging family members and friends.
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