When signs of DEMENTIA could actually be DEPRESSION
Forgetfulness. Confusion. Irritability. They’re seen as early indicators of brain decline. In fact, it’s often a hidden mental illness that can be treated with therapy
Paul Garnett felt ‘incredibly embarrassed’ explaining to his GP at the age of 71 that his depression was out of control. ‘I felt so ashamed of myself — a man who couldn’t cope,’ he says, recalling the difficult months that led to the appointment with his doctor.
‘everything felt so bleak once I’d stopped working,’ recalls Paul, now 73. ‘I had this morbid feeling that I’d achieved nothing in my life. I was eaten up with self-loathing.’
though he’d experienced mental health problems since his 30s, Paul had always managed to continue working.
‘I felt I had to be the strong one and I was able to keep my feelings buried,’ says Paul, who lives in Manchester.
He’d had a difficult childhood, and then his wife had suffered a series of devastating miscarriages. His GP had prescribed antidepressants — and these had helped.
But after retiring at 70 from his job as a retail manager, Paul’s coping mechanisms started to unravel. He began drinking more and stopped eating regularly.
‘Sometimes, I couldn’t stop crying; or I’d become angry and verbally abusive with my family — the people who loved me most,’ he recalls. ‘My behaviour was out of character.’
Paul isn’t unusual. One in five people over the age of 65 experience depression or anxiety, according to nHS reports — about the same rate as the rest of the population. With older patients, though, there are concerns that doctors ignore depression or misdiagnose the disease as dementia.
LOCKDOWN HAS WORSENED MENTAL HEALTH ISSUES
tHIS year, it’s likely that the pandemic has pushed up rates of depression among older people, according to the charity Independent age.
‘With Covid-19, we’ve seen an increase in mental health problems such as depression,’ says Deborah alsina, the charity’s chief executive, as it launches a report about mental health in later life.
‘For many, the pandemic added to the stress, loneliness and anxiety they were already experiencing,’ she says.
the charity found that 75 per cent of older people have experienced anxiety or low mood at least once since turning 65, and one in ten felt like this regularly or all the time. ‘this is an urgent problem,’ Deborah says. Indeed, data from the Office for national Statistics showed that the mental health of two in five of the over-70s — that’s 2.9 million people — worsened during lockdown.
and there is increasing concern, experts say, that not only is the impact of depression and anxiety often far worse for older people, they are also less likely to be treated for it.
‘ When younger people are affected, they generally become lethargic and withdraw from life,’ explains Dr James Warner, clinical director of older adults mental health services at Central and north West london nHS trust.
‘ However, with the elderly, depression reduces them to a state of extreme agitation.’
there is evidence that retirees are particularly vulnerable to depression and anxiety through loss of identity and self-confidence when they stop working.
‘Older people also face isolation and multiple bereavements, as well as a higher risk of chronic pain disorders,’ says Dr Warner.
‘ Men and women who have managed all their lives — bringing up families, working — can become indecisive to the point of paralysis, wringing their hands in despair, the total absence of pleasure in their lives etched on their faces.’
Worse still, the over-65s face an additional problem when it comes to getting treatment: ageism.
Only 6 per cent of people referred for counselling are over 65, despite this age group making up 18 per cent of the population, according to a survey of over-65s for age uK and the nHS published earlier this year.
and this is despite evidence which shows that older people who are referred for talking therapies respond well — and often do better than younger patients.
Indeed, data from the nHS IaPt (Improving access to Psychological therapies) programme for 2019/20 shows that people aged 65 and over had an overall recovery rate of 64 per cent, compared to 50 per cent for those aged 18 to 64.
STIFF UPPER LIP STOPS THEM SEEKING HELP
DePreSSIOn and anxiety in later life are often dismissed as a ‘normal part of ageing, with older people regarded, wrongly, as beyond help’, says alistair Burns, a professor of old age psychiatry at the university of Manchester. another issue is that some older people may not be comfortable discussing their problems, suggests Caroline abrahams of age uK.
‘People who grew up in an era when there was a real stigma associated with mental illness find they cannot be open about it — an essential pre- condition to people getting help,’ she says.
Indeed, a YouGov poll of more than 2,000 British adults published in november 2018 found that nearly one in four (24 per cent) of over-65s felt uncomfortable about friends and family knowing they had depression, compared to just seven per cent for arthritis.
‘the bitter irony is that talking therapies are most effective in the over-65s,’ says Dr amanda thompsell, chair of the faculty of old age psychiatry at the royal College of Psychiatrists. ‘Yet the stigma around mental health and fear of being thought less of by family and friends is deterring them from seeking help.’
earlier this year, a government campaign aimed to persuade GPs — and their patients — that providing treatment for mental illness in older age should be a priority.
‘anyone out there who is feeling down needs help and should get it f r om t he nHS,’ Professor Burns wrote in a letter to every GP in January.
the message to people such as Paul is ‘seeking help is a sign of strength, not weakness’, she adds. ‘We need to challenge the idea that older people should have a stiff upper lip towards mental illness.’
June Cooke, 85, a former cleaner and great grandmother of six, from london, says she had experienced severe depression and bipolar disorder most of her life — but it was only when she had a breakdown aged 76 that (with the help of her three daughters) she was referred for medication and counselling.
‘nobody talked about mental illness when I was young,’ says June. ‘ I thought of myself as “crackers”, or that if I talked about suicidal thoughts, my children would be taken away and I’d be put in a mental institution.’
June received treatment, including talking therapy, at the Central and north West london nHS Foundation trust and says: ‘I think this is the happiest I’ve ever been.’
SYMPTOMS OFTEN MISDIAGNOSED
tHe royal College of Psychiatrists estimate that 85 per cent of older people with depression receive no help at all from the nHS.
What worries experts is that, generally speaking, attitudes within healthcare have not changed since 2009, when a pioneering study published in the journal Current Gerontology revealed ageist attitudes among GPs.
In the study, 121 GPs had been asked to consider a plan of treatment for two case studies with identical symptoms of depression, one aged 39 and the other, 81.
the majority of doctors planned a ppropriate di a g nosi s a nd treatment only for the younger patient, taking for granted that the symptoms of the older patient were
caused by physical health problems, such as increased disability and incidence of chronic pain, and were therefore inevitable.
The reason such attitudes prevail, according to the mental health charity Mind, is that many GPs still believe misery is the price of ageing.
‘We regularly hear from people who say their mental health problems are dismissed by their GPs as merely a part of getting older,’ Vicki Nash, head of policy at Mind, tells Good Health.
And, in some cases, patients’ symptoms are misdiagnosed as dementia (see right). The problem here is that symptoms including irritability, tearfulness, lack of motivation and problems with memory are common to both illnesses.
However, there are also clear differences. People with dementia lose cognitive function, failing to recognise the people around them as well as the date, time and year. Those with depression may not remember at first, but usually manage to recall this basic personal data once prompted.
Also, the severity of depressive symptoms usually varies throughout the day, while dementia symptoms stay the same, according to retired GP Dr Keith Souter.
Professor Burns, supported by Age UK, is calling on GPs ‘to think twice before offering medication as a first-line treatment option for depression and anxiety in older people — and instead refer more patients for talking therapy’.
Paul’s story highlights the need for the provision of such care — and the power it has to transform lives. Luckily for Paul and his family, his GP referred him to Age UK Manchester for talking therapy.
‘Even after my first session, it felt like a huge burden had lifted from me,’ he says. ‘ The counsellor provided a safe space for me to talk about things that I had never, talked to anyone about before.’
In 14 weeks of therapy, Paul also learnt coping mechanisms to use every day.
‘It wasn’t easy at first, and I still get the occasional bout of anger, but I now feel confident that I can manage it. I just feel so positive in everything I do.’