IT’S WRONG TO THINK LOW MOODS ARE ‘NATURAL’ IN OLD AGE

WHEN it comes to their mental heal t h, o l der people are being routinely let down. Over the 16 years that I’ve practised as a psychiatrist, I’ ve seen repeated examples of how poor the provisions are for this group.

Even after the recent surge of interest in mental health, with celebrities and the Royal Family raising its profile, the mental wellbeing of older people rarely gets a mention. The focus is almost always on youngsters.

Services for older people remain a Cinderella speciality — and it’s clear that ‘ageism’ underpins this lack of consideration .

Ageism is also at the root of many of the assumptions and prejudices which lead to older people with depression being dismissed or ignored.

Depression in older people is more common than dementia, yet it i s significantly underdiagnosed and undertreated. In f act, t he s ymptoms of depression ar e f r e quently mistaken for dementia.

There is an assumption that the elderly are supposed to be down and a bit grumpy; their distress and despair is dismissed in a way that would never happen to any other group.

And although suicide rates generally are declining, they are still higher in older people than in the young. Yet there are scant services and resources to address mental health problems in older people.

Four in ten people over the age of 75 are suffering some signs of depression, but as few as 3.5 per cent of cases are referred for therapy. This is utterly disgraceful.

I have direct experience of this. In one service for older people’s mental health where I worked, we did not have a single psychologist: we just had to THE prescribe antidepressants.

number of older people on antidepressants has doubled in the past 20 years, according to figures published last year — and this is despite older people being far more at risk of sideeffects and complications from taking such medications.

Their metabolisms mean that the side- effects can be more serious, too.

Antidepressants can cause chemical i mbalances i n the blood and reduce its ability to clot; they can increase confusion and make patients feel dizzy or l i ghtheaded; t hey can also interfere with medications that are commonly prescribed in older people for conditions such as high blood pressure.

That’ s not to say t hat antidepressants aren’t useful and that some patients shouldn’t be taking them.

My worry, though, is that these pills are too easily dished out when psychotherapy would be a far better option. However, patients in this age group simply won’t get access to this.

Once again, the poor provision of psychotherapy is pure ageism, based on stereotypical assumptions that older people ‘won’t change’.

Yet there i s good evidence that the elderly respond just as well as younger people to talking therapies.

In fact, some studies show they respond better because they are more likely than younger people to attend sessions.

Senior citizens have just as much right to therapy as anyone else, and it’s scandalous that they aren’t being offered it.

Part of the problem is that GPs are not always in tune with how older people experience depression. More than half of older people with depression have no history of i t , and this ‘ late- onset’ illness often has subtly different symptoms from the depression that affects younger people, which can make it tricky to spot.

Older people tend not to complain of ‘feeling sad’, but rather find they have no enjoyment in life. They can become more preoccupied with physical health symptoms and develop anxiety or obsessive compulsive disorder (OCD).

In more than 70 per cent of cases, there is evidence of poor memory or thinking, symptoms which mimic those of dementia — that is why we sometimes call it pseudodementia.

As a result, the patient’s true problem — depression — is all too easily missed.

It would be wrong to put all the blame on GPs. I’ve seen hospital doctors, too, overlook depression in older people. The problem is endemic.

I remember one patient I saw early on in my training, while working in geriatrics. She was sitting in a chair by her bedside, staring out of the window.

She was in her late 80s, frail and stooped. She had been on the ward for the past month after falling at home. She rarely spoke, and when people asked her questions, she stared at t hem, t hen s hrugged her shoulders. Her memory was very bad and she frequently forgot what people told her.

She obviously had dementia, and it was decided on the ward round that it would be best if she went into a home.

Her husband had died four years previously and she had no family, so I phoned her GP to explain our plan.

YETthe GP was dumbfounded when I said she had dementia. ‘I only saw her a few weeks before she fell and she was as fit as a fiddle,’ he told me. ‘She had a better memory than me!’

The GP was adamant, so after I put down the phone I went over to the patient and asked her basic questions about where she was and what the date was.

She shrugged her shoulders each time.

But it niggled me that she could have been so different when her GP saw her, so I phoned the old-age psychiatrist who, after an hour of assessment, confirmed the patient actually had depression.

She was transferred to the mental health unit, began treatment and, incredibly, over the next few weeks her memory improved and she went back to her own home.

It had a profound impact on me and was a valuable lesson in not jumping to conclusions — and, in particular, how easy it i s to dismiss someone simply because of their age.