Original Air Date: February 1, 1998

An examination of the perceptions and misconceptions about the aging process; how to live the best you can as long as you can; information about depression, an extremely misunderstood and misdiagnosed senior/caregiver affliction.

• The Psychology of Aging
• Depression

The Psychology of Aging

The major myths/misconceptions about aging

0. Getting old is a dead end - that there's no growth or potential for being actively engaged. Aging is not all loss and decline inevitably leading to sadness/depression. It does happen to some, but not to all. Most seniors are very much engaged.
1. Decline in mental function. This is the most frightening myth for most people. Fear of loss of independence in this way (or because of physical ailment) is at the root of all our myths and misconceptions about aging.
2. Old people are abandoned by their families. Not the norm at all. Most seniors have frequent contact with their children, siblings and friends.

The common denominator in all of the above is fear of losing independence.

Why do these myths/misconceptions arise?

• They arise because we know someone to whom they have happened. As is human nature, we then tend to focus on that negative aspect. We tell ourselves, "That's what it's like to be old" when we see someone who's had a stroke, suffers from dementia, is in a wheelchair, etc.
• We have a tendency to lump all seniors into one demographic group. But the term senior can cover a span of 40 or 50 years. We wouldn't dream of generalizing about the period of birth through age 50, so we shouldn't do the same with seniors. They are a very diverse group. In fact, as people grow older, they get more different from each other due to individual milestones: being widowed or other changing family circumstances, personality is more entrenched, etc. There is no common denominator among a given group of seniors other than age.
• There is the myth of mental decline. We forget things even when we're younger. When we're younger, however, we accept/dismiss it as just having too much on our mind at a given time. But when we're old and forget things, we automatically blame age.
• "Environmental/societal" factors contribute to the myths as well, like a crosswalk where even a very able-bodied person has trouble crossing before the light changes. The senior that holds up traffic trying to cross doesn't have a problem - the light just changes too fast for anybody. Things like too-small print on packaging, dim lighting in public areas, and grey-on-grey elevator buttons all set seniors up to "fail."

Why do we treat getting old as problem as opposed to a natural part of life?

• Today, our society responds to situations or intervenes only when they are problems - when someone is in need. Therefore, if you are in need of some type of assistance and you are old, then aging is seen as the problem that has caused you to be in need. In other words, if you have a "need" for public intervention, then you must have "a problem."

How do different cultures differ in their views on aging?

• North American culture embraces youth. By contrast, aboriginal people view the elderly as repositories of tradition and wisdom, and they are revered as a result. The Chinese view is very similar.
• Older people in North America are often segregated, living in nursing homes or the like, and there is not as much interaction between generations as in some cultures.
• Parents who were first-generation immigrants to Canada can often be disappointed when they've brought "old country" traditions and expectations, but their children have adopted the North American thinking in this regard.

The danger of myths and misconceptions vis-a-vis caregiving:

• Projecting our misconceptions onto a cared-for loved one is HUGELY damaging. Attitude is the single most important factor in healthy psychological aging.
• When we project a limiting myth onto a senior, it becomes self-perpetuating in that it (although it may be done with only good intentions) fosters dependence ("If I'm supposed to be frail and feeble at my age, then I must be frail and feeble...."). These myths rob the person of their opportunity to participate and be independent.
• An example of this would be an adult child unilaterally deciding that Mom should move out of her house - that the stairs are too dangerous - even though Mom never considered it and doesn't see the problem.
• There is a term called "dignity of risk," which refers to a person's entitlement to decide, if they are able, what risk(s) they will expose themselves to in the name of independence, etc.
• Our reactions to decision-making capability are not good. Just because a person can't do one thing for him/herself (i.e. balance a cheque book) doesn't mean he/she can't do another, possibly related task (handle his/her own finances). (Lots of us can't balance our cheque books!)
• Educate yourself if you're a caregiver! Learn what is a normal result of aging. Separate fact from fiction/myth.

How do people deal with the role-reversal that often happens in caregiving?

• Talk it out. Often, people know well in advance that they will end up being the caregiver for an aging parent or spouse, and they are comfortable with it when it eventually happens. In cases (like stroke) where roles can be reversed in a split second, it can take time, and people just have to work through it, talking it out if the cared-for individual is able.

What's the best thing about aging?

• The majority of seniors report that they're happy despite health problems that may be present. People adjust their goals and adapt to circumstances as they age.
• Things take on different priorities - things that may have caused you stress 20-30-40 years ago may not be as important to you. Seniors' accumulated wisdom allows them to accept that there are things you just can't change.

• Attitude!! Having meaning and purpose in life (and it doesn't matter what it is that gives your life meaning - it could be stamp-collecting - it's not a value judgment).
• The only thing that separates people like Rick Hansen or Terry Fox from the rest of us is their attitude toward life. If you have a good, positive attitude, it can more than compensate for a number of other things that may be lacking.

• Yes, and it's incredibly insidious. It's rooted (like all "isms") in devaluing the aging population - they're past their prime.
• You can see ageism in action in things like unemployment rates among seniors and resource allocation (i.e. cutbacks to long-term care facilities, etc.). You can tell society's valuation of a population by the amount of resources that are allocated to its members.

• They'll be more demanding. They'll feel "entitled." They will have an increased level of awareness about their health, what makes people sick, and know what interventions and medical advances are available to help them.

• Those who study aging are struggling to separate what is an inevitable effect of aging from what is avoidable or can be changed. There are memory changes, etc., but many of these effects of aging can be ameliorated.

Top of page

Quality Of Life
When asked, seniors indicate the following as being important to their perceptions of quality of life:

0. Independence: health/well-being; not needing to count on children for things; ability to travel. They don't relish the idea of having to need others for basic functions.
1. Relationships: family; friendships are very important.
2. Money to live reasonably well.

Memory
Do we "lose" our memory as we get older?

• A lot of what we call memory "loss" is really just a slowing down of the ability to retrieve material. It's still there, we're just not as quick at accessing it as we used to be.
• Verbal fluency may slow down, as does naming (finding names).
• There is some debate over whether it is harder for older people to solve new tasks.
• Generally, as we get older, we gain a lot of accumulated knowledge, skill and understanding.

• In general, the analogy is like exercise for the body, but it's not really clear if there is really anything one can do to "tone" memory.
• Reading, doing crossword puzzles, and other such activities are good to keep the mind "vigorous."

• North American culture places a very high premium on youth.
• In contrast, Chinese culture is very reverential and respectful of seniors. They are valued for their knowledge and experience.
• The main difference in perception is in each society's valuation of its seniors.
• When these values clash, "Old World" parents can be disappointed.
• Also, cultures differ in their acceptance of "psychological problems."

Depression

How common is depression among seniors?

It depends on how you define depression. There are two types:

0. the "serious illness" is clinical depression. Approx. 2-5% of those over 65 are affected (not dissimilar to the general population). In nursing homes or hospitals, that population can be affected up to 25%.
1. individual depressive symptoms are much more common. 15-20% of healthy seniors can have one or two symptoms, but that doesn't qualify them for clinical depression.

Previously unaffected seniors can develop "late onset" depression. A person can have been totally fine until a very advanced age, and can then become depressed. Often when this happens there is an underlying medical cause.

Causes Of Depression:

• Experts think of causes as being either biological (physical), psychological or social.
• Biological: illness is the major physical cause of depression among seniors. For example, depression is really common in the months after a stroke - the combined effects of the "shock to the system" and chemical changes in the brain. Also, some drugs can cause depression, including tranquilizers and beta blockers.
• Psychological: losses (trying to cope with the death of a loved one is a common precipitant); changes to lifestyle (retirement); changes to family relationships.
• Social: isolation, loneliness, financial difficulties.
• There are some seniors who may have had a life history of depression. Those people have an underlying chemical vulnerability to depression, so they may be depressed for no identifiable reason.

• There are no differences between the way in which men and women present their depression to medical care providers. (Women, as a group, seem more vulnerable to depression, but that may be a reflection of the fact that they tend to outlive men.)
• While rates of depression are about equal between the sexes, suicide rates in men are higher because they choose more "effective" means (guns, other weapons) v. women's "gentler" attempts (i.e. pills).
• Depression in seniors v. young: seniors don't always present with definite complaints of depression, as opposed to younger people who will often approach doctors saying "I'm depressed."
• Seniors may not be as aware that they're depressed. They may feel "something's wrong," but may attribute it to a physical cause - headaches, weakness, lack of energy, constipation. As a result, doctors may just treat the physical complaints.

• Changes in appetite (increase or decrease) or sleep patterns; loss of energy; loss of interest in usual activities; inability to concentrate (suddenly stop reading); they ruminate/feel guilty ("I'm a burden; I feel useless"); they express thoughts of death/suicide ("I don't see the point of going on"); they stop planning for the future.

• The new generation of anti-depressants (not "brand new," but one generation newer than Prozac) includes Zoloft, Paxil and Effexor.
• Often, seniors are given tranquilizers to treat their ailments, when they are really in need of anti-depressant medication.
• Psychotherapy: it's really just "talk therapy." Can be individual, group or family.
• "Supportive psychotherapy": talking, what's going on with the person, in their life, what's bothering them. Allowing the person to vent. Simple, but important, especially to those individuals who are otherwise isolated.
• "Cognitive psychotherapy": people get depressed because they have negative thoughts. Talk to them about their negative thoughts and how they are affecting state of mind.

• Encouragement is the big thing. The depressed person doesn't think he/she's going to get better. Depression will go away with time - they need to be encouraged not to give up, and reassured that things will get better.
• Do not dismiss the problem.
• If possible, mobilize the person. Exercise (even exercises that bedridden people can do in bed) increase endorphin levels.

• People who are seniors today are quite stoic. They lived through the "hard times": the Depression, the World Wars. They consider themselves tough, and it's hard to admit to a perceived weakness.

• Some patients who have brain disease (i.e. Parkinson's) are mistakenly diagnosed as depressed. (This happens because of the disease's effect on the facial muscles - the face droops, they don't smile, so they look depressed.)
• Conversely, a person with Parkinson's and depression may not be diagnosed as depressed because the facial indicators can be "written off" to the Parkinson's.
• Overall it is harder to diagnose depression in a person with any type of brain disease.
• Thyroid problems are also commonly misdiagnosed as depression.
• An underlying cancer (i.e. pancreatic) can cause symptoms that look like depression.

• Many people think depression and old age go hand-in-hand. They do not. Many people live to a "ripe old age" in perfect mental health.
• Depression in seniors is not inevitable - and if it does happen, it's really very treatable.

0. Excessive worriers: They worry obsessively about every little thing and are entirely overprotective of their loved ones.
1. Those in denial: They don't want to see any changes in their parents, so they write-off deterioration or changes as "just part of getting old," when these things are problems that could be dealt with and improved upon with proper treatment.

When To See A Doctor:

• Assuming a person isn't grieving over the loss of a loved one or some other such devastating event, if a person exhibits symptoms of depression for more than two weeks, consult their doctor.
• It is important, however, that the doctor spend some time (not just 15 minutes; a good hour or so) with the depressed person to allow them to really talk about it.
• Most family doctors will start treatment they think appropriate, but if there is no improvement in about 12 weeks, they'll likely refer the patient to a psychiatric specialist.

• When the person "can't function," is in danger physically (i.e. from weight loss), is suicidal, is psychotic (strange thoughts/ideas/delusions), he/she should be hospitalized.