Sunrise senior Florence Wechsler has plenty of reasons to be depressed. She lost her husband two-and-a-half years ago, her two sons live across the country in New York and California, and she has no family living nearby.
But the octogenarian refuses to let herself get down. Always on the move, Wechsler swims three to four days a week, bowls twice a week, plays mah-jongg twice a week, volunteers tutoring children Monday and Wednesday mornings, meets friends every Saturday afternoon for a movie date and attends the ballet when it’s in town.
“I like to be around people,” said Wechsler. “That’s what it boils down to. I love people. Sure, I get low many times. That’s when I get my behind moving.”
Hollywood seniors Shelley and Alan Stieb follow the same prescription for happiness: staying busy, social and physically active. Ever since moving to Florida from New York City more than a decade ago, they have plunged into political and social activism. Alan, 70, is the president of his condo. Shelly, 69, is a member of the League of Women Voters. They both serve on the board of the Hollywood Beach Civic Association and are precinct captains for the Broward Democratic Executive Committee. They also walk the Broadwalk by Hollywood beach regularly.
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These South Florida seniors are doing everything right, according to experts. But, sadly, they are not in the majority.
According to experts, depression is practically an epidemic for the senior population, affecting 6.5 million people 65 years or older. Twenty-five percent of patients seen by United HomeCare, a nonprofit home healthcare agency serving South Florida, are diagnosed with depression, according to Marina Bravo, a licensed clinical social worker with the agency.
Even more troubling for social workers and gerontologists: The suicide rate for seniors is now the highest among any age group. There is an average of one suicide among the elderly every 90 minutes, according to experts. In that age group, the highest proportion of suicides occur in white males.
“Seniors have higher risk factors for depression,” noted Bravo. “They tend to have health problems or disabilities, chronic pain, loneliness and social isolation, loss and bereavement, plus loss of financial status. They have to combat a lot of things.”
Also, notes Dr. Clara Alvarez, a psychiatrist and director of Memorial Regional Outpatient Behavioral Center, they may have virtually no support system, with family living in other states.
“We have more and more elderly patients living on their own,” she said. “We’re living longer and also the children are moving away, plus people are having fewer children.”
As more and more baby boomers become senior citizens, that age group is fast becoming the largest segment of the population, making depression a priority for health professionals. The issue is of particular importance in South Florida, where hundreds of thousands of elderly retirees have moved to enjoy what is supposed to be their golden years but often turns into the opposite.
While physicians, social workers and home healthcare workers previously focused primarily on seniors’ many physical complaints, they are now starting to screen them for psychological issues such as depression. United HomeCare, for example, now requires all social workers to do a depression assessment when first visiting an elderly patient.
“Previously, they would look for diabetes or high blood pressure, but now they are being trained to look for depression,” noted Bravo. “It’s a standardized tool that they use.”
In the past, social workers might ask seniors one question about whether they feel depressed. They now realize that’s not sufficient because the patients might not even realize they are depressed. Instead, the home healthcare workers ask specific questions designed to detect symptoms of depression, such as whether the patient has had trouble sleeping, a change in appetite, an increased use of drugs, feel they are a burden to their families, have experienced a loss of concentration and have been talking about ending their lives.
The patients are then assigned a number on a numerical scale for depression, which physicians then use to determine whether treatment is in order.
“Doctors like numbers,” noted Bravo. “Now, case managers have an actual tool to use to assess depression.”
Alvarez agreed that depression among seniors has become better diagnosed. She estimates that two-thirds of her patients over 60 are diagnosed with clinical depression.
“Doctors are becoming more involved in the screening for depression,” Alvarez said. “Primary doctors are becoming more involved in the screening.”
Before doctors prescribe treatment for depression in the elderly, they first rule out physical illnesses that could be masked as depression, such as Alzheimer’s disease, Parkinson’s disease, hypertension and kidney disease.
However, once clinical depression is diagnosed, there are a number of treatments available, which are similar to those for younger patients.
Antidepressants are often prescribed. Today’s antidepressants have far fewer side effects than the old-line drugs and therefore can be tolerated better by seniors, who are often taking multiple medicines. Alvarez said she tries to start with low doses of the drug and just prescribe one rather than two or three, since liver function in seniors can be affected by the drugs more than in younger patients.
Other seniors are encouraged to increase their social engagement, perhaps by visiting one of the many senior centers in South Florida. Senior centers throughout Miami-Dade and Broward counties offer a variety of activities and classes. Local libraries also offer activities for seniors such as meditation, yoga and computer classes.
Bravo and other social workers often encourage seniors to get a pet.
“Everyone needs a sense of purpose,” she said. “It could be something as simple as feeding a dog every day.”
As in younger persons, experts also encourage seniors to get daily exercise, which has been proven to release endorphins, which elevate the mood. For seniors, lighter forms of exercise such as walking or tai chi are key.
Finally, a healthy diet and adequate sleep can be an antidote to depression, say experts.
“We just try to engage the client and find out what the activities are that are doable,” said Bravo. “For example, they might have liked going to the beach before but they may be limited now. So I say let’s make a goal. Let’s find a nearby lake instead.”
For his part, Stieb encourages seniors not to use illness or disability as an excuse to grow depressed or become shut-ins. He suffers from chronic pain and walks with a cane after a work accident 26 years ago when he fell off a ladder and shattered his knee, broke his back and suffered a head injury. Shelley Stieb also struggles with pain due to severe gum problems.
“I was feeling sorry for myself and an elderly man told me, ‘Consider yourself lucky. Now you can do good work for others and volunteer,’” recalls Stieb. “That stayed with me.”
Adds Shelley: “I advise seniors to take a walk, go to the YMCA, go to one of the many parks in South Florida, go to a community center and take a class, or take laughing yoga. Or, walk on the Hollywood Broadwalk. There is always someone to talk to.”
Active older adults
MDPROS has partnered with Walgreens to present weekly “Healthy Choices Clinics” by Walgreens at the 14 Active Older Adults Recreation Hubs. The clinics will provide blood pressure, glucose and cholesterol screenings as well as immunization shots for flu, pneumonia and shingles. For more information, call 786-372-9701.
Retired and Senior Volunteer Program (RSVP)
The Retired and Senior Volunteer Program (RSVP) acts as a clearinghouse to provide opportunities for persons 55 years of age and older to use their talents, skills and experiences to enrich the lives of others. More than 1,000 RSVP volunteers serve in 79 agencies and organizations throughout Miami-Dade County. For additional information, call 786-469-4851 or visit RSVP at 701 NW First Court, 11th Floor, Miami.
The program provides participants the opportunity to enrich their lives through providing services to other seniors less able than themselves. Applications are in English and Spanish. For additional information, call 786-469-4851 or visit at 701 NW First Court, 11th floor, Miami.
Enhance Fitness Classes
Classes combine three key components of fitness: Strength-Training, Flexibility, and Cardio-Conditioning, Each class is a full hour, held indoors three times per week. Classes are held in fitness centers at many Miami-Dade Parks. For information, go to http://www.miamidade.gov/parks/active-adults.asp or call 786-372-9701.
Baptist Health South Florida
Baptist Health offers more than 200 free monthly community exercise programs, from aerobics to Tai Chi to stretching to walking clubs to many more. For information, email communityexercise@BaptistHealth.net or call 786-596-7044.