Depression in Older Adults
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection was Haigh et al. (2018), Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. I have included my reflection below.
Depression in Older Adults
This week, I chose to reflect on Haigh et al. (2018), Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. Haigh and her peers begin by telling us of some groundbreaking work by Blazer twenty years ago that debunked five myths associated with depression in the elderly. Haigh wants to revisit and update Blazer's myths using more recent research findings. The first myth is that depression in later life has different symptoms than in earlier life, to which Haigh responds, maybe. While some studies suggest that older adults might experience more somatic symptoms, other research does not support significant differences, so there is no definitive conclusion. The second myth is that depression is more common in older adults, which Haigh refutes, saying that while the evidence again is mixed, it appears that major depressive disorder is actually more prevalent in younger populations; older populations may have more prevalent subclinical levels of depression, though.
The third myth suggests that older adults may experience more chronic depression than younger adults. Haigh acknowledges that while the evidence of chronic depression in older adults is mixed, older adults may indeed experience higher rates of relapse and recurrence, particularly when they have medical comorbidities. More relapse and recurrence could contribute to more chronic forms of depression in older populations. The fourth myth suggests that depression in late life is more difficult to treat. Haigh disputes this, noting that psychotherapy and ECT are just as effective in older adults, while antidepressants may be less effective. Finally, the fifth myth, that psychological factors cause depression in later life, Haight refutes, stating that older people probably have better psychological resilience than younger folks, and in fact, it may be biological or social contributors causing depression in old age more than psychological.
My initial reactions upon reading this piece were very positive. I enjoyed the tentative and non-dogmatic tone used in the article very much. Haigh and her team made it clear from the outset what they wanted to do: update Blazer's myth research based on new research in the past 20 years, and they did exactly that. Each myth presented showed a balanced perspective, citing many diverse sources of evidence on either side and reaching a tentative conclusion in each case. I have a lot of respect for Haigh and this approach. I am extremely wary of any research that has strongly held one-sided opinions, and Haigh was a breath of fresh air for me in seeing both sides of each myth for the most part.
I found this paper personally compelling as I have an extended family member who has suffered from depression for many years; he is now in his sixties. I was pleased that Haigh brought attention to depression in older adults, as it relates to the experience with my family member. With our aging population, I see the increasing importance of this field. I felt incredibly uplifted that we could have a fresh, unbiased view of depression in the older population, and it seemed very hopeful that treatment, especially psychotherapy, could have a great impact on these folks.
While tentative conclusions, such as those Haigh reached, are, in my opinion, more helpful and true, tentative conclusions do not drive people to action the same way an overly simplified, politicized, idealistic conclusion may. Therefore, I have questions for Haigh, even after reading her conclusions and recommendations for further research in the fields of medical and biological contribution to depression in older age, preventative programs for depression, and more targeted interventions. I still wonder what I can do personally to address the growing challenges of depression in an aging population. Her tentative conclusions are less galvanizing and require a reader to self-motivate instead of igniting one's passions with a clear call to action. On the whole, though, passionate zealots are not what I want, so I am happy to take the burden on myself instead of mindlessly following the prescriptions of others. Others looking to be led may shrug their shoulders after reading this article and move on to someone else to idolize and outsource their thinking to.
As a counselor, this article made me again conclude that in most all situations, the answer is "it depends," and the best we can do is reach a tentative assumption. It also made me more aware of depression in an aging population. If I do meet an older person with depression, I will remember that there are paths for them, and we can help heal or even cure their depression. I will not give up on them, thinking that depression in older people is something we cannot change, and I will not put it in the too-hard basket. I also am thinking a lot about our aging population. I believe that our older population has tremendous wisdom. Their wisdom is an asset and a real treasure. It will be a privilege for me to work with this population. In exchange for facilitating attempts at their improved mental health, we also can facilitate attempts at unlocking and sharing their wisdom with the rest of our population, unlocking their psychological resilience, and using it as a healing salve against what feels to me to be an epidemic of division, ignorance, and hatred in the world today. In my opinion, the challenges of today are fueled by unfounded religious, scientific, and political certainty. I desire that this sharing of wisdom from our older population goes hand in hand with a sharing of tentativeness, a tentativeness to counteract this unfounded certainty, and a tentativeness I see and admire in this very piece by Haigh.
