Healthy Ageing; Depression Among Elderly Population

Hi everyone,

Today, I'm going to start writing a series regarding healthy ageing. There were many challenges imposed on the current system and living in the midst of ever-growing elderly community is one of them. While being elderly is often associated with various diseases and possibly cocktails of medicine which has to be brought everywhere and every time, the notion of having a society which consists of a possibly twice the number of elderly people compared to the young adult population is quite worrisome. According to the United Nation's Department of Economic and Social Affairs, the number of elderly people will reach up to 1 billion people in 2020 which is a pure estimation from a documentation made in 2012 which found that the number of elderly people exceeds the total number of people who were aged 15 years and below.

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If sometimes in the future, the number of elderly people were remarkable, the traditional definition of "old age" can no longer be used. The age and criteria to retire need to be reviewed and the elderly population need to be given opportunities to contribute to the socioeconomic development as long as they were having a good health and vitality. Tun Dr Mahathir Mohamad for example, is the current Prime Minister in Malaysia who has been given opportunities and trust by the Malaysian to lead once again after his governance back in 1981 til 2003. He's currently the oldest leader in the world appointed as the 7th Malaysia's Prime Minister at age of 93 years old. People have been criticizing the decision made to uphold him once again as the prime minister of Malaysia at his current age but according to the former Director General of The World Health Organisation, Dr Margaret Chan:

"If older people can remain active participants in society, they can contribute to our socioeconomic development"

If it is indeed important to include elderly population in sustaining a good economic development, it is also important to ensure the vitality of elderly population were well-monitored by the government to preserve a good amount of manpower to maintain a good economy. In this article, we will be discussing regarding depression and how travel can be a potential cure for the impending depressive crisis while maintaining good health among the elderly population.

What You Need To Know About Depressive Disorder in Elderly

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Previously, in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), any condition which can be categorised as the depressive disorder were classified under the roof of mood disorders but in DSM-V, depression is a standalone diagnosis. Unlike the hallmark of psychiatric illness which is Schizophrenia, depression is usually diagnosed among young adult. The thing that makes it difficult for a clinician to certify the diagnosis of depression among elderly people is because most of the physical and psychological changes that happened during an ageing process resemble depressive symptoms such as early awakening, disinterested in a usual pleasurable activity (anhedonia) and reduced appetite. All of the similarities in physical symptoms have made depression one of the most underdiagnosed psychiatric illnesses among elderly.

However, it is widely accepted that depressive symptoms in a young adult will present itself quite differently from the depressive symptoms in people who were regarded as elderly. It will, of course, depends on whether this is the first presentation or just a recurrence of depressive symptoms which is usually caused by various factors mostly environmental insults (the above statement doesn't really apply to the latter). According to the World Health Organisation, the term "elderliness" can be defined as a period of time whereby there was a reduced level of competency in terms of their interaction with environmental factors. However, there are some discrepancies regarding the age in which an individual can be thought belong to the elderly population; some were using 60 years old as the earliest age of elderhood but general consensus state that the lowest boundary of the elderly population is between 60-65 years old.

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In the second episode of the series entitled "Conficker's Journal" which I have published two weeks ago, I've stated that I've been diagnosed with Major Depressive Disorder as a consequence of my childhood experiences coupled with a few problems which, during the time, I felt were too much for me to handle. Even though the central to the illness is the disturbance of mood, the first symptom that is usually encountered especially by the elderly people is anhedonia, simply translated to disinterested in a usually pleasurable activity. Some elderly people were known to become socially withdrawn as a result of anhedonia which could lead to a condition which can either make the affected people feeling anxious all the time followed by unintended, purposeless motions (psychomotor agitation) or become slow in terms of their physical and thought process (psychomotor retardation).

Other symptoms related to depressive disorder can be found usually later than the onset of anhedonia. People will start to:

• Feeling hopelessness
• Having some pessimistic thoughts
• Easily fatigued
• Back pain (which suggested the depressive symptoms have gone psychosomatic)
• Poor attention span
• Sleeping disorder (can be insomnia, early awakening and excessive sleep)
• Eating disorder (binge-eating, reduced or increased appetite)
• Suicidal ideation or attempt (which is usually considered as the most severe form of depressive disorder)

Of course, the symptoms listed above were incomplete and if you didn't experience some of it, it doesn't rule you out from being diagnosed as having some sort of depression. The standard procedure to diagnose people with depression has been outlined in the latest edition of DSM or The International Classification Of Diseases (ICD-10).

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The reason why elderly people were depressed might not be the same as why a young adult felt overwhelmed. According to a paper which has been published in 1997, the most important things that could shield an elderly people from getting a depression is experiences. Old age is often thought of as a time period whereby an individual starting to accept the positive and negative things as a whole and cease to be afraid about their future prospect. If they have failed for a significant number of times when they were young, the experiences gained will provide a protective effect against stressful situations that they were going to face later; failure to adapt to the stressful changes associated with ageing processes will result in depression. However, even if certain elderly people gained a vast amount of experiences during his/her adulthood, whether or not they were predisposed to be affected by depression will depend on a few aetiological factors which are often presented as a biopsychosocial model; experiences were only thought of as a supplement to prevent depression, it can't do more than that.

• Biological Factor: The two main aetiological factors in the biological component were genetics and hormones. Genetics has been thought to affect the majority of psychiatric illnesses. In the case of depression, if one parent was affected, the chances of their child to be affected later range from 10-25%. If both were affected, the chances of being affected by depression were twice (20-50%). In a twin's study, the concordance rate (the chances to be affected by depression if one child in the twin were affected) for a monozygotic twin were 70-90% while for a dizygotic twin were 16-35%. Hormone imbalance also contributes to the probability for an individual to be diagnosed with depression. Women who have menopause are associated with a reduced level of oestrogen and an increased in a stress hormone called cortisol making them prone to be affected by depression.

• Psychosocial factors: This is one of the most common aetiological factors that can be identified among depressive patients by clinicians. People who were diagnosed with depression could have gone through some sort of adverse life events that happened at least within 3 months prior to the appearance of the first symptoms. In a theory called "Beck's Cognitive Theory" stated that people who are diagnosed or fulfilled the criteria to be diagnosed with depression usually have some dysfunctional thoughts. They were filled with negativity and can't seem to look at the positive side of the things which were taking place in their own environment. They will often feel helpless when they were presented with difficult situations, throwing normal stressful stimuli out of proportion.

Travel And Depression

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In a rather famous Framingham study which has been conducted in 1948, one of the questions being asked as a part of the survey was how often they went for a vacation. The result was kinda divided into two separate groups; one is for those who travel once every 6 years and another is for those who travel at least twice a year. It was found that people who have been travel twice a year have fewer coronary heart incident and heart attack compared to those who travel for less. I know, it doesn't give the right picture for the topic of our discussion which mainly focuses on depression but some studies have been conducted which actually yielded positive correlations between active travel and depression. People who rarely travel were commonly burden by the thought of works and eating disorder which finally will result in practising unhealthy lifestyle compared to people who were travelling at least twice a year.

Travelling has a proven benefit of stress reduction in which if it is not well-controlled, can lead to a full-blown depression along with other complications which are usually associated with the depressive disorder such as weakened immune systems, adrenal gland dysfunction, elevated cortisol etc. A survey which was conducted in 2012 has found that approximately 80% of the American population which has been travelling claimed that they have an improved focus, energy and productivity. This would usually lead to a high-quality work, a great productivity which is usually followed by a satisfying results hence lower incidence of work-related depression. Nearly 80% of the American traveller believe that they will need a much longer travelling period especially when the economy was difficult.

It's relatively easy for an elderly to go for a vacation as they are usually have retired from their work which makes travel a reasonable activity that they can participate in, especially if they have some money saved specifically for that purpose. In a large-scale survey involving American retirees conducted by global research firm GFK has found that approximately 10 million Americans felt remorse as they have only a few savings dedicated for travelling suggesting travel might be an important aspect of life after retirement whether they were associated with greater health benefits or not.

In the future article, I would be explaining more about the health benefits that a travel can impose on a general population. Thank you for your attention.

Sources

• Depression in the Elderly: Clinical Features and Risk Factors
• Destination Healthy Ageing
• Vacations Improve Mental Health Among Rural women: The Wisconsin Rural Women's Health Study
• Traveling is a Good Method to Release Stress
• Vacations Are Good for You, Medically Speaking

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