Victoria Times Colonist: 30March2014

Seniors already dealing with health problems, financial constraints and shrinking social circles often confront an accompanying challenge.

Depression, as one elderly Victoria sufferer says, is “a hidden disease,” something that seniors are especially loathe to admit.

British Columbians 70 and older account for about 12 per cent of suicides in the province, according to statistics from the B.C. Coroners Service.

In 2011, people 80 and older had the second highest suicide rate, behind only people in their 50s, according to combined data from the B.C. Coroners Service and B.C. Stats.

And the rate for men over 85 is double the average for all men in the province — about 35 versus 17.5 deaths per 100,000 people, according to the Canadian Mental Health Association’s B.C. division.

It’s not a new phenomenon, said Susan Eng, national vice-president for advocacy of the CARP organization for aging Canadians.

Researchers have identified common themes among elders who express suicidal thoughts, she said. They include social isolation that grows as their social circle shrinks, grief, as well as financial and health problems.

“They don’t adapt well [to injuries], especially if they’ve been healthy, able people, and then they face an acute event that makes them not capable of doing the things they were doing for themselves before,” Eng said.

While financial problems like job loss can push people of any age to depression, seniors don’t have the opportunity to get another job. “Those personal financial problems for an older person are intractable,” she said. “For a younger person, you think your world has ended. But in reality, you’ve got time to fix it.”

CARP is advocating for strategies to mitigate those problems. For example, Eng said, Denmark has a “postal system” for nurses who make home visits to clients on a circuit, such as a mail deliverer.

Eng said that many housebound seniors end up in the emergency room when things go wrong. Part of the way to stave off medical problems is to have these weekly visits — but just as importantly, it would add social contact to the senior’s routine.

•••

It’s just after tea time at the Friendship Centre on Skinner Avenue, where about a dozen seniors meet weekly to do crossword puzzles, arts and crafts, and travel together to the thrift shop.

Each was referred to the group — hosted by the Capital Mental Health Association — by a counsellor, physician, psychiatrist or community organization. Gathered in a circle on a Wednesday, they describe what depression feels like.

“Hopelessness,” says one woman.

“It’s like a cartoon, where there’s a little rain cloud over a character’s head and there’s a bit of rain on that one person,” says another.

“Loneliness,” says another, who recently moved into an independent-living facility. “You feel like sometimes you’re in a prison, it’s too confined. You have to eat when you’re supposed to and you’re not free like you used to be.”

The loss of independence that comes with moving into a care facility is a common theme. But the range of aggravating factors is wide, from losing your “treasures” when you downsize, being surrounded by dementia patients when you’re perfectly healthy, and trying to care for a partner who is also losing mobility.

When you don’t feel like you can communicate your feelings, it just adds to the isolation.

“My daughter and her friends, they just expect to look good and feel good and get on with it and keep your spirits up. They’re not patient at all,” says one woman. “And that makes me feel like it’s very important to be guarded and cheerful when you’re among people who are really young and happy and busy. Be a good listener, otherwise it will come out sounding like complaining or self-pity.”

Dignity can be a difficult thing to retain when your body and sometimes your mind begin to falter. The same woman, who sat in a recliner, said one moment was a turning point for her.

“It was like a crossing, a dividing line, when I put my teeth in the fridge. I thought, my daughter doesn’t want to know about that. I’m absolutely on my own,” she said.

“But then I thought, I’ve got to be watchful in the community. Somewhere, there will be safe places where that’s acceptable. This is one of those places, where it’s OK to be older.”

•••

Noriko Oka is an outreach worker with the James Bay Community Project. Oka said she has met many seniors who express loneliness and despair, feeling like they’re facing “a shrinking island.” The hardest part for many is losing a partner.

“With this population, you’re dealing with a lot of grief and loss because they’re at an age where they’re having to deal with their changing bodies and a lot of changing relationships. Depending on how they’re coping at home, they may have to change residences as well,” she said.

She believes many North Americans of European descent don’t value their elders the way people of other cultures do.

Seniors are “kind of dismissed and minimized,” she said. “I don’t find we value the elderly the way they need to be. The fact that we live in a culture like that, I think, has a really negative effect on seniors.”

Raymond Welch, chairman of the seniors advocacy group CARP Victoria, said that the topic of assisted suicide often comes up at meetings.

“The idea comes up that we should be able to decide a dignified time,” he said. “Going back to being entirely dependent on other people — it runs against what we’ve been conditioned to do.”

Reports of higher rates of depression and suicide in care homes also rang true.

“When you get into long-term care, it’s like getting a 10-year sentence and it might be like solitary [confinement], where you have problems communicating, you no longer have control of your bowels and bladder, half the time you can’t eat on your own. The idea that you’re useless can be very reinforced,” he said.

According to Statistics Canada, three men commit suicide for every woman who does the same across the country. Welch said he has witnessed women come together socially as they age, while traditional relationships between men can be less emotionally intense. Also, men who have depended on their wives for basics like cooking and cleaning suddenly have to learn new skills.

However, Welch believes it to be a generational phenomenon — he’s seeing his sons, who are in their 20s and 40s, make more intimate relationships with both men and women, as well as share domestic duties and depend less on their careers for self-worth.

•••

A key to suicide prevention involves changing attitudes toward talking about depression and suicide, said Dr. David Leishman, a geriatric psychiatrist and site chief for the South Island’s division of geriatric psychiatry for Island Health. Many people who self-harm have already shared their intentions with family and friends.

“When someone comes to you and says they think their life is over or they want to end their life, some folks think that we shouldn’t be talking about that. But that’s exactly the wrong thing to do,” he said. “The thing to do is actually engage the person in what their thoughts and feelings are about.”

Major depression is something that can be treated, if identified, he said.

Leishman encourages individuals experiencing depression to access local support groups or alert their family doctor. Isolated seniors can request home visits from outreach workers, or may be referred to the service through community groups.

The seniors at the Friendship Centre said reaching out can be the hardest part. But talking to a friend and support worker is the first step.

“Get out and do things with friends, even when you don’t want to,” one woman said.

Being patient with yourself and seeing small things — like the ability to cook your own food — as precious gifts helps, even if it takes longer than it used to.

Family is key. While some reported feeling neglected or like a burden on family members, most agreed that a weekly visit would make the world of difference.

Even cats can help, according to two women who have them.

A group of seniors, who face similar challenges but said they don’t suffer serious depression, said making an effort to get out of the house and meet new people is important. They get together weekly to play shuffleboard at Saanich’s Silver Threads.

Ron Marston, 77, said having to support his wife through medical problems including dementia and arthritis, made him realize the importance of asking for help.

“When you have the task of looking after someone, that makes you realize how much more you need people around you.”

Oka said it might help if younger people challenged their own misconceptions about the elderly. She remembers a petite woman in her 90s she once worked with in Ontario. The woman, who had arthritis, had never worn a bathing suit, but Oka invited her to join a new aquafitness program anyway. The woman said yes.

It’s a common encounter in her line of work, she said.

“It counters that kind of perception that they’re older, they’re not going to change and they’re not going to try new things because they’re already set. But that’s not my experience. My experience is that it’s an interesting time of life. … You kind of step out of the responsibilities and obligations you had before. And what do you do?”

Some can’t escape depression. But those who focus on the new problems and challenges that come with old age are more at risk for loneliness and despair, she said, while those who are creative and open-minded about new experiences fare the best.

Back at the Friendship Centre, the woman in the plush recliner said she lost a sister to “this problem.” At the time of the funeral, her family gathered together and made a pact to fight the taboo, support one another and never to let the “hidden disease” win again.

- See more at: http://www.timescolonist.com/news/local/seniors-and-depression-on-a-shrinking-island