Depression in Elderly: Is It Just Aging or More?

Is it depression in the elderly or an issue related to aging?

Hello Dr.
Ouyang, my grandfather is nearly 90 years old this year.
After my grandmother passed away over ten years ago, he has been living with my two aunts and often stays home alone.
Therefore, we hired a female caregiver for companionship.
Since many of his friends have also passed away, his daily life consists mainly of eating and sleeping, and he feels lonely (he is not very good at communicating his feelings with family and tends to open up more to outsiders).
Recently, the caregiver has reported that she has noticed some unusual behaviors from my grandfather, including transferring his emotions onto her, resembling a romantic relationship (there is nearly a 50-year age difference between them).
My father mentioned that my grandfather seems to still have a sex drive and occasionally behaves inappropriately towards the caregiver.
We have also observed that he has been experiencing facial flushing.

I would like to ask Dr.
Ouyang:
1.
Is my grandfather's facial flushing a sign of menopause?
2.
Are my grandfather's behaviors indicative of depression or some other mental health issue? If we take him to see a doctor, which specialty should we consult? Could you recommend a hospital or a physician? (My grandfather lives in Taipei.)
3.
Will medication cause him to be drowsy all day? (According to the caregiver, most medications prescribed for the elderly tend to make them feel foggy-headed to suppress sexual urges or other symptoms.
Are there no alternative medications?)
Thank you, Dr.
Ouyang, for taking the time to address these concerns from a worried granddaughter.

Sun nv, 30~39 year old female. Ask Date: 2005/09/12

Dr. Ouyang Wenzhen reply Geriatrics

It is not unusual for a 90-year-old person to have sexual desire and engage in sexual activity; however, attention should be paid to their cognitive abilities, judgment, and physical capacity.

1.
In terms of cognitive judgment, it is crucial to consider whether the individual has dementia, such as Alzheimer's disease or dementia resulting from a stroke.
This means assessing if they have experienced recent memory loss or forgetfulness regarding recent events or conversations.
Additionally, if there are difficulties with "organizational judgment," language expression, comprehension, recognition of people, events, and objects, as well as impairments in daily living activities such as eating, drinking, toileting, dressing, and bathing, a diagnosis of dementia may be appropriate, rather than depression in the elderly.
2.
Furthermore, if the elderly man is experiencing facial flushing, it is important to first consider hypertension (which is likely not related to menopausal symptoms) or skin-related issues.
3.
Indeed, some medications can suppress sexual desire and cause drowsiness; however, there are currently many medication options available.
Starting with a lower dose and gradually increasing it can help avoid drowsiness.
If you are in the southern region, you may consider the Chia-Nan Rehabilitation Hospital under the Department of Health, where I or Dr.
Hsieh Chao can assist you.
If you are in the northern region, you may consider the Geriatric Psychiatry Department at Taipei Veterans General Hospital, led by Dr.
Huang Cheng-Ping.
Wishing you all the best,
Director Ouyang Wenzheng
Chia-Nan Rehabilitation Hospital, Department of Health
September 14, 2005

Reply Date: 2005/09/12

More Info

Understanding depression in the elderly can be complex, as it often intertwines with the natural aging process, loss of loved ones, and changes in social dynamics. Your grandfather's situation raises several important points that warrant discussion.

Firstly, regarding your grandfather's facial flushing (潮紅), this is not typically associated with menopause, as that term is specific to women. In elderly men, facial flushing can be attributed to various factors, including hormonal changes, medication side effects, or even emotional responses. It’s essential to consider the context of his overall health and any medications he may be taking.
Secondly, the behaviors you've described—such as transferring emotional attachment to the caregiver and inappropriate physical advances—could indicate several underlying issues. These behaviors may stem from loneliness and a desire for connection, particularly after the loss of your grandmother. However, they could also suggest the onset of cognitive decline or even a form of dementia, which is not uncommon in elderly individuals. Depression in older adults can manifest in atypical ways, including irritability, emotional withdrawal, and changes in behavior.
To determine whether your grandfather is experiencing depression or another mental health issue, a thorough evaluation by a healthcare professional is necessary. I recommend consulting a geriatric psychiatrist or a neurologist who specializes in cognitive disorders. These specialists can provide a comprehensive assessment, including cognitive testing and evaluation of mood disorders. If you're looking for specific recommendations in Taipei, consider reaching out to local hospitals with geriatric departments or mental health clinics that focus on elderly care.

Regarding your concerns about medication, it is true that some medications prescribed for depression or anxiety can lead to sedation or cognitive impairment in older adults. However, there are various classes of medications available, and not all will cause these side effects. A geriatric psychiatrist will be able to tailor a treatment plan that considers your grandfather's overall health, potential drug interactions, and specific symptoms. Non-pharmacological interventions, such as psychotherapy or counseling, can also be beneficial and may be recommended alongside or instead of medication.

In addition to seeking professional help, it’s crucial to foster a supportive environment for your grandfather. Encouraging social interaction, whether through family visits, community activities, or even engaging with the caregiver in meaningful conversations, can help alleviate feelings of loneliness.
Lastly, it’s important to approach the situation with empathy and understanding. Aging can be a challenging process, and your grandfather may be struggling with feelings of loss, isolation, and confusion. Open communication with him, when possible, can help him feel more connected and supported.

In summary, your grandfather's symptoms warrant a thorough evaluation by a specialist in geriatric psychiatry or neurology. Addressing his mental health is essential, and there are various treatment options available that can minimize side effects. Your involvement and concern as a family member are invaluable in navigating this challenging time.

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