“Why should I carry on when I can’t do any of the things that used to make me happy?” This revelation by my friend, a good-looking man who relished his prowess as a runner into his 60s, set off an alarm in my head.
My friend was now in his 70s and his knees were shot. Replacement knees didn’t turn the clock back to the days when he could sprint out his front door.
It wasn’t great that his male prowess also was in decline; having sex with his wife had become far from spontaneous. He had to take Viagra – but it only worked on an empty stomach, only at a very specific time of day, and even then it worked erratically.
Finally my friend’s existential angst became so consuming that he confided he’d gone out and bought a gun. Fortunately both his wife and I realised at about the same time that something was terribly amiss. We convinced him to check himself into a psychiatric hospital.
Suicide is a hidden epidemic among the elderly.
We think of suicides as involving young people — especially in the case of men. But, in fact, rates of suicide increase with age. Actually killing oneself becomes more common with ageing, in part, because older people are more deliberate in their plans, and their plans are more lethal.
Self-harm in older folks is more common, too, because depression, although only rarely severe enough to promote self-harm, affects a whopping 15 per cent of elders living in the community and up to 40 per cent of those in nursing homes.
Getting old can become a saga of one loss after another. Loss of loved ones — friends, perhaps a spouse. Loss of the self-respect and social position that goes along with a job. Loss of physical abilities. Perhaps it is not surprising that half of cases of depression are new onset after the age of 65.
Depression can be difficult to detect as people age because it can masquerade as dementia or withdrawal. To make matters muddier, physical limitations that contribute to depression — such as hearing loss and memory loss – can look the same as depression. So is Grandpa getting senile, or is his hearing aid not working well? Or should he be seeing a mental health professional?
Often the answer is, “I love and want to protect Grandpa, but I don’t know what’s going on.”
When that’s the case, the next thought should be, “I’d better get the help of a geriatrician or a geriatric psychiatrist or psychologist.”
What a well-trained professional will do is to get data in the form of psychological testing and possibly brain scans, lab tests or hearing and vision tests. If the diagnosis is depression, out-patient medications paired with talk therapy can be highly effective; but, dependent on severity, overnight hospitalisation or day hospitalisation may be necessary.
What this tells us is that, although internal psychology is almost surely important in determining how an elder experiences his or her life, external connections and social valuation may be more important. Connections that improve quality of life need not even be human relationships — animals and robots improve mood and cognition.
Human connections, the more dense and varied they are, avert depression. The quality of links to children, are, of course, key for maintaining mental sustenance. But what about elders who do not have children or who have troubled relationships with their children?
Here’s where a link to a mental health worker can make a big difference.
Recently I visited an old friend whom I hadn’t seen in many years. She lives in the countryside and has no children — only a brother who is moving out of the country. As my friend turns 65 and ages beyond, she cannot rely on the support of family.
What she has done instead is to build a family out of her community. She and a group of like-minded folks have all moved into a row of 200-year-old cottages, sharing a common garden. They socialise, take over chores when another is sick, grow food and tend farm animals together, and they cook communally.
Although the lack of family is hard on my friend, the presence of warmth and caring from friends almost makes up for it.
Many of us (myself included) begin to realise as we age that quality of life is hugely enhanced by close relationships. I have no intention of waiting until I am on my deathbed to clear up old hurts or to reach out and make new friends.
I now spend lots more time mending personal fences, and once mended, I keep them up. I volunteer and meet like-minded folks that way. My friends get more involved in their churches or in social groups.
Let me recommend that even before you get old, you get better at play. Rather than working extra hours or checking that next email, go to a movie, play cards or just hang out with family or friends. Build up a reserve of loved ones and caring connections for the day when they can make a difference in your whole outlook on life and even in your willingness to continue living.
The New York Times
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