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Jewish World Review Oct. 31, 2005 / 28 Tishrei, 5766 Depression often misdiagnosed in the elderly By Jan L. Warner & Jan Collins http://www.JewishWorldReview.com | Q: Since my mother's death early this year, my husband and I have gone to visit my 81-year-old father several times a week. We thought he was doing wonderfully until six weeks ago when we noticed he was becoming more distant and looked very sluggish. When I peeked in his refrigerator, I found it to be nearly empty, and what was there was spoiled. His house, which had been immaculate, was disheveled, he had noticeably lost weight and he wasn't interested in visiting. Since I am the only child within 500 miles, I feel responsible. Dad denies any problems and refuses to see his doctor, who won't talk to me without some type of release. Owing to his forgetfulness, my husband and I believe Dad has early signs of dementia, but we are frustrated because we can't find out what is wrong and how to treat him. A: Because of your frequent visits, you and your husband are probably the best reporters of historical data to your father's physician; however, without a release signed by your dad, you will not get any information from his doctor. Not being able to interact with your father's medical providers is quite an impediment to assuring that a parent receives appropriate treatment. That said, if you try to coax your father into signing a medical authorization, he may assent voluntarily or he may become antagonistic. Regardless of the outcome, we believe your father may not be suffering from dementia, which, unfortunately, almost everyone is too quick to use as a diagnosis. Instead, his problem could be depression — an affliction that many say is the most pervasive mental illness facing older Americans but few recognize as the underlying problem. According to the U.S. Department of Health and Human Services, depression involves a dozen fundamental symptoms: (1) ongoing sadness or anxiety; (2) lack of interest in common activities; (3) lack of energy; (4) changed sleeping patterns; (5) changed eating patterns; (6) problems in making decisions or recalling things; (7) being distracted; (8) feeling worthless; (9) having suicidal or death thoughts; (10) being in bad moods; (11) crying regularly; and (12) having chronic aches without physical diagnoses. It may be easy to ignore one or two symptoms when dealing with older Americans. But when you see three or more over a period of several weeks, it may well be that your dad is clinically depressed. Depression can be caused by the side effects of medications, alcohol, physical health issues, genetic personality traits and major lifestyle changes. The good news is, once depression has been diagnosed, it can be treated with a very high success rate. However, like any illness, early intervention and treatment are essential. In conversing with experts in geriatrics, we believe that, even if your father's physician will not talk, you should make sure he or she is aware of the problem. If the physician still won't talk because of privacy issues, we suggest you write him or her and outline your fears. You may also want to try an experienced geriatric-care manager (www.caremanager.org) in an effort to gain your father's cooperation. But at the same time, you should consider frank discussions with him about your concerns for his safety. Obviously, it is best to have an authorization or a durable health-care power of attorney so the physician will be free to discuss these issues with you. However, if you feel you must act because of safety concerns, we suggest contacting a lawyer well-versed in guardianship and conservatorship matters to discuss whether your father is sufficiently incapacitated to justify court intervention. In our view, this should be your last option; but it may be necessary to protect him. Since these types of problems are difficult for family members to face and deal with successfully, it is wise to read up on depression issues — in books or over the Internet — to learn as much as you can about this most prevalent problem. Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here. Archives © 2005, Jan Warner

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