A year ago, Bernard Belisle was in a bad way. Pain throbbed in his legs all day, every day, and he was angry and irritable much of the time.
Then, he enrolled in a novel study on preventing depression in older adults at the University of Pittsburgh Medical Center. Belisle says the move has changed his life.
While this 73-year-old still has pain, he’s less oppressed by it after four months of therapy that taught him new ways to adapt to his osteoarthritis.
“My pain is still there, but I can manage it better and I have a much more positive attitude,” says Belisle, whose emotional response to his chronic pain had put him at risk of becoming depressed. “If I feel I’m becoming upset these days, I stop and go on to something else,” he said. “I take more breaks, and I don’t take on more than I can handle.”
The Pittsburgh investigation is the largest effort to explore whether helping older adults cope with their illnesses can forestall major depression, an underrecognized and undertreated mental health problem that often has a dramatic impact on seniors’ overall health.
“It’s a vicious cycle: Pain can make people feel hopeless and helpless, which leads to depression, which can lead to [fitness] deconditioning, fatigue, worse sleep at night, which then amplifies pain and just perpetuates the cycle,” said Jordan Karp, who is heading up part of the study.
The Centers for Disease Control and Prevention estimates that up to 5 percent of Americans age 65 and older living in community settings have major depression, which can result in acute psychological anguish, disability, suicide and early death. Rates for seniors who are hospitalized or living in nursing homes are much higher, 25 to 40 percent.
“Depression disables everyone, but all too often it kills older people,” said Barry Lebowitz, a professor of psychiatry at the University of California at San Diego. Overall, the risk of an earlier-than-expected death is almost doubled in seniors with major depression, research indicates.
It’s the most common serious mental illness among older adults with traditional Medicare coverage, and it frequently complicates care for the sickest, most-expensive patients — those with three or more chronic illnesses, who account for more than 80 percent of Medicare spending.
A growing body of research suggests that older adults with depression have an almost two-fold greater risk of developing Alzheimer’s disease, a condition poised to affect 9.1 million elderly Americans by 2040 and cost up to $511 billion annually.
“Depression is toxic to the brain,” said Charles Reynolds III, a geriatric psychiatrist heading up the Pittsburgh study that helped Belisle.
He added that additional health risks arise from the hopelessness or apathy that often accompanies this condition; these feelings can lead seniors to forgo taking medications as advised or following other medical recommendations. That’s also a problem with minor depression, which has fewer symptoms and more limited effects but which afflicts two to three times as many older adults. 