The Caregiver Role in DepressionIt is often a temptation for caregivers to lecture the depressed elder about getting busy or cheering up. However, such lectures are not only ineffective; they can cause the elder to have more feelings of sadness, inadequacy, and despair. So what approaches are useful?
- Whenever possible provide choices. One component of depression is a quality of “learned helplessness.” As people’s capabilities decline and they must rely more on others for help, the depressed person may become increasingly passive. By providing choices in the environment, the elder begins to relate more actively with the world, decreasing that passivity. For example, “We could either take a walk before lunch or after lunch. Which would you prefer?”
- Provide opportunities for success. When depressed elders withdraw from activities, they have fewer and fewer opportunities to feel successful. By providing simple, useful tasks for the elder, you are also offering an opportunity for a sense of mastery and self-esteem. Better yet, provide a choice of tasks. Cooperative projects such as doing a craft activity together can both increase self-esteem and decrease that sense of isolation.
- Praise positive gains rather than commenting on negative behavior. When someone is deeply depressed, it is often difficult to find signs of progress, but the more you can identify and comment on gains, the more you will encourage remission of symptoms. “You put on your pretty sweater and pin today! You look so nice!” is preferable to “Why the long face today?”
- Take time to communicate, especially about painful issues. Again means increased loss; loss of loved ones, loss of function, loss of meaning. Elders need a chance to grieve these losses in order to move beyond them. The caregiver should provide a supportive, listening ear whenever possible, without admonitions to “cheer up” or “look on the bright side.”
- If the elder is very slowed down by the depression, gently introduce activity in small doses. This should be done gradually so it doesn’t become overwhelming. A walk around the block, participation in an exercise class, and moving to music can all encourage a more positive mood.
- Provide opportunities for socialization. Loneliness is an important trigger for depression. If the elder can participate in a day program or get together with friends on a regular basis, then that sense of isolation will diminish greatly. Socialization should also include human touch. Many elders are starved for a hug, a hand squeeze, an affectionate kiss. “Contact Adult Home Care” is essential to emotional health.
- Encourage reminiscence. Although younger people are in the process of making memories, most seniors face the task of looking back at their life and finding a sense of meaning. A caregiver can assist in this process by looking through photo albums with him or her, requesting information and historical events in the elder’s lifetime, or assisting the elder in writing a life history. With these activities comes a positive sense of achievement and worth.
- Maybe most importantly, find ways to laugh together. No activity provides more positive changes in chemistry than laughter! Investigate what amuses the elder and, whenever possible, tickle that particular funny bone. That may mean renting movies by a favorite comedian, reading aloud from humorous books, or finding silliness in daily activities.
Melva Sherwood, RN