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Today's Rural Caregiving: Managing Mood
Without Medication

Gemma Reilly is a 72 year-old woman who, with her 74 year-old husband Bob, divided her time between visiting four adult children and 10 grandchildren, worked in the family garden, and maintained a busy schedule of church activities. After Bob’s death three years ago, Gemma tried to cope, but the recent death of her childhood best friend seemed to be the final blow. She began to lose interest in her previous activities, missing church services, letting the garden go to seed and attending fewer and fewer family functions. She also has become reluctant to take her arthritis and blood pressure medications, saying: “I have to expect some aches and pains in old age”. More recently, she has begun wearing the same dress and sweater every day. Gemma’s oldest daughter tells the other brothers and sister that she is afraid “Momma is getting senile”. 

Recognizing and distinguishing depression from other illnesses in an elder can be challenging because elders and their family members often attribute any new symptoms to the aging process. While some depressive symptoms in the elderly are similar to those in younger adults, others may remain unnoted because they are often mistaken for age-related decline. Apathy and withdrawal from the world, changes in grooming and hygiene, changes in sleep, appetite, elimination and activity patterns, negative mood, slower thinking and responding, and increased complaints of physical ailments are common signs of depression in elders. 

When depression is suspected, the physician or health professional can more easily sort out suspected medication problems when provided with: (1) an accurate list of the elder’s daily medication regimen, including OTC medications (over-the-counter cold medications that include antihistamines and/or alcohol can be major factors in an elder’s level of alertness); (2) information on the elder’s current nutrition, exercise and sleep patterns; and (3) observations and concerns of the family/caregiver (Hint: take a written diary of key symptoms and the date and time they occurred, to aid in sorting out possible medication side effects). 

Medication and Mood 

Non-compliance with a medication regimen should also be suspected if an elder’s symptoms change over time. Since older adults metabolize drugs more slowly than younger adults, their medication programs are often more difficult to monitor and manage. It’s important for family caregivers to understand the elder’s medications and their side effects. Drugs currently used to treat memory loss can have troublesome gastrointestinal side effects including nausea, vomiting and diarrhea; antidepressants can cause side effects ranging from dry mouth and constipation to lowered blood pressure and mental confusion. Some elders conclude these types of side effects and/or the costs of some drugs are worse than the symptoms, and often discontinue those medications without consulting their family or health care provider.   

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