Things to Watch: Depression in Older Adults Who Are Blind or Visually Impaired

From the American Foundation for the Blind:

Depression can present a unique challenge as people age and retire. Often, this is a result of unresolved grief and loss and is characterized by despair, discouragement, disinterest, distress, despondency, and disenchantment. Depression is painful and debilitating – and sometimes deadly:

• Many studies report that as many as one-third of all older adults are depressed.
• A major cause of suicide is mental illness, very commonly depression (World Health Organization).
• 20% of all suicides are committed by people aged 65 and older, with white males being particularly vulnerable (Mental Health America).
• Among people with advanced age-related macular degeneration who are age 60 or older, almost one-third have a depressive disorder (Brody et al.).
• Compared to older adults with no sensory impairments, those with impaired vision are twice as likely to report being depressed (Crews and Campbell).

Depression and disability seem to have an interactive relationship; disability causes depression and depression leads to increased disability. Cause and effect is intermingled and it is less about actual visual acuity loss and more about losing functions.

Signs and symptoms of depression lasting two weeks or more include:

• feeling unhappy, sad, tearful
• loneliness, less involved with family and friends
• hopelessness
• concentration problems
• loss of interest and enjoyment in life
• feeling fatigued, irritable
• changes in eating or sleeping patterns
• wishing for death

Identifying Depression

Identifying depression and referring the person to mental health services can help reduce the burden of additional disability and improve the person's quality of life. The Burns Depression Checklist (PDF), developed by David D. Burns, M.D., author of Feeling Good: The New Mood Therapy, is a useful initial screening tool to help identify people who may be at risk for depression and suicide.

Using a screening tool, such as The Burns Depression Checklist, can help the person, along with their family members, friends, and caregivers, to monitor their progress and changes in mood. A screening tool can also give the person permission – and the opportunity – to talk about their feelings; some people will be able to recognize depression in themselves for the first time.

If the older person requires immediate care because of severe depression,

• Call 9-1-1 or go to the nearest Emergency Room if the person expresses suicidal ideas or threats.
• Refer the person to a family doctor or mental health professional for depression.
• Ask permission to inform family members
• Give Suicide Hotline Numbers to the older person and family members, caregivers, and friends: 1-800-SUICIDE or 1-800-273-TALK. If the older person has low vision, use large print and write with a wide-tip marker to record the phone numbers.
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