Sleep Disruption and Depression

Sleep Disruption and Depression

It is accepted that sleep disruption is common in the elderly.  Many see sleep problems as inevitable as we age.  Sleep patterns do change as we age but that does not mean that there is nothing wrong.   Studies have shown that sleep disturbances contribute to morbidity and mortality. “Despite the almost standard management of sleep disturbance, insomnia is not always in itself a primary diagnosis:  it may be a cause, a symptom or an epiphenomenon of illness” (Livingston, Blizard and Mann, 1993).

There are several studies that show that there is a relationship with sleep disruption and depression.  Sleep Disturbance studies frequently indicate underlying depression and this is reinforced if mental health issues are present.  Studies also point to sleep disturbance being a predictor of future depression. “Insomnia is the most frequent sleep disturbance in depressed patients, and such sleep impairment is viewed as a symptomatic dimension of current depression.  Sleep disturbance often lingers and its persistence can represent a residual phase of a major mood disorder.  Alternatively, emergence of disturbed sleep may serve as a precursor or prodrome of depression that occurs later in life” (Cho, et. al., 2008).

People who have difficulty sleeping have less energy to carry out their daily activities. They are more irritable and cannot focus as well.  Frequently, people are frustrated they either cannot get to sleep or stay asleep.  “Even small levels of sleep deprivation over time can chip away at your happiness. You might see that you’re less enthusiastic, more irritable, or even have some of the symptoms of clinical depression, such as feeling persistently sad or empty.  All these alterations to your mood can affect not only your individual mental health, but your relationships and family dynamics as well” (National Sleep Foundation, 2018).

“The link between sleep and mood has been seen over and over by researchers and doctors. For example, people with insomnia have greater levels of depression and anxiety than those who sleep normally. They are 10 times as likely to have clinical depression” (National Sleep Foundation, 2018).

Sleep deprivation has been shown that it does something to our brains which make us more susceptible to depression. “Even though scientists still don’t fully understand what causes depression or sleep disorders, they have found neurochemical links between the two. Corticotropin-releasing factor (CRF) is a neuropeptide and is found in elevated levels in people with depression and anxiety disorders. It also is found in high levels in many insomniacs. The hypothalamic-pituitary-adrenal (HPA) axis is stimulated perhaps excessively in both depressed people and insomniacs” (Tuck, 2017).

“The more a person experiences insomnia and the more frequently they wake at night as a result, the higher the chances of developing depression” (National Sleep Foundation, 2018).  “It is easy to think of reasons why insomnia might lead to depression: it is extremely frustrating and causes a person to lie awake at night and ruminate on unpleasant thoughts. Then, the excessive daytime sleepiness the following day reduces their general quality of life” (Tuck, 2017).  “Sleep deprivation makes it difficult for the brain cells to communicate effectively, which, in turn, can lead to temporary mental lapses that affect memory and visual perception” (Mathewson, 2017) making it more difficult to navigate through a life where someone is already aware of changes in their physical health and their ability to care for themselves independently.

Sleep disturbances can be related to medical or psychological issues.  Whether it is a medical or psychological issue, leaving sleep disturbances unattended, can lead to unintended medical and/or psychological problems.  There are some sleep tips that are important for all seniors to follow in order to get good quality sleep.  Roepke and Ancoli recommend not spending too much time in bed, maintaining consistent sleep and wake times, getting out of bed if unable to fall asleep, restricting naps to 30 minutes in early afternoon, regular exercise, spending more time outside, without sunglasses, especially late in the day, increasing overall light exposure, avoiding caffeine, tobacco and alcohol after lunch and limiting liquids in the evening.

If sleep difficulties continue it is important that this be explored with your physician to determine the cause of the disruption and address those issues and thus preventing additional problems developing due to ongoing sleep disturbance.

Cho, H. J., Lavertsky, H., Omstead, R., Levin, M. J., Oxman, M. N., Irwin, M. R. (2008). Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study.  Retrieved from:  https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.2008.07121882

Livingston, G., Blizard, B., Mann, A. 1993.  Does sleep disturbance predict depression in elderly people?  A study in inner London.  Retrieved from:  https://bjgp.org/content/bjgp/43/376/445.full.pdf

Mathewson, S. (2017). Here’s What Happens in the Brain When You Don’t Get Enough Sleep.  Retrieved from: https://www.livescience.com/60875-sleep-deprivation-sluggish-brain-cells.html

National Sleep Foundation. 2018. The Complex Relationship Between Sleep, Depression & Anxiety.  Retrieved  from: https://www.sleepfoundation.org/excessivesleepiness/content/the-complex-relationship-between-sleep-depression-anxiety

Roepke, S. K. and Ancoli-Israel, S. (2010). Sleep Disorders in the Elderly. Retrieved from: http://pdfs.semanticscholar.org/cf97/d5a166d051ca684f84a21c45ddd543c8f1c0.pdf

Tuck Advancing Better Sleep. (2017).  Depression and Sleep Disorders.  Retrieved from: https://www.tuck.com/depression-and-sleep/

Sleeping and Executive Function

 

Taking care of ourselves long term is so important to maintaining our independence.  As we age our evening of restful sleep may be interrupted. “Adjustments to sleep quantity and quality can very difficult” (Roepke & Ancoli-Israel, 2010). “It has been estimated that as many as 50% of older adults complain about difficulty initiating or maintaining sleep” (Crowley, 2011).

Executive functioning or EF, is important to our independence.  Executive functioning impacts a person’s ability to carry out activities of daily living such as walking, grooming and other activities needed to care for self as well as more difficult activities such as planning our day, keeping track of appointments, planning a meal and cooking.    “Adequate executive functioning is necessary for selecting and monitoring actions that facilitate the fulfillment of chosen goals and supports older adults to perform complex activities in everyday life” (Johnson, Lui, Yaffe, 2007).  “Sleep continuity is associated with cognitive performance, especially for executive functions” (Wickens, et. al. 2014).  In a group of seniors, “higher sleep continuity was associated with better inhibitory control, memory recall, and verbal fluency. Very short and very long total sleep time was associated with poorer working memory and verbal fluency” (Wickens, et. al., 2014).

Many seniors just feel that they have to live with problems sleeping and don’t address it.  What many do not realize is that the problem is addressable as well as the problems that are encountered if sleep issues remain untreated.   “Poor sleep results in increased risk of significant morbidity and mortality” (Crowley, 2011).

“Given that changes in sleep quality and quantity in later life have implications for quality of life and level of functioning, it is imperative to distinguish the normal age-related sleep changes from those originating from pathological processes” (Crowley, 2011).

“There are several treatments for the various sleep disturbances that older adults experience. Careful assessment of sleep such as a comprehensive sleep history and, when appropriate, studies should be conducted in order to be certain of the nature of the sleep complaint.  In addition, evaluation of the person’s medical history, psychiatric history, and lifestyle and environmental factors should be carefully considered when choosing treatment modalities.  Treatment should target both the sleep problem and any co-morbidities thus optimizing the chance for improvement in quality of life and functioning in the older adult” (Roepke & Ancoli-Israel, 2010).  The senior should consider investing time to meet with their physician to better understand the source of their sleep disturbance.  In some cases, the impact of increased daily stress, depression or other medical conditions can be diagnosed and a treatment plan created to address the problem.

There are some sleep tips that are important for all seniors to follow in order to get good quality sleep. Roepke and Ancoli recommend not spending too much time in bed, maintaining consistent sleep and wake times, getting out of bed if unable to fall asleep, restricting naps to 30 minutes in early afternoon, regular exercise, spending more time outside, without sunglasses, especially late in the day, increasing overall light exposure, avoiding caffeine, tobacco and alcohol after lunch and limiting liquids in the evening.

Crowley, K. (2011). Sleep and Sleep Disorders in Older Adults. Neuropsychological Review 21:41-53. Neuropsychology Review.  Retrieved from https://link.springer.com/article/10.1007/s11065-010-9154-6#citeas

Johnson, J. K., Lui, L. Y., Yaffe, K., (2007).  Executive Function, more than global cognition, predicts functional decline and mortality in elderly women.  Retrived from https://www.ncbi.nlm.nih.gov/pubmed/17921427/#

Roepke, S. K. and Ancoli-Israel, S. (2010).  Sleep Disorders in the Elderly.  Retrieved from http://pdfs.semanticscholar.org/cf97/d5a166d051ca684f84a21c45ddd543c8f1c0.pdf

Wickens, K. A., Woo, S. G., Kirk, A. R., Erickson, K. I., Wheeler, M. E. (2014). The role of sleep continuity and total sleep time in executive function across the adult lifespan.  Retrieved from https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25244484

Making Choices to Care for Self

 

Making choices to (prevent falling) care for self

Would you make changes in your life and do something if you thought it would improve your independence and ultimately, your safety?  What if you could reduce the risk of falls by making a lifestyle change? Would you make that change?

A main activity that can cause a person to lose independence as well as leading to other decline is walking.  When walking is impaired, the incidence of falls increases which can cause an increased risk of broken bones, leading to other complications such as pneumonia in the older person.  In addition, it can become scary for the person to walk and as a result they become less mobile and thus, more dependent on others.

One thing we can make a choice about is our lifestyle.  I am focusing on our lifestyle of exercise to maintain cognitive health.   As we age our cognitive (thinking) abilities change and can make independence more of a challenge.  “There are indications that the decline in cognitive functioning with the aging process is one of the determinants of walking difficulty that is often observed in older persons” (Ble, et. al., 2005).

One of the cognitive abilities we lose as we age is called executive functioning. Executive function helps us plan and perform an activity without being distracted.  It also helps us complete tasks that require doing more than one thing at a time, such as a cognitive (thinking) task and a physical task together.  “Executive functions (EFs) make possible mentally playing with ideas; taking the time to think before acting; meeting novel, unanticipated challenges; resisting temptations; and staying focused “(Diamond, 2012).

“Recent studies have established the fact that attention demanding tasks change the walking pattern in all subjects, to some degree, and that alterations in executive function, in particular attention, are associated with gait disturbances. There is ample evidence demonstrating a relationship between these two seemingly disparate domains including numerous investigations which have documented changes in the gait pattern in response to dual tasking” (Yogev, Hausdorff and Giladi, 2008).

You wouldn’t think so, but walking requires attention and planning.  When walking, we encounter variations in the surface we are walking on such as carpet versus other surfaces.  When outside, those variations increase with curbs you need to step up on, changing surfaces from cement to dirt to stones and changing levels with the elevated edges of sidewalks that have erosion and items dropped on the ground.  All of these changes encountered need you to take the time to think, meeting unanticipated challenges and stay focused.  “Among healthy older adults, individuals with poorer EF are more prone to falls. Higher-level cognitive functions such as those regulated by the frontal lobes are apparently needed for safe everyday navigation that demands multitasking” (Herman, et. al, 2010). “Impaired executive function may result in reduced ability to quickly plan effective and efficient motor strategies that are required in the execution of complex attention-demanding physical tasks, such as climbing over an obstacle, avoiding domestic or street hazards, and avoiding injurious falls” (Ble, et. al, 2005).

“There are many activities that have been used to help improve executive functioning in children as well as adults and the aging population.  There are increasingly more studies being conducted with the aging population to postpone the natural decline of executive functioning that comes along with aging.  It has been shown that executive functioning impacts gait patterns and those with poorer executive functioning are at higher risk for falls and increased death rates due to falls. Interventions that prevent decline of or improve executive function may also improve the performance of complex lower extremity motor tasks in older adults without dementia” (Ble, et.al., 2005).

Liu-Ambrose et al found “twelve months of once-weekly or twice- weekly resistance training benefited the executive cognitive function of selective attention and conflict resolution among senior women”.   “Our finding adds weight to previous observations of a strong relationship between gait speed and cognitive function. The implication for clinicians is that improved gait speed is a predictor of substantial reduction in mortality”.  ( Liu-Ambrose, et. al.).

“Even after multivariate adjustment, neuropsychological tests that were executive in nature were positively associated with physical activity participation in a cohort of older community dwelling adults” (Eggermont, et. al., 2009).

Before beginning any new physical activity, which includes speed walking and resistance training a physician needs to be consulted and give the okay to proceed with the intended physical activity.

Physical activities are not the only activities to engage in to improve executive functioning.  According to Molly Minchew other activities could include: dividing tasks into smaller segments, managing time (estimate duration an activity will take to complete before starting and allowing ample time to complete the task’s steps), learn something new, participate in personalized brain training, play sports, make lists and play video games.  Other activities that are important to maintaining executive functioning is to avoid loneliness and participate in Mindfulness activities.

Ble, A., Volpato, S., Zuliani, G., Guralnik, J. M., Bandinelli, S., Lauretani, F., Bartali, B., Maraldi, C., Fellin, R., Ferrucci, L. 2005. Executive Function Correlates with Walking Speed in Older Persons: The InCHIANTI Study.  Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1532-5415.2005.53157.x

Diamond, A. 2012. Executive Functions.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/

Eggermont, L. H. P, Millberg, W. P., Lipsitz, L. A., Scherder, E. J., Levielle, S. G., 2009. Physical Activity and Executive Function in Aging:  The MOBILIZE Boston Study.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286835/

Herman, T., Mirelman, A., Giladi, N., Schweiger, A., Hausdorff, J. M. 2010. Executive Control Deficits as a Prodrome to Falls in Healthy Older Adults: A Prospective Study Linking Thinking, Walking and Falls. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949331/

Liu-Ambrose, T., Nagamatsu, L. S., Graf, P., Beattie, B. L., Ashe, M. C., Handy, T. C. 2010. Resistance Training and Executive Functions A 12-Month Randomized Controlled Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448565/

Minchew, M. 2016. 10 Simple Exercises to Improve Executive Function at Home. Retrieved from https://blog.cognifit.com/exercises-to-improve-executive-function/

Yogev, G., Hausdorff, J. M., Giladi, N. 2008.  The Role of Executive Function and Attention in Gait.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2535903/

 

 

 

 

 

 

Depression can be Disabling

Depression is a disabling condition that can impact every part of your life:  physically, mentally, socially and financially.  Anyone can be affected by depression. Depression clouds thinking and the way things are perceived whether it is through feeling unwanted, experiencing pain more or feeling unable to physically engage in activities.

“Clinical depression in the elderly is common. That doesn’t mean it’s normal. Late-life depression affects about 6 million Americans ages 65 and older. However, only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. (Web MD, 2016).  Many of the life events that seniors go through can contribute to the development of depression.  “Five factors that are significant risk factors for depression are: bereavement, sleep disturbance, disability, prior depression and female gender” (Cole & Dendukuri, 2003).

Depression has also been associated with increased risk for other diseases.  “Studies of depressed adults with depressive symptoms, with or without depressive disorder, have poorer functioning comparable, to or worse than that of people with chronic medical conditions such as heart and lung disease, arthritis, hypertension, and diabetes.  In addition to poor functioning, depression increases the perception of poor health, the utilization of medical services and health care costs”. (Cole & Dendukuri, 2003).

Often times we think of depression of losing interest in things we used to enjoy, feeling sad, feeling easily irritated, not wanting to be around others, or feelings of hopelessness. Other symptoms include frequent crying and changes in appetite, maybe not wanting to eat or eating too much.   With seniors, depression can be exhibited through different symptoms and these symptoms are often missed as something else by the primary care physician.  “Depression in the elderly is frequently confused with the effects of multiple illnesses and the medicines used to treat them” (Web MD, 2016).

Signs and symptoms of depression as stated by Robinson, Smith and Segal in Depression in Older Adults are:

  • Sadness or feelings of despair
  • Unexplained or aggravated aches and pains
  • Loss of interest in socializing or hobbies
  • Weight loss or loss of appetite
  • Feelings of hopelessness or helplessness
  • Lack of motivation and energy
  • Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
  • Loss of self-worth (worries about being a burden, feelings of worthlessness or self-loathing)
  • Slowed movement or speech
  • Increased use of alcohol or other drugs
  • Fixation on death; thoughts of suicide
  • Memory problems, slowed movement and speech
  • Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene).

We can’t always control what happens in our life, like the death of a loved one, a disabling condition or unanticipated medical problems that take away some of our independence or forces us to accept that there are things we can no longer participate in.  We can control how we allow it to affect our life.

Steps can be taken to deal with the depression and those include exploring and finding new and different activities that may be interesting.  This may mean looking at different activities for the current level of functioning if loss of function may be contributing to the depression. It is also important to get and stay involved with others, become involved in a physical activity, maintain a balanced diet and a regular sleep schedule.

“Depression treatment is just as effective for older adults as it is for younger people.  However, since depression in the elderly is often triggered or compounded by a difficult life situation or challenge, any treatment plan should address that issue.  If loneliness is at the root of the depression, for example, medication alone is not going to cure the problem.  Also, any medical issues complicating the depression must be addressed” (Robinson, Smith & Segal, 2018).

I welcome your thoughts on this topic!

Cole, M. G. and Dendukuri, N. (2003). Risk Factors for Depression Among Elderly Community Subjects:  A Systematic Review and Meta-Analysis.  American Journal of Psychiatry 160:6. Retrieved from https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.160.6.1147

Robinson, L., Smith, M., Segal, J., (2018). Depression in Older Adults:  Recognizing the Signs of Elderly Depression and Getting Treatment.  Retrieved from https://www.helpguide.org/articles/depression/depression-in-older-adults.htm

WebMD. 2016. Depression in the Elderly. Retrieved from https://www.webmd.com/depression/guide/depression-elderly#1-2

 

 

 

 

 

Should We Question our Thoughts?

We all have thoughts, positive and negative that occur throughout each and every day. Those thoughts can set our mood.  They affect how we think about ourselves.  Happy thoughts bring about pleasant, comfortable feelings.  Negative thoughts bring about feelings of unhappiness. “Thoughts help determine which mood we experience in a given situation.  Once a mood is present, we often begin thinking additional thoughts that support and strengthen the mood” (Greenberger & Padesky, 2016).

“One of our biggest challenges is that we often take those initial brain-based thoughts, urges, emotional sensations, impulses and desires at face value and assume they must be true” (Gladding, 2011). When in fact, those thoughts may not be, and likely, are not true. This tells us to question our thoughts! But do we know how to take the next step?

Most seniors get down at various times, and these are not predictable.   These moods may become more prevalent as some seniors age. They might think that their family doesn’t care about them, that their friends don’t care about them, or that their medical problems will keep them from enjoying their life. It can be very easy to fall into what is called negative thinking and think the worst. In reality it may mean that their family and friends are very busy or dealing with their own stresses.  It may mean that their medical problems seem overwhelming.  And yet, once they adjust to the changes they can move to make changes in their life and begin enjoying their days again.

Thinking “I can’t make friends”, or maybe “I’m no good for anyone”, or “no one likes me” are other examples of negative thinking which can lead to isolating, reinforcing those thoughts of being unable to make friends and being unlikable. “It is distressing when unwanted negative thoughts intrude on one’s consciousness.  Whether they take the form of doubts about self-worth, concerns about the future or misgivings about the past, such thoughts can undermine one’s sense of well-being and promote a negative mood” (Wenzlaff, Wegner & Roper, 1988).

It is important to remember that thoughts are not necessarily true.  Realize you have the tools to challenge your thoughts. Queston, am I viewing events and situations accurately?  Amy Morin, a psychotherapist suggests you: “Look for evidence to the contrary. Take note of any times when your beliefs weren’t reinforced. Acknowledging exceptions to the rule will remind you that your belief isn’t always true.  As well as:  Challenge your beliefs. Perform behavioral experiments that test how true your beliefs really are. If you think you’re not good enough, do something that helps you to feel worthy. If you’ve labeled yourself too wimpy to step outside of your comfort zone, force yourself to do something that feels a little uncomfortable” (Morin, 2016).

Another tool is sitting quietly and being in the present and not focusing on the past or the future.  “Activities like meditation, yoga, and tai chi help you step back from the constant thoughts that run through your mind. That turns out to be a powerful way to change your outlook on life and gain more control over the ups and downs. Mindfulness works best when you set aside time to practice each day” (WebMD, 2017).

Seniors can take control of their thoughts, think differently and make a positive out of a negative thought and move on to a better view of their life ahead.

When people are aware of their thoughts and feelings about an event they can work at modifying how they look at that event.  This can result in a change of feelings.  Imagine a friend cancelling a lunch date with you.  You can look at it and think “he’s avoiding me” and you may feel a negative feeling such as anger, sadness or feeling unwanted.  Suppose you take that same situation and think “I’m sorry he can’t go but we can try again next week.”  You may feel optimistic.  See how the thought would dictate the feeling being negative or positive.  “When people learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and their behavior” (Beck, 2011).

Some seniors may find it difficult to dispel these negative thoughts.  For someone who is depressed, it is more difficult to quell these negative thoughts. They may have difficulty finding evidence to the contrary or have difficulty challenging their thoughts.  Reaching out to a physician or health care professional may be the best step forward to overcome advanced negative thinking and to receive help.

Beck, J. S. (2011) Cognitive Behavior Therapy: Basics and Beyond. The Guilford Press. New York, N. Y. www.guilford.com. P.3.

Gladding, MD., R. (2011) Don’t Believe Everything You Think or Feel.  Psychology Today.  Retrieved from https://www.psychologytoday.com/blog/use-your-mind-change-your-brain/201106/don-t-believe-everything-you-think-or-feel

Greenberger, D and Padesky, C. A. (2016) Mind over Mood:  Change How You Feel by Changing the Way You Think. The Guilford Press. New York, NY. www.guilford.com. P. 17.

Morin, A. (2016) This Is How Your Thoughts Become Your Reality.  Retrieved from https://www.forbes.com/sites/amymorin/2016/06/15/this-is-how-your-thoughts-become-your-reality/#a83a803528a0

Web MD. (2017) Focus on Your Inner Self to Boost Your Mood.  Retrieved from https://www.webmd.com/depression/depression-healing-practices#1

Wenzlaff, R. M., Wegner, D. M., and Roper, D. W. (1988) Depression and Mental Control: The Resurgence of Unwanted Negative Thoughts. Journal of Personality and Social Psychology, Vol 55, No. 6,882-892.  http://psycnet.apa.org/doi/10.1037/0022-3514.55.6.882

Social Withdrawal, Loneliness, Depression and Rumination

There are many reasons we may find ourselves alone.  We may have moved, we may have lost our loved one through death or a move to a new, unfamiliar community.  As we age it is more difficult to meet others and as a result may find ourselves more alone and isolated and many lapse into what is called rumination.

Ruminating means constantly thinking about an event or situation that was upsetting and getting so caught up in those thoughts that little else is thought about.

All of us ruminate from time to time and it can be helpful.  Most times it can be destructive to us.  It is important to know and be aware of the difference.  Sometimes, ruminating can help us come up with a solution to our problem and gain new insight.  We might decide that joining a book club may help with the isolation and seek that solution. That is healthy rumination.  At other times, ruminating can go on and on and we can get stuck in a cycle and cannot we get out and as a result become depressed.  “Unhelpful rumination can trap us into constantly rehashing, and reliving an upsetting situation.  It can lead to anxiety and depression, substance abuse and eating disorders.  Rumination can impact how negatively we see the rest of the world, it can impair our problem solving skills, increase stress and can sabotage relationships” (Winch, 2013).

“A major component of depression is rumination, which involves dwelling and brooding about themes like loss and failure that cause you to feel worse about yourself” (Soong, 2010).  In addition to  isolation and depression, rumination has been linked to anxiety and substance abuse.  “Rumination is a destructive habit that causes people to remain fixated on negative experiences and impairs problem solving” (Vanhalst, Luyckx, Raes & Goossens, 2012).

“Rumination can cause a person to interpret neutral events in a negative fashion. For example, when you’re buying groceries, you may notice that the checkout person smiles at the person in front of you but doesn’t smile at you, so you perceive it as a slight” (Soong, 2010).  This person may feel emotionally attacked by the slight and allows this event to play over and over in their head.  As a result, they may change grocery stores, may keep their eyes averted from others or may isolate themselves and stop shopping. “There appears to be a possible cyclic relationship between self-focused rumination and social withdrawal. As individuals ruminate, they tend to isolate themselves socially. This social isolation increases interpersonal distress and decreases interpersonal functioning skills because of the lack of social interaction“ (Paivandy, Bullock, Reardon & Kelly, 2008).

You may hear “get out of your head” from loved ones and this is important advice.  People who follow this can lead a more positive and healthy life.  Take time to celebrate those that take an interest in your well-being! It is important to be aware when you have solved an issue that you move on rather than keep going over it again and again.  It is also necessary to notice when you just churn the negative thoughts over and over in your head and don’t arrive at any solution.  This is a time to move on to other things.

One of the best ways to stop ruminating is to seek out friends and situations to engage in activities with friends. “People who receive more support are more likely to have their negative beliefs challenged and experience more confidence in confronting their feelings because they do not feel alone doing so” (van der Houwen et. al., 2010).

Set a goal to stop or reduce ruminating.  Take control and distract yourself through other means such as playing a game, reading a book, going for a walk and paying attention to what is occurring on your walk.

Paivandy, S., Bullock, E. E., Reardon, R. C., Kelly, F. D. (2008)The Effects of Decision-Making Style and Cognitive Thought Patterns on Negative Career Thoughts. Journal of Career Assessment. Vol. 16, Number 4.  Retrieved from  http://journals.sagepub.com/doi/abs/10.1177/106907270831890

Soong, Jennifer. (2010). WebMD.  6 Common Depression Traps to Avoid. Expert advice on how to sidestep pitfalls that often accompany depression.  Retrieved from https://www.webmd.com/depression/features/depression-traps-and-pitfalls#1

Van der Houwen, K., Stroebe, M., Schut, H., Stroebe, W., and van den Bout, J. (2010). Mediating processes in bereavement:  The role of rumination, threatening grief interpretations, and deliberate grief avoidance.  Social Science and Medicine71 (2010) 1669-1676.  Retrieved from https://www.sciencedirect.com/science/article/pii/S0277953610005848

Vanhalst, J., Luyckx, K., Raes, F., Goossens, L. (2010).  Loneliness and Depressive Symptoms: The Mediating and Moderating Role of Uncontrollable Ruminative Thoughts.  The Journal of Psychology, 2012, 146 (1-2)259-276.  Retrieved from http://www.tandfonline.com/doi/full/10.1080/00223980.2011.555433?scroll=top&needAccess=true&

Winch, Guy. (2013).  The Seven Hidden Dangers of Brooding and Ruminating.  Retrieved from https://www.psychologytoday.com/blog/the-squeaky-wheel/201306/the-seven-hidden-dangers-brooding-and-ruminating

 

Emotional loneliness is not the same for everyone

Do you know someone who you sense is lonely or maybe they have expressed to you that they are feeling lonely?  Perhaps you are the one feeling lonely.  Each person is unique and each will need a unique solution to the loneliness.

All relationships serve a purpose.  That purpose may be one that gives comfort and is a confidant.  It may be a relationship where one feels cared for and taken care of.  There are also relationships where the person feels needed.  Some relationships encompass all of these.

When a close and special relationship is lost, most people, first and foremost, want that relationship back. They feel an empty void.  They may not know how to fill that void even after a period of time.  But the person who has lost the relationship cannot be told that all they have to do is to go out and meet people.  If a person is lonely because they lost their spouse and they are told to be content with being with their neighbors, this will most likely not solve their loneliness.  If a person misses their family, telling them to go meet friends at the local senior center will not help that person fill the void of the absent family.  Someone with unrealistic expectations for others will not be satisfied with an occasional visit from their children.  Someone suffering from depression or anxiety will not be able to “just go meet people”.

“The purpose served by one type of relationship cannot simply be replaced by another type of relationship” (Fokkema & Knipscheer, 2011).  Just like there are different kinds of relationships and the purposes they serve, there are also different ways to combat the loneliness.  First, explore why the loneliness is present and the causes behind the loneliness.  Is the loneliness because a loss has been experienced?  Is the loneliness because family is missed?  Is the loneliness present because the person wants more friends?  Is the loneliness due to a mental or physical disability?  Is the loneliness the result of high expectations for friends and relationships?

If you don’t gain an understanding of what is contributing to the emotional loneliness, then efforts to provide the person with resources for the loneliness can be ill-directed.  Suggestions may be offered out of care and love but may not be received openly.  Suggestions that are well-meaning will most likely be ignored because the real cause is not addressed and frustration builds.

Sit, talk and try to understand the person’s loneliness from their perspective.  Exploring with the person their feelings of loss, who they miss and how they think they can deal with the loneliness can be helpful to get an understanding of what the person needs. Ask open ended questions about the person’s thoughts and feelings about the loss.  Try to refrain from giving advice on how to get the person to feel less lonely.  Listen to their responses.  After understanding the root cause of someone’s loneliness, solutions can be explored and the loneliness reduced and/or resolved.  It is after you understand what the person needs is when you can make appropriate suggestions that will be more easily accepted because it will target the real need for the senior’s loneliness.

Once you have identified what is causing the loneliness, a plan can be developed.  If the person is grieving the loss of a spouse, a support group or therapy may be indicated.  They may need to work on seeing themselves as an individual and doing things on their own.  If the person is lacking social contacts, a group activity may be recommended.  Maybe a volunteer position would help.  Therapy may be helpful if the person has unrealistic expectations of a relationship (maybe wants to have their children visit every day) and needs to develop a more realistic expectation.  Does the person have anxiety, depression or are they lacking good social skills?  Anxiety and depression will impact a person’s motivation and ability to go out and meet others.  For more information on this topic I am including a link to Mayo Clinic website https://www.mayoclinic.org/diseases-conditions.  “A person’s social skills may make it difficult to develop or maintain relationships” (Peplau and Perlman, 1982). Getting this person coaching in how to build and keep relationships might be achieved through therapy or a social group.   A person’s physical and mental state may make it difficult to get out of the house and using the internet to form relationships may be a good solution to reduce their loneliness.  With the person’s need in mind, look for resources that match or meet the need expressed and as a result, the loneliness can be reduced and the senior cooperating because their needs are being heard and met.

My goal is to help you and those you care about better understand the aging process and resources available to help.  If I can be of further assistance in providing more information to you please share your thoughts by responding to this blog.  A Journey Through Aging https://aloneathomenet.wordpress.com

Fokkemaa, T. ; Knipscheerb, K.  Escape loneliness by going digital: A quantitative and qualitative evaluation of a Dutch experiment in using ECT to overcome loneliness among older adults a Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague Department of Social Cultural Studies, Vrije Universiteit Amsterdam, The Netherlands.  Aging and Mental Health.  Retrieved from

http://dare.ubvu.vu.nl/bitstream/handle/1871/39467/202328.pdf?sequence=1

Peplau, L. A., Perlman, D. (1982) Loneliness: A sourcebook of current theory, research and therapy. John Wiley & Sons.  Retrieved from

http://www.peplaulab.ucla.edu/Peplau_Lab/Publications_files/Peplau_perlman_82.pdf