A stiff upper lip could be masking depression in over-55s, GPs told

Kat Lay, Health Correspondent

The Times

 Gerry Gajadharsingh writes:

“There is no doubt in my mind, that many patients presenting with physical symptoms have anxiety/depression as part of the cause if not the main cause of their symptoms.

 There are many approaches that can help if a patient does not want or need to go down the prescription medication route. The problem is that many patients simply do not believe that underlying psychological issues can cause their physical symptoms.

 Many will have seen numerous specialists, undergone numerous medical investigations to determine if there is an obvious medical answer, sadly quite often, no obvious cause can be found.

Many older patients (compared to younger ones) still have a reluctance to accept that “stress/anxiety” or “depression” can cause their problems, which complicates matters further, often making symptoms chronic and even more difficult to sort out. A quarter of those polled said that they thought it was more difficult for older people to discuss mental health problems than the younger generations. They said that anxiety and depression had not been recognised as health conditions when they grew up, but were seen as weaknesses.

Many people ask what it is that I actually do? My answer is that I often help people change their current beliefs on health.

 If you have an ongoing problem that is not being sorted out and the tests are coming back as negative or interventions are not working, something needs to change, probably with the beliefs of the patient or the clinicians who are trying to help.

 I find that only when the patient has a better understanding (chronology of events leading up to the development of the symptoms), how body and mind systems work (physiologically), how symptoms are developed, how lifestyle impacts on the ongoing symptoms (negatively and positively), offering treatment intervention that makes sense to the patient, can they really start to have an impact on their health problem.”

 

GPs have been given guidance on spotting mental illness in people used to having a “stiff upper lip”, as research suggests that almost half of those aged over 55 have suffered depression.

Annoying behaviour, gallows humour or not enjoying visits from grandchildren could all be signs of mental ill health. A Yougov poll for Age UK found that 7.7 million people aged 55 and over had experienced depression and 7.3 million had suffered from anxiety.

Alistair Burns, national clinical director for dementia at NHS England, said: “Older people mustn’t miss out on help because of a ‘stiff upper lip’ approach to dealing with problems, or because they aren’t offered or don’t know where to go for help.”

The poll found that ill health, the death of loved ones and financial worries were the most common triggers for depression and anxiety in older people. More than a third said that they did not know where to go for help and support.

The guidelines state that depression is the most common but also the most reversible mental illness in old age. Doctors should just listen to their patients, the document says, and monitor their own response to patients, adding: “A person who consistently annoys you could well be depressed or have a personality disorder, and a person who perplexes you might be psychotic.”

The guidance suggests gauging the severity of depression by asking if people enjoy visits from their grandchildren. “People who don’t tend to be very depressed,” it states. Doctors are also advised that older people with depression may report physical symptoms such as dizziness or constipation rather than emotional symptoms.

GPs should also be alert to apparent mental illness being caused by physical illness, it says, noting that people who become paranoid for the first time may have had silent heart attacks, and that severe depression can be the presenting symptom of pancreatic cancer.

A quarter of those polled said that they thought it was more difficult for older people to discuss mental health problems than the younger generations. They said that anxiety and depression had not been recognised as health conditions when they grew up, but were seen as weaknesses.

Caroline Abrahams, director of Age UK, said: “In recent years there’s been nothing short of a cultural revolution in our willingness to be open about mental ill health, which is an essential pre-condition to people getting help, but it’s one that may well have left many older people behind.”

 

2017-10-07T11:31:40+00:00