Depression and ageing: not inevitable

Depression is not uncommon in old age, and is sometimes brought about as a complication of other aspects of ill health. If ignored, this depression can cause further deterioration in both mental and physical well-being. Many old people take a negative view of this period in their lives, seeing it as a time of losses rather than gains: the death of friends, the loss of employment through retirement, the loss of financial security and the loss of independence. Widowhood is an important further aspect. Although a proportion of people learn to live with the loss of a lifelong partner, for many the separation is never fully accepted. More women are affected than men, because men tend to die earlier. Few widows remarry, partly because of the lack of suitable partners; partly because widows often avoid the social gatherings where mixed single company is to be found; and partly because the prospect of remarrying is often too painful to deal with. Even if the loss of a husband or wife is overcome, there will often be a residue of loneliness.

Apart from bereavement the desire for social contact may decline for other reasons too. Being housebound or less mobile clearly makes socializing difficult, and failing sight or deafness can cause communication problems. Other more embarrassing problems such as incontinence may lead to a withdrawal from social contact. Increasing frailty may be responsible for keeping old people indoors for fear of being the victim of assault or robbery in the streets, or simply for fear of injuring themselves in a fall. Social isolation and loneliness can hasten the decline in an old person’s state of mind. On the other hand, it is not unknown for old people to choose to become recluses, sometimes living in appalling squalor, or hoarding useless items such as old newspapers. Such people are often found to be of above average intelligence and of sound mind. For most people, a well-adjusted old age demands a healthy balance between privacy and social interaction.

People with severe dementia can live for many years. Although the outward characteristics are often the same, two main forms of dementia exist. The so-called Alzheimer’s disease may afflict the very elderly or the middle-aged. At post-mortem examination, characteristic patches and tangled mats of abnormal cells can be seen in the normal structure of the brain tissue. These same changes are seen, to some degree, in the normal aged brain, in the brain of Down’s syndrome adults and in the brain tissue of boxers suffering with dementia pugilistica or ‘punch drunkenness’.

In biochemical terms, the activity of the neurotransmitters (chemicals that make the brain cells function) is severely reduced, and some forms of treatment have been directed towards reversing this trend. A substance named lecithin has been used in diets to promote the absorption of choline necessary to produce the neurotransmitter acetylcholine, but the results are inconclusive.

The other kind of dementia is of the ‘multiple infarct’ type. As the name suggests, the brain is damaged by repeated leakage or blockage of the many small blood vessels within it. People at risk are those who have suffered strokes and hypertension as well as heart disease. The mental decay caused by multiple infarct dementia is much faster than that of the Alzheimer type. It affects men much more often than women.