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Depression
Not a Normal Part of Aging

by Paula M. Trief, PhD

Depression is a serious concern for anyone, and no less so when a person has diabetes. Studies have shown that if you have both diabetes and depression, you are more likely to have high blood glucose, diabetes-related complications, and a shortened life span. While this may be because seriously depressed people typically don’t take as good care of themselves, researchers think that the link may go beyond that. Fueling their suspicions are the facts that the incidence of depression is higher among people with diabetes than in the general population and that being depressed raises the risk of developing Type 2 diabetes.

Depression is also common among older Americans, and as the U.S. population ages and the incidence of diabetes continues to rise, the number of people dealing with both diabetes and depression is expected to rise, as well. Consider these numbers: In the next 20 years, as the baby boomer generation ages, the number of Americans age 65 and older is expected to double. In roughly the next 50 years, according to Centers for Disease Control and Prevention estimates, the number of people between the ages of 65 and 74 who have diabetes will triple and the number 75 and older with diabetes will increase by a factor of five. Currently, it is estimated that 8% to 20% of older people living independently (not in nursing homes) are depressed, and it is known that people over 85 have the highest suicide rate of any age group. All of these statistics point to the need for effective treatments for depression in older people.

Depression is not just the normal sad feelings that occur at times of loss, stress, or disappointment. A person who is depressed typically feels deep sadness, feels very little pleasure in life, and may even contemplate suicide.

While the stress of coping with any chronic disease can contribute to depression, researchers are studying what unique aspects of diabetes might account for the high rate of depression among people with diabetes. They are exploring whether, for example, there may be biological factors such as changes in hormone levels that contribute to both diabetes and depression. In the meantime, however, it is known that identifying and treating depression in people with diabetes is possible and important for their overall physical and emotional health, as well as for their diabetes control. This article examines some of the particular stresses that diabetes and the process of aging cause for older people, the link of these stresses to depression, and what can be done to help.

Physical causes and effects
As a person ages, his body inevitably changes. No matter how much exercise he does, his muscle mass decreases, his ability to do strenuous activity declines, his bones become more brittle, and his joints become less flexible. Certainly, getting regular exercise and practicing good nutrition can slow this progression and help compensate for the decline. But to a certain degree, these changes happen to everyone, and the resulting loss of ability may cause or contribute to depression.

People with diabetes have the added stress of knowing that the longer they have lived with the condition, the higher their likelihood of developing diabetes-related complications, such as kidney and eye disease. The aging heart also becomes more vulnerable to the negative effects of diabetes, and many people with diabetes develop cardiovascular disease as they age. It is thought that diabetes complications such as heart disease may also lead to biological changes that cause or contribute to depression, although how they do so is not known.

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