Some of the bodily changes that occur with aging can have a negative effect on diabetes control. For example, many older people experience hormonal changes that make it difficult for them to notice symptoms of low blood glucose. This raises the likelihood that mild hypoglycemia will turn into moderate or severe hypoglycemia, which is particularly dangerous in older people. Not only can hypoglycemia lead to a fall, but severe hypoglycemia may trigger a heart attack or stroke. Many people also eat less as they age, which also raises the risk of developing hypoglycemia.
While the link between aging and depression may be partially due to physical changes, it is likely that there is an emotional connection, as well. There are many losses that older individuals must adapt to, and loss is a major psychological cause of depression. Older people may experience the physical changes that accompany aging as a loss of self, possibly feeling that “I’m not the person I was when I was younger.” Physical changes may also mean they are not able to participate as readily in social activities, and so they additionally experience a loss of social contact and friendship. Older people often have other real losses in their lives, such as the deaths of family and friends and the loss of their vocation because of illness or retirement. As older people face their own mortality, anxiety and distress may emerge.
While most older people adapt and thrive in the face of these transitions, some become emotionally overwhelmed and experience persistent sadness. Add to this burden the emotional challenges of diabetes such as fear of complications, resentment over the lifestyle changes that are required to manage it, and stress on relationships, and it is easy to see how diabetes can make a person even more vulnerable to depression. Indeed, one study that looked at the effects of depression and diabetes together found that having both conditions resulted in a higher incidence of disability and complications than did having either condition alone.
Certain aspects of American culture may also promote depression in older individuals. For example, in today’s youth-oriented Western cultures, which are fast-paced, quickly changing, and dependent on new and advanced technologies that are often difficult for older individuals to master, older people may be mocked and their inabilities, rather than their abilities, highlighted.
Moreover, modern families are commonly dispersed geographically, often leaving older — and younger — people feeling isolated and disconnected from needed support. This environment can make an older person feel out of place and alone in facing the challenges ahead, leading to feelings of hopelessness (“It will never get better”) and helplessness (“There’s nothing I can do to make it better”), both of which are attitudes that underlie depression. Add to this the environmental stresses of diabetes, such as the need for frequent medical visits and the high cost of treating it, and it is clear how having to cope with diabetes may contribute to depression.
Signs and symptoms
When a person has experienced certain symptoms for most of the day nearly every day for at least two weeks, he can be diagnosed with depression. These symptoms include persistent sadness, lack of interest in activities that used to bring pleasure, changes in appetite (eating more or less, sometimes resulting in weight loss or gain), changes in sleeping habits (sleeping more or less), feelings of guilt or worthlessness, low energy, difficulty concentrating or thinking clearly, sluggishness or agitation, and thoughts of death or suicide. A person only needs to be experiencing five of these symptoms to be diagnosed with major depression. People who are experiencing some but fewer than five may be diagnosed with minor depression or a depressed mood that is associated with a major life problem.