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Depression in Seniors: Reversing the Downward Spiral

Innovative program uses activity to improve mood
Depression in Seniors: Reversing the Downward Spiral

Nearly one in five Americans over the age of 65 struggles with depression, which can be a debilitating and life-threatening condition. Social isolation, illness and the loss of loved ones can all trigger or worsen depression, as can certain medications.

Center Communities of Brookline, one of HSL’s supportive housing communities, recently implemented a depression management program that delivers treatment, support and hope to seniors. The program, developed by Baylor College of Medicine, has been shown to reduce the severity of depression symptoms in older adults.

We call our program "MARPEH," for "Making Real Progress in Emotional Health"; loosely translated, marpeh is also the Hebrew word for "health" or "cure." Because depression has a stigma attached to it for many people, the title on my nametag reads "MARPEH Care Manager," which can make it easier for some residents to seek assistance.

In addition to depression screening and education, MARPEH links residents with primary care, mental health care and social-service providers to coordinate services more effectively. It also empowers residents to manage their depression through a technique called behavioral activation, which encourages involvement in meaningful activities.

Depression is a condition of negative and positive cycles: The worse you feel, the less you do and the less energy you have; the more you engage in activities you enjoy, the more energy you have and the better you feel.

With behavioral activation, you don't wait until you feel better to take part in activities — instead, you push yourself to do things you can find rewarding. Through this process, it's possible to reverse the downward spiral of depression and begin to feel better. Although our program is designed for seniors, behavioral activation can work at any age.

I work with participating residents to create a list of activities that they want to accomplish by a specific date. An activity can be a new one, or something the resident hasn't done in a while. We focus on setting small, realistic, achievable goals — even something as simple as, "Next week I'm going to call someone I haven't talked to in a while."

I speak regularly with the resident to provide support and accountability: If the goal isn’t met, we talk about what might have stood in the way, and think of a different option that's more achievable. There’s no failure in this program.

Several residents have said that they feel better just talking about their feelings; they don't want to burden friends or family with their troubles, and they find some relief from their depression knowing that there is someone who wants to help them and work with them.

Through behavioral activation, participants see the positive sides of themselves, and benefit from having the support and validation of someone else. The really empowering part of the technique is being able to do it on their own later on, if they start to notice that they're feeling depressed.

The response to MARPEH has been so positive that we're rolling out the program to two more Hebrew SeniorLife communities: Jack Satter House in Revere and the Simon C. Fireman Community in Randolph.

About Hebrew SeniorLife Outpatient Health Clinic
The health clinics within Outpatient Services at Hebrew SeniorLife offer high-quality, specialized care for Boston-area seniors. We offer a wide-range of medical services, including treatment for conditions such as hearing loss, memory disorders, osteoporosis, difficulty with speech and language, chronic illness, rehabilitation and wound care. When you visit Outpatient Services, you'll be treated by experts who understand the unique health needs of older adults, working to improve each patient’s health and quality of life.

Lori Feldman, MSW's picture

About the Blogger

Depression Care Manager

Lori Feldman, M.S.W., is Depression Care Manager at Hebrew SeniorLife’s housing sites in Brookline, Randolph, and Revere. Concentrating in older adults and end of life, she earned her master’s in social work from Salem State University, where she was first introduced to Center Communities of Brookline as a student intern. Before coming to Hebrew SeniorLife in her current role, for many years she worked in research at Boston Medical Center, studying centenarians and families with longevity to try to discover how to help others stay healthier for longer.

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approach seems sensible
I like this blog
Iget depressed because I don't know what kind of job I can do. Have worked up until now and just retired. I wil be 69 in November of this year. Memory and concentration are not as good as once were. Husband says he can see a difference.Mydoctor does not. I want to work 2 daysa week, answering phones,filing,cleaning the work area,ordering supplies but....jobs for seniors are not as easy as one would thing. Don't want to use a computer,be a cashier etc. I think time is running out for me and get cranky when I think about it. I walk alot, read as much as I can, do puzzles. I eat good food and sleep good at night as well as taking a sometimes nap of 1/2 hr or 1 hour. Have no friends to do anything with. Have tried but....others don't like to do what I like and vice versa. The golden years are doctor appts for me it seems. No sun gets me down , I am on vit D and Vit c as well by my doctors.What can I do?
Hi Lorraine, thanks for writing into the blog and sharing your story. Please check your email for a reply from the HSL blog team.

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