How well you age will help dictate how long you stay alive and how happy you are to do so. Whether or not your family is long-lived, the answers lie less in your genes than in your actions. Do you smoke? Do you eat well or poorly? Do you stay active? Are you a healthy weight? What ailments do you have now and, judging from family background and your current lifestyle, which ones are you likely to get?

No matter what your age or stage of life, you have the power to change many of the variables that influence disability and longevity. In this section, you can learn how. Read More

Getting older brings many advantages: wisdom, patience, contentment... But it also brings negatives, espe
cially as our bodies become less able to do what they once did. Perhaps it's no wonder depression is common among the elderly.

It's a mistake to assume depression is an inevitable part of ageing. Depression is never normal. But despite this, many older people hide their worries and struggle alone when they feel very low. And even though effective treatments are available, elderly people are more likely to see suicide as the only way out.
If you or an elderly friend or relative has problems with bleak moods, get help from your GP as soon as possible. 

The biology of depression

Older people are more likely to blame their depression on events or social circumstances. But while the death of a partner or friends, or coping with a chronic illness are all important contributory factors, there are real biological changes that account for depression.
We know from brain-imaging studies that in depression the brain circuits responsible for regulating mood, thinking, sleep, appetite and behaviour all fail to work properly. The chemicals that brain cells use to communicate with each other, called neurotransmitters, become out of balance. This happens in young and old alike and is always abnormal.

Particular patterns in the elderly

Depression has particular causes and shows certain patterns in the elderly. For example, it's much more common in the years after retirement, when people may struggle to adjust to a new role and routine in life. It's then less likely for the next decade until they're in their mid-70s, when factors such as chronic illness, frequent loss of peers and friends, and increasing restrictions on mobility may be factors.

Depression also has a different pattern of symptoms in older people compared with the young. Anxiety is particularly common, and the slowing of thought and activity.

Older people also tend to have more bodily symptoms, although it can be difficult to work out whether these are signs of depression or simply part of the increase in general illness seen with age. For example, they're more likely to battle with weakness, as well as headaches, palpitations, loss of interest in sex, abdominal or back pain, shortness of breath and constipation. Imaginary illness and hallucinations are more common too.

Similarly, deterioration in mental function can occur with depression at 18 or 88, but young people have greater mental reserves, so these problems often show up more in older people. But it's important to separate the effects of depression from those of conditions such as Alzheimer's disease.

Illness and depression

There are several conditions that can cause depression in the elderly, including heart problems, low thyroid activity (hypothyroidism), vitamin B12 or folic acid deficiency and cancer. 

Many drugs also cause, aggravate or trigger depression, including beta-blockers and other blood pressure drugs, and heart drugs such as digoxin, steroids and sedatives.

Depression often occurs after a stroke, and getting it treated may be critical to restoring normal abilities.

Effective treatment

Antidepressants drugs can help to restore the balance of neurotransmitters in the brain, while social support and psychotherapy can help to deal with many of the triggers of depression. There's an excellent review of depression treatments for older adults from the US Surgeon General at www.mentalhealth.com. 

Studies have shown that over 80 per cent of people with depression improve when given the appropriate treatment with a combination of medication, psychotherapy and other measures. However, it can take longer with older people than with younger people to get a response to treatment - on average, it takes 12 weeks to achieve remission, so be patient. In elderly people in particular, the research has shown that a combination of psychotherapy and antidepressants is extremely effective in preventing depression from recurring. 

Dealing with social isolation is another important part of helping to treat depression in older people. The health benefits of being part of a family or tight community are well known: living in care doubles the risk of depression, while being an active part of a church congregation lowers the risk.

Self-help remedies may be worth a try, but beware. St John's wart, for example, is increasingly self-prescribed and does help in mild to moderate depression, but it can interfere with other drug treatments, which the elderly are much more likely to be taking. Always talk to your doctor about any complementary remedies you are trying.

If you’re like most people, you’ve learned to bottle up "unacceptable" emotions, such as anger, fear, frustration, and grief. Sometimes, of course, the cap slips off. Then these emotions are let loose at high intensity, though not necessarily in the right direction. One safe way to decant any emotions—even the most hurtful, terrifying, or sad feelings—is journal writing. A blank sheet of paper and a pen can offer enormous release and, possibly, insight into hidden conflicts.
 
Writing about traumatic events can have physical benefits, too, according to psychologist James W. Pennebaker, who began studying this issue in the late 1970s. A series of studies required one group of people to write down their deepest thoughts and feelings about the most traumatic event they recalled. A control group wrote only about trivial events. Both groups wrote for 15 minutes a day for four days. In one study, the group that expressed deep emotions reported feeling better and also had significantly fewer doctors’ visits and symptoms of illness for nearly half a year afterward. After a similar experiment, the group that revealed deep emotions had livelier immune system defenders called T cells for the next six weeks. Research shows people with asthma and arthritis benefit from journal writing, too.
 
Why does writing about emotional issues make a difference in physical and emotional health? Pennebaker theorizes that confiding bottled-up feelings can relieve stress, which ratchets up blood pressure, heart rate, and muscle tension.

Writing It Out

Clinicians at the Mind/Body Medical Institute have found that the following journal exercise helps relieve ongoing sources of stress. A single attempt is not enough, though. When you first sit down to write about a problem, you may feel more anxious. The wound, once exposed, may initially hurt more than it did while hidden. But continuing to write about the same problem over the course of several days often enables you to work through difficult emotions and reach resolution or acceptance.
 
Here’s some advice before you begin:

• Deeply troubling events and situations, such as domestic violence, rape, or direct exposure to acts of terrorism or war, are best explored with an experienced therapist. For other situations, you can proceed on your own and seek professional help only if you feel you need assistance.

• If you’re physically healthy, choose the most stressful event or problem you currently face. It’s usually one that you frequently dwell upon. Or, if you think your current problems stem from past circumstance, write about traumatic events in your past.

• Truly let go. Write down what you feel and why you feel that way.

• Write for yourself, not others. Don’t worry about grammar or sentence structure. If you run out of things to say in the time allotted, feel free to repeat yourself.

• Do this exercise for 15–20 minutes a day for three to four days or as long as a week if you feel writing continues to be helpful.

Mini-Relaxations

The best-written book on stress control is no help to you if you can’t find time to read it. If you only have a short while to spare, dip into the stress-busting suggestions described in this section. Whether you have one minute or half an hour, you’ll find ways to ease your day.

Mini-relaxations can help allay fear and reduce pain while you sit in the dentist’s chair or lie on an examining table. They’re equally helpful in thwarting stress before an important meeting, while stuck in traffic, or when faced with people or situations that annoy you. Here are a few quick relaxation techniques to try.

When you’ve got 1 minute
Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in slowly. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe deeply for one minute, pausing for a count of three after each inhalation and exhalation.

Or alternatively, while sitting comfortably, take a few slow deep breaths and quietly repeat to yourself “I am” as you breathe in and “at peace” as you breathe out. Repeat slowly two or three times. Then feel your entire body relax into the support of the chair.

When you’ve got 2 minutes
Count down slowly from 10 to zero. With each number, take one complete breath, inhaling and exhaling. For example, breathe in deeply saying “10” to yourself. Breathe out slowly. On your next breath, say “nine,” and so on. If you feel lightheaded, count down more slowly to space your breaths further apart. When you reach zero, you should feel more relaxed. If not, go through the exercise again.

When you’ve got 3 minutes
While sitting down, take a break from whatever you’re doing and check your body for tension. Relax your facial muscles and allow your jaw to fall open slightly. Let your shoulders drop. Let your arms fall to your sides. Allow your hands to loosen so that there are spaces between your fingers. Uncross your legs or ankles. Feel your thighs sink into your chair, letting your legs fall comfortably apart. Feel your shins and calves become heavier and your feet grow roots into the floor. Now breathe in slowly and breathe out slowly. Each time you breathe out, try to relax even more.

When you’ve got 5 minutes
Try self-massage. A combination of strokes works well to relieve muscle tension. Try gentle chops with the edge of your hands or tapping with fingers or cupped palms. Put fingertip pressure on muscle knots. Knead across muscles, and try long, light, gliding strokes. You can apply these strokes to any part of the body that falls easily within your reach. For a short session like this, try focusing on your neck and head.

• Start by kneading the muscles at the back of your neck and shoulders. Make a loose fist and drum swiftly up and down the sides and back of your neck. Next, use your thumbs to work tiny circles around the base of your skull. Slowly massage the rest of your scalp with your fingertips. Then tap your fingers against your scalp, moving from the front to the back and then over the sides.
• Now massage your face. Make a series of tiny circles with your thumbs or fingertips. Pay particular attention to your temples, forehead, and jaw muscles. Use your middle fingers to massage the bridge of your nose and work outward over your eyebrows to your temples.
• Finally, close your eyes. Cup your hands loosely over your face and inhale and exhale easily for a short while.

When you’ve got 10 minutes
Try imagery. Start by sitting comfortably in a quiet room. Breathe deeply for a few minutes. Now picture yourself in a place that conjures up good memories. What do you smell — the heavy scent of roses on a hot day, crisp fall air, the wholesome smell of baking bread? What do you hear? Drink in the colors and shapes that surround you. Focus on sensory pleasures: the swoosh of a gentle wind; soft, cool grass tickling your feet; the salty smell and rhythmic beat of the ocean. Passively observe intrusive thoughts, and then gently disengage from them to return to the world you’ve created.

The Benefits of Massage

A massage at the hands of a skilled practitioner can be rejuvenating. Research shows massage has a physiological impact, too.

A 2005 review of research studies involving massage therapy showed that massage consistently lowered levels of cortisol while increasing activity of pleasure-related brain chemicals in patients with a broad range of physical and psychological conditions. Massage also lowers blood pressure and heart rate and may enhance certain measures of immune function. A 2005 study showed that women with breast cancer who participated in massage therapy three times a week for five weeks showed more immune system activity and reported less depression, anxiety, and fatigue than the women who didn’t receive massages regularly. Some studies have found that massage is also beneficial in boosting the immune systems of people with HIV.

Whether it’s for therapeutic reasons or purely for pleasure, massage offers the comforts of a warm touch and release from muscle tension. There are currently no national licensing requirements or standards for massage therapists. Experienced practitioners can be found through professional organizations, such as the American Massage Therapy Association (888-THE-AMTA) and the National Certification Board for Therapeutic Massage and Bodywork (800-296-0664).

Affirmations

Affirmations are statements that express love, acceptance and, often, a joyous vision for your self and your life. A stream of positive thoughts can drown out more negative ones. Try incorporating simple affirmations, such as "I breathe in healing" or "I breathe out tension," into relaxation techniques. Or paste them to your mirror or another prominent place where you can read them several times a day. The more often you repeat an affirmation, the more likely you are to believe it and act on it.
 
Whether you write your own affirmation or borrow one from a helpful bumper sticker ("One day at a time"), the words should resonate for you. When creating an affirmation, choose a stressful aspect of your life and decide what a positive outcome would be or how you wish you felt about the situation. Try to craft first-person present-tense statements:

• "I can do this."
• "I am doing my best."
• "I am calm."
• "I deserve respect."
• "Week by week, I am growing healthier and stronger."
• "I can relax my body."
• "I am a loving, caring person."

Imagine these techniques and self-nurturing acts as dry seeds for a garden. Lush growth rewards those who do more than scratch the earth, toss in a few seeds, and step back to see what comes up. Dig deep. Water frequently. Remove choking weeds from the plot when necessary. Combining the richness of your past experiences, a willingness to expand your current boundaries, and a desire to fill your life with courage, love, and joy can make a great deal of difference in what you reap.

Power of Prayer

Several large studies suggest that people with an active religious life tend to stay healthier, live longer, and be happier. For example, a review article published in 2000 in the Journal of the American Geriatrics Society cited an international study of nearly 170,000 men and women from 14 countries that found religious affiliation and attendance at services significantly increased the likelihood of happiness and satisfaction. Twelve years of data from 2,800 older adults enrolled in the Yale Health and Aging Study, reported in 1997 in theJournals of Gerontology, showed members of religious congregations had a slower onset of physical disability. Other studies on how religion affects health have noted less hostility and anxiety, lower blood pressure, and better quality of life among people with strong beliefs.

But the power of prayer is not easy to document. A 2002 study in the Annals of Behavioral Medicine sifted through research claiming religion and spirituality have positive effects on cardiovascular disease and hypertension. The investigators disputed these results, citing numerous flawed or irrelevant supporting studies.

But prayer offers solace and comfort to many people. Religious communities can be part of a larger social network that keeps a person afloat with emotional support and outright assistance (see Social Support). By reinforcing positive emotions, religious belief might stimulate healthy physiological responses through complex nervous system pathways much as a constant flood of negative thoughts may set the opposite reaction in motion. And, of course, certain religions encourage better health habits, such as avoiding alcohol and tobacco.

If prayer is meaningful to you, it can enhance the relaxation response and perhaps your health as well. You may want to use your favorite prayer or a phrase from it to help you focus.

Social Support

Just as a ship is protected by the rubber bumpers that separate it from a hard wooden dock, so, too, do people benefit when social buffers soften the inevitable bumps and bruises of life. Studies show that social ties—at least those that represent positive relationships—significantly protect health and well-being.
 
In Sweden, researchers following more than 17,000 men and women for six years found that the group that reported the most isolation and loneliness had almost four times the risk of an early death as those with good social networks. California researchers who tracked roughly 7,000 Alameda County residents for nine years found that a lack of strong community and social bonds multiplied the likelihood of dying by nearly two to three times.
 
Confidants, friends, acquaintances, co-workers, relatives, and spouses or companions weave a life-enhancing social net. Their support may involve outright assistance or may be largely emotional. Studies show that people who have greater social support fare better on measures of immune function when faced with stressors as diverse as caregiving, surgery, exams, and job strain. For example, women with breast cancer who felt they had high-quality emotional support from an intimate relationship, social support from a doctor, and nourishment from other connections had more natural killer cells—capable of destroying virus-laden cells and certain tumor cells—than those who lacked these advantages.
 
Not surprisingly, the quality of relationships counts. Research suggests negative ones—an embattled marriage or a draining caretaking arrangement—can be more harmful than helpful.

Strengthening Your Social Bonds

Given the pleasures and benefits of social ties, why not grasp opportunities to expand your social circle and deepen the ties you’ve already made? Here are some ways to do just that:

• If you normally wait for others to reach out, pick up the phone and propose a date.
• Explore some of the many volunteer opportunities available, from wielding tools to spruce up affordable housing to mentoring a child or business-person. Check with http://www.volunteermatch.org or http://www.seniorcorps.org or call your local chapter of the United Way for opportunities that fit your talents and interests.
• Harness the warmer side of technology. E-mail and telephones extend your reach around the world. Libraries and senior centers may offer free online time and may even help you set up a free e-mail account.
• Find like-minded people through intriguing classes, organizations, and your community newspaper.
• If it’s hard to get to religious services, ask fellow congregants to escort you. If a significant illness keeps you away, find out if your spiritual leader makes home visits.
• Social support is a two-way street. Offer assistance to friends, family, and neighbors and accept it when it’s offered to you.
• Share a confidence. Doing so can turn a friendly relationship into an even deeper one.
• If depression, low self-esteem, or social phobias affect your ability to make connections, seek help. Start by talking with your doctor. Many people have been aided by Professional Counseling, medications, and/or both.