The loss of a spouse or a job. Serious medical problems. Reactions to medications. One of these factors - or any combination of them - can lead to depression in the elderly.
At Wesley Woods Center near Emory University Hospital, Karen Maloney, MA, OTR/L, and Barbara Hewett, OTR/L, work with elderly patients who have physical ailments but also may be dealing with mental health problems such as depression or dementia.
The therapists work with a team of nurses and doctors at the hospital. "We take a holistic view of our patients - and look at not only the physical, but the emotional and social components of their health," Hewett said.
"We meet with [patients] and see how much they can do," Maloney added. "It's important to talk to the family to understand how much 'Mom' was able to do before she came to the hospital."
For example, if a parent was always impeccably groomed, and suddenly won't get dressed, there might be an underlying physical problem.
"Sometimes we can identify something we can treat - like a painful shoulder that makes it difficult for her to dress herself," said Maloney, who carries a list of simple questions for her clients, to help clue her into specific problems.
More often, "it's not uncommon in our diagnostic work where families will say, 'she will not take a shower,' " Maloney said. During the therapists' observation however, "we find that she is unable to start the process, not because of pain, but because of memory loss."
In those cases, "we go through the process and cue them through the steps they need to take," Maloney said.
Many times, patients have advanced dementia, but the family isn't aware of it. These cases usually come to light only after the death of a spouse who has been covering up their loved one's declining mental health, the therapists said.
While daily grooming habits are a clue to determining a patient's mental state, there are other ways occupational therapists can assess it. A small kitchen at the hospital helps therapists determine if the client can safely operate appliances.
"If cooking is something they are responsible for at home, we watch them in the kitchen, using the oven, the stove and the microwave," Maloney said.
The therapists also address the clients' medications, money management and their vision. Maloney questions how clients keep track of multiple medications, and determines whether the medications could be the source of any memory loss.
"Sometimes they can't read the prescription label," Maloney said. "I know patients who cannot open the medication bottles."
Hewett said her patients often don't understand what an occupational therapist does. "I get, 'Honey, I've retired, I don't need a job,' " she said. "I tell them I help them in the work of taking care of yourself, 24 hours a day."
"Our job is to help them succeed in their environment, keep them safe, keep them functional, so they can stay as independent as possible," Maloney said.