長者突然對什麼都提不起勁?4大特質,易患老年憂鬱症


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根據高雄醫學大學在南部所進行的研究,可以推測台灣約有10%憂鬱的老人,有潛在的憂鬱情緒問題。其中,居住在護理之家的老年住民,更是高達30%以上,有憂鬱的症狀。

推估起來,全台灣約有31萬名老人有憂鬱症的困擾,但是老年憂鬱症的就醫比率仍然偏低。(本文摘自《一直喊不舒服,卻又不去看病》一書,以下為摘文。)

突然對什麼都提不起勁,是憂鬱症嗎?

「爸,家裡這麼暗,怎麼沒開燈?」凱開下班,接了孩子回家,一進門,發現家中昏暗。

「你今天沒看電視啊?」凱開擔心的問。

父親最近悶悶不樂,幾乎整天待坐家中,什麼事都不想做。

「沒有什麼想看的。」老爹嘆了氣,又搖搖頭。

「里長說,今天晚上社區有烤肉活動,免費參加,又可以摸彩,我們一起去,好不好?」凱開企圖拉老爸出門走走。

「不要,我不喜歡那個味道。」老爹打槍兒子。

「那還是我們去外面吃晚餐?附近新開了一間餐廳,聽說不錯。君君前天坐車經過,一直說想去吃。」凱開搬出寶貝女兒,想勸說老爹答應。

「免啦,你們帶君君去就好。我沒力氣,待在家裡就好。」老爹揮了揮手,逕自回房休息。

凱開心裡很擔心。老爸上週才回內科門診,醫師說抽血報告都很好,沒有什麼異常數值,但是老爸自從聽到要好的老朋友周伯伯生病過世後,就變得無精打采,什麼事都提不起勁,體力也好像瞬間變差了一個等級。

老年憂鬱症不易被發現,就醫比例也偏低

僅為情境配圖。取自unsplash圖/僅為情境配圖。取自unsplash

《他是憂鬱,不是失智》一書中,作者和田秀樹醫師提到老年憂鬱症的症狀,諸如,最近看起來沒什麼活力,好像悶悶不樂,經常說自己身體不舒服,開口、閉口都是抱怨這、抱怨那個,減少外出的舉動,大腦運轉也不像以前靈活,有時會出現失眠,或是食欲不佳。

這些徵兆,某種程度看起來,都與上了年紀有關,因此容易被認為是自然的老化現象,而大家也覺得發生在長輩身上很正常,不覺得違和,所以,很容易就被當作「上了年紀,本來就會這樣」,進而遭到病人本人及周遭親友的忽視。

其實,依照世界各地研究老年人口的精神疾病盛行率報告,憂鬱症是盛行率最高(約16%至26%)的身心疾患,比現在最受到矚目的失智症,還要高出許多。

根據高雄醫學大學在南部所進行的研究,可以推測台灣約有10%憂鬱的老人,有潛在的憂鬱情緒問題。其中,居住在護理之家的老年住民,更是高達30%以上,有憂鬱的症狀。

推估起來,全台灣約有31萬名老人有憂鬱症的困擾,但是老年憂鬱症的就醫比率仍然偏低。

和成年人相比,老年人比較不會主動尋求精神醫療的專業幫助。經過多年的努力宣導,減低汙名化的影響,成人個案比較能主動且明確地陳述自己有情緒的問題,有些人甚至會主動表明自己需要治療,但相反的,老年人較無法清楚且主動地表明自己憂鬱的情況。他們往往說東說西,就是沒說出情緒。

老人憂鬱症患者常是用「行為改變」來呈現,例如,以前常去唱歌、聚會、爬山,現在卻都推託,不想出門。平時喜愛看連續劇或是綜藝節目,現在電視機連打開都不打開,也可能會不斷地抱怨身體的種種病症。家人往往只注意到他們抱怨的部分,而帶去看內外科,卻一無所獲,因此,忽略了憂鬱症的存在,延遲了憂鬱症的治療時機。

根據統計,大約60%以上的憂鬱症患者,接受單一種憂鬱症治療藥物,就能夠痊癒,因此,憂鬱症的治癒率是很高的。

只要發現家中老人有憂鬱情緒,建議一定要盡早帶到醫院治療。

四大特質,易患老年憂鬱症

什麼樣的狀況,容易罹患老年憂鬱症呢?

過去的研究,整理出許多可能會促發老年憂鬱症的因素,可以提供給大家作為參考。針對有這些因子的高危險群,給予適當的關懷與協助,消滅可能的危險因子,或許能減少老年憂鬱症的發生。

一、年輕時要求完美、自我要求高,習慣控制一切的人,在年老時,反倒是憂鬱症的危險群

僅為情境配圖。取自unsplash圖/僅為情境配圖。取自unsplash

年輕時擁有不錯的地位,當老化時,發現身體不再受自己控制,或退休、失去工作,感覺自我價值下降。倘若調適不當,無法接受,就容易出現憂鬱情緒。

二、家族病史中有憂鬱症,也會有比較高的比例罹病

但相較於年輕的憂鬱症患者,老人憂鬱症的遺傳性比較低。無論是成人,還是老人,女性得到憂鬱症的比率都比男性高。

對於長輩,影響情緒最多的,就是「鰥,寡,孤,獨,老,病,久,衰」。當生命進入銀髮期,除了身體的自然老化之外,難以避免地會面臨許多失落,伴侶離世、獨居、退休、久病、失能等,都有可能成為老人憂鬱症的危險因子。

過去研究發現,一個人若喪偶,7到12個月之間,是憂鬱症病發的高危險期,病發率高達24%。

三、亞洲人普遍重視工作,年輕時沒有規劃退休生活的概念,退休後,生活重心突然被抽走,也容易感到不適應

四、老化、身體逐漸失去功能,甚至出現疾病,也是一大挑戰

身體疾病可能會造成憂鬱、疼痛,而憂鬱又會加重身體疾病的痛苦,這種痛苦又讓疾病變得更加嚴重,形成一種惡性循環。

舉例來說,一個老人原本有退化性脊椎疾病,若憂鬱症病發,他對疼痛的敏感度就會上升。原本可能感受到的疼痛是5分,但病發後,病人感受到的痛可能達到10分。當越來越痛,最後家人只能讓他吃止痛藥,但卻不知道其實病人痛是因為憂鬱,所以即使吃了止痛藥,心情也不會好,反而常造成藥物過度使用。

又痛又憂鬱,老人會誤以為自己的病治不好了,甚至可能出現結束生命的想法。

要小心的是,某些對中樞神經有影響力的藥物,容易導致憂鬱症病發,例如,部分抗高血壓藥、類固醇藥、嗎啡類止痛藥、抗帕金森氏症藥、毛地黃類藥、干擾素、癌症化療藥物等,但若得病,這些藥物又非吃不可。因此,若家中老人有服用這些藥物,一定要與醫師保持良好溝通,隨時注意病人情緒。

必要時,須更換藥物種類,或是改用非藥物方式,治療憂鬱症。


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