Study: Exercise Treats Elderly Depression

Exercising three times a week could be more effective than medication in relieving the symptoms of major depression in elderly people and may also decrease the chances that the depression will return over time.

Researchers at Duke University Medical Center, in Durham N.C., studied 156 majorly depressed patients 50 and older and found that after 16 weeks, those who exercised showed significant improvement compared to those who either took medication alone or those who combined the therapies. In a six-month follow-up study, Duke psychologists found that depression returned in only 8 percent of the patients in the exercise group, versus 38 percent for the drug-only group and 31 percent for the drug and exercise combined group.

Study participants in the exercise group engaged in one half-hour of brisk walking three times a week.

“The main conclusion is that maintaining an exercise program can significantly help in reducing depression,” says the study’s lead researcher, Duke psychologist James Blumenthal, whose work is published in the current issue of the journal Psychosomatic Medicine. He believes this is the first study that actually looks at exercise as a treatment for depression for any age group, but says the results, “just confirm what a lot of people think exercise can do anyway.”

Number One Anti-Aging Medicine

“If exercise could be put in a pill it would be the number one anti-aging medicine and the number one anti-depression medicine,” agrees Dr. Robert N. Butler, President of the International Longevity Center, at Mount Sinai Medical School in New York City. “It’s also cheap, and it avoids problems such as the side-effects of medication.”

Depression is prevalent for the elderly. A recent report by the National Institute of Mental Health called depression in the elderly “widespread” and “a serious public health concern.” Surveys suggest more than 15 percent of the elderly population experiences depression at some point, while an additional 25 percent of elderly individuals have periods of persistent sadness that last two weeks or longer.

Contributing to depression in the elderly are medication side effects; the onset of Alzheimer’s disease and other ailments and a sense of loss that is perhaps different from depression younger people may experience. The elderly are more subject to depression because they tend to experience more loss and they “no longer get the income of self-esteem” that comes with working, says Norman Abeles, professor of psychology at Michigan State University in East Lansing.

Abeles, who is the former president of the American Psychological Association, called the Duke finding “interesting” and added that exercise could serve as an adjunct to the counseling often recommended for the elderly because antidepressants may adversely interact with the other medications the elderly take.

“If you bring up medication, often people don’t want to take it,” says Dr. Joseph Gallo, assistant professor of Family Practice and Community Medicine at the University of Pennsylvania in Philadelphia. He says that elderly patients often deny depressive symptoms, and that using exercise to treat those symptoms could be effective because exercise builds on “self-efficacy and self-confidence.”

But not everyone will benefit from exercise, cautions Gallo. Because depression plays a role in how people take care of themselves, he points out it’s unlikely all depressed people will be motivated to start or keep exercising. Additionally, older adults may have medical complications that prohibit them from being active. The disability can contribute to their depression, he says, but also makes movement an impossible treatment for them.

Study leader Blumenthal says it’s still unclear how exercise affects depression. Further studies will examine whether the improvements experienced in the exercising group actually came from the social support of exercising with others. He plans to look at a home-based exercise versus group-exercise group to establish what impact the exercise is actually having.

The Economist explains

How to live for ever

JEANNE CALMENT (pictured), who lived for 122 years and 164 days (longer than any other person), said the secret to her longevity was a diet rich in olive oil, port wine and chocolate. She smoked until the age of 117. Alexander Imich, who was the oldest living man (111) until he died in June, did not have a secret. Asked how he lived so long, he replied, “I don’t know, I simply didn’t die earlier.” Scientists are looking for more plausible and definitive reasons why some people live much longer than others. Many think the genes of centenarians like Calment and Imich hold the key. And some believe that their research might one day provide a positive answer to the question that has fascinated man since at least the time of Herodotus: is it possible for humans to live for ever?

There are a number of biological components involved in the process of ageing. These cause the body to slowly degrade at the cellular level. Old age is also a leading risk factor for many common illnesses, such as cancer and heart disease. Tackling ageing, therefore, is seen as a way to combat many diseases at once. This is the motivation behind Google’s anti-ageing startup called Calico, which was founded last year and is led by Art Levinson, the former head of Genentech, a pioneer of the biotechnology industry. Craig Venter, a geneticist who was instrumental in the sequencing of the human genome, created a similar company earlier this year. The primary goal of these and other efforts is not necessarily to extend humans’ lifespan, but rather their healthspan, or the number of years lived in good health. Many scientists, though, believe that any effort to slow or stop the progression of age-related diseases must deal with the cellular damage involved in ageing—so longer life is an inevitable and welcome byproduct.

These newer outfits and much anti-ageing research over the past decade have focused on genes. The chances of a person living to 80 are based mostly on behaviour—don’t smoke, eat well and exercise—but the chances of living beyond that are based largely on genetics. So scientists are looking for the “protective genes” that slow cellular decline and ward off diseases in people like Calment and Imich. If researchers can find them it is hoped that pharmaceutical firms might create drugs that mimic their effects in people otherwise likely to achieve normal lifespans. That might only get them to Calment’s age, which some scientists believe is the absolute limit of human longevity. Others think that to go further the body must be treated like a machine in need of regular repair and replacement parts. Regenerative medicine offers some hope in this regard. Scientists are using stem cells to grow human replacement parts, like tissues and organs. In theory, a person could keep going back to the shop for new parts, so long as his brain remained intact. Scientists even talk about treating diseases that ravage the brain, like Alzheimer’s and Parkinson’s, with replacement nerve cells.

Optimists, like Aubrey de Grey, a provocative anti-ageing researcher in England, believe that technology will allow people alive today to live well beyond Calmet’s 122 years. Most others believe that such progress is some way off. A more realistic hope is that anti-ageing research will lead to lower health-care costs. One of the characteristics of the very old is that they tend to be healthy right up until their deaths. They therefore cost health-care systems less than most old people, especially those suffering from chronic diseases. Scientists talk of a “longevity dividend” that might be achieved by compressing the period of ill health at the end of life for everyone. This would at least address the paradox of the quest for eternal life: people want to live for ever, but they don’t want to grow old.

Why palliative care should come sooner than end-of-life

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Special to The Globe and Mail

I often hear from the families of patients who are fighting an illness, such as cancer, wondering when the right time for palliative care is. Most people think of it later than is ideal, in fact, raising it only as a measure to be addressed towards the end of life. In contrast, there is now a movement towards what has been called “early palliative care” – getting help when it is needed, rather than waiting until all other treatments have been stopped.

But would early palliative care mean giving up too soon? There are many myths about palliative care and one is that it will remove hope or shorten someone’s life. This is untrue and deters many people from getting help at a stressful time in their lives.

What is palliative care? Palliative care arose from the hospice movement, which gained momentum in the 1960s in the United Kingdom. Dame Cicely Saunders, who is considered the founder of the hospice movement, drew attention to the care of the dying and the concept of “total pain” – that suffering is social, spiritual and psychological as well as physical. At that time, care was aimed at the very end of life, but it has become recognized that the benefits of palliative care can be relevant much earlier on.

Palliative care has evolved a lot since then . The World Health Organization now defines palliative care as an approach that improves the quality of life of patients and their families facing serious illnesses by the early treatment of pain and other problems. Early means not right at the end of life, but when active treatment of the disease is still ongoing with the aim of prolonging life. Early also means treating problems proactively and preventatively, rather than letting them get out of hand.

Treating pain and other problems early will not shorten life, but will improve its quality. Research conducted in the United States in patients with advanced cancer showed that those who received early involvement with palliative care teams survived longer than those who were not followed by palliative care. And research in the U.S. and Canada has shown that early palliative care improves overall quality of life (including physical, social, psychological and functional well-being), increases satisfaction with medical care and reduces depression.

Early palliative care in these studies took place in palliative care ambulatory clinics, where patients were being followed by a specialized palliative care physician and nurse while they were also receiving active anti-cancer treatment (chemotherapy and/or radiation) from their cancer doctor. But palliative care can also be provided for patients who are hospitalized or at home.

Palliative care can provide help in several areas. These include:

Pain and symptom management When people think of palliative care they usually associate it with pain management, but palliative care specialists also treat symptoms such as shortness of breath, nausea, lack of appetite and trouble sleeping.

Coping with a serious illness Coping with cancer or another serious illness can be difficult for the whole family. The palliative care team can provide counselling or refer you to more specialized support services in the hospital or in your community.

Social support Most palliative care teams include social workers, who can provide assistance with financial matters as well as individual and family counselling.

Help at home Palliative care teams can connect you with community care resources to provide help at home. These can include nursing care, help with dressing and bathing, physical therapy and occupational therapy, and advice on how to modify your home (e.g. raised toilet seats, walkers, shower grab bars).

Advance care planning It is a good idea to plan ahead for a time when you may not be able to make decisions on your own, to discuss your preferences with your family and to identify a “substitute decision maker” who will be able to speak for you when you are not able to do this yourself. The palliative care team can help you start this process, which is best done when you are well.

So if your physician offers to connect you or a family member with a palliative care team, take them up on it. It will provide you with a support system to guide you through the complexities of living with a serious illness and it will not shorten survival – it may even prolong it.

Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Dr. Camilla Zimmermann heads the Palliative Care Program at University Health Network (UHN), and is medical cirector of the Al Hertz Centre for Supportive and Palliative Care at the Princess Margaret Cancer Centre, UHN. She is an associate professor and holds the Rose Family Chair in Supportive Care in the Faculty of Medicine, University of Toronto.

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