80 year old dad has been increasingly sleeping over the last 18+ months, physically inactive to the point he can barely walk outside the home. He sleeps up to 18-20 hours a day, barely leaves the house. Has been checked by cardiologist, pulmonologist, gerentologist, ophthalmologist, etc to screen for other possible causes of no energy. No issues except for sleep apnea have been found. He will start treatment for that. the family would like to see him treated for depression and PT started for him to gain some strength. His dr says he is mildly depressed but doesn’t like to prescribe meds for it.
When we try to get him to walk he says it hurts and he refuses. He basically sleeps in a recliner all day and watches cable news.
we are worried he eventually will be immobile.
any ideas on how to proceed? He’s very guarded with sharing information on his health.
As to the mild depression, if this continues it is worth trying a low dose anti depressant as the more "off his feet" he gets, the weaker he will become, hence the vicious circle of weakness leading to more weakness and less "will" to move.
I am 82. I sympathize. I am very active, care for my home, my garden, shop, cook, walk, and etc. But there are days you wish you could just stop. In his 90s my dad admitted, good life that he had had, he was OVER it and just exhausted, longing only for sleep and the "last good long nap". It happens to us. We do simply have it eventually all become just too hard, and we long to crawl under a good feather tic with a pretty duvet and go to sleep. It is something one must actively fight to stay involved with life. Stay involved! Hey, why do you think I am HERE, pounding away on the keyboard, pretending I am "still" a nurse and a caregiver and can STILL help.
Such is life. All complicated. You have done all the right things. You have got a diagnosis. Wait until treatment (not easy one as most seniors hate the apparatus) starts, see if it helps. And I am one who might consider forcing the issue on low dose anti depressent. Just a tiny bit of gas for the engine.
ULTIMATELY it is up to Dad. We all make our own decisions on this end of life stuff. When we are ready to pull in the sails and batten down the hatches and crawl into the easy chair, just LET US. After you tried what could be tried, just let us, OK? We have HAD our lives. It's OK. Not your responsibility to make us happy, or well, or active, or involved, or even to make us care. Just be there to say Hi. Give us a good book. Make our favorite casserole. Send chocolates. A picture you remember. Chat with us and get on with your own life them. That time after Dad leveled with me that he longed only for the last long nap, and got out of bed just for my mom, he and I would lie on his bed chatting. He told me so many stories of his life; he told me the worst thing he'd ever done in his life; the thing he never stopped remembering (so small a thing). They were our BEST TALKS and I remember them to this day. So just chat with Dad. That's all. Don't push him. Don't worry in his face. Just leave him and don't negate his thought, his wishes. And don't enable him; let him fetch his own coffee (if that's safe; but you get my meaning).
Good luck.
maybe that led to the depression too…
He's depressed so he is sedentary. Because he's sedentary, he has no energy and it now hurts when he walks because that's what happens when you're 80 and stop moving... like the Tin Man in Oz. You seize up and it's a lot harder and takes longer to get back to your former abilities.
In her early 80s my MIL had chronic back pain from a prior broken back injury (and her not doing her PT) and also memory loss. We moved her to AL. She eventually refused to get out of bed for no other reason than probably depression and the beginnings of dementia. We tried everything: more PT, a progress chart, a poster with her sons' faces on it, reason and logic, begging. She became bedridden and for more than a year she even refused to do anything socially or even eat with others on her LTC floor. It's an excellent facility so it felt like such a waste. But then the staff just kept patiently encouraging her and now at 89 she participates in everything, from her wheelchair. It is what it is.
Hopefully having the sleep apnea addressed will help to some degree .
He is 80 though , a decline in energy will happen .
Is he willing to take an antidepressant ? If he is , then get another doctor’s opinion about that .
Ultimately you can lead a horse to water ……..
It may also be time to look at some assisted living facilities . Perhaps life is just getting too difficult for him , and he needs help with daily life and perhaps live with people his own age who understand each other .
He & my mom plan to stay in their home. She is 79 - quite fit, still works, works out, etc.
I read that depression can physically manifest too..,
That may be enough of a wake up call if he's not quite ready to throw in the towel yet to have him seek the help he needs.
And if it doesn't work as a wake up call, I would bring hospice on board as "failure to thrive" would qualify him for their services.
Sleep apnea could affect everything - in how he feels. See how that goes. You are a very loving, caring daughter/family. We all should be so fortunate to have family like you.
While chemistry / scientific, here is some research I found.
(1) Elderly people who take antidepressants, particularly those who take SSRIs, may experience a severe fall in sodium (salt) levels, known as hyponatraemia. This may lead to a build-up of fluid inside the cells of the body, which can be potentially dangerous.
(2) see:
https://pmc.ncbi.nlm.nih.gov/articles/PMC3949203/#:~:text=Older%20adults%20have%20less%20physiologic,serotonin%20syndrome%20(15)%20in%20this
In part: Antidepressant side-effects are a significant public health issue, associated with poor adherence, premature treatment discontinuation and in rare cases significant harm. This is especially relevant for older adults, who assume the largest and most serious burden of medication side-effects. We investigated the association between antidepressant side-effects and genetic variation in the serotonin system in anxious, older adults participating in a randomized, placebo-controlled trial of the SSRI escitalopram.
From: https://pmc.ncbi.nlm.nih.gov/articles/PMC1116008/#:~:text=Citalopram%2C%20moclobemide%2C%20and%20probably%20fluoxetine,older%20antidepressants%20in%20this%20population.
New antidepressants for old people?
Depression is common in elderly people. Old people are at greater risk of developing adverse events while taking any medication—including antidepressants—because of concurrent illness, consumption of other prescribed and over the counter drugs, dose miscalculation because of forgetfulness, and altered drug kinetics.1 The efficacy and safety of antidepressants in elderly people is therefore an important treatment issue. In all age groups the use of tricyclic antidepressants for depression has been declining in favour of serotonin reuptake inhibitors.2 Although views differ on whether serotonin reuptake inhibitors should be used as first line treatment in depression,3 the drop out rates from treatment are similar for both classes of drug—about a third in each group.4 What is the evidence for efficacy and safety of serotonin reuptake inhibitors and other newer classes of antidepressants drugs in elderly depressed patients?
MASSAGE ____________
* Give him a foot and/or hand massage. They do wonders.
* You could get hand massagers, or a chair that vibrates/massages or a longer full-back massager (to put on a chair). This would help his circulation and he might enjoy how it feels.
His reactions could be due to dementia or his brain chemstry changing, which would be understandable.
Let us know what you decide. It could help many others here.
Gena / Touch Matters
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