Byline: Kelly Glista

A small crowd had gathered in the lunchroom of the Worcester Senior Center to hear a talk by Dr. Scott H. Gonzalez, a geriatric psychiatrist.

The sun was shining through the windows and in the corner of the room someone was playing "Take Me Out to the Ball

Game" on a small organ. Some sat at tables and chatted with friends while others enjoyed the daily paper or a book of crossword puzzles. At the front of the room was a whiteboard with a list of common symptoms of diagnosable depression, the topic of Dr. Gonzalez's lecture. Though it hardly seemed a prominent issue for the smiling crowd, depression among seniors is a common and serious problem. According to city's Division of Elder Affairs, older adults have the highest suicide rate in the country and suicide attempts by people 65 or older are more likely to result in death - one in every four attempts results in fatality for seniors compared with one in every 20 for all other age groups.

Dr. Gonzalez's talk was one of several events coordinated by the senior center and the Division of Elder Affairs in May during National Older Americans Mental Health Week.

Elizabeth H. Connell, assistant director of the Division of Elder Affairs, said this particular topic was one she became keenly aware of four years ago when an elderly resident came to her office and expressed a desire to commit suicide.

"We weren't trained to handle that," she said.

That first encounter with senior depression drove Ms. Connell to learn as much as possible about mental health among seniors and the quality of care available for them. She helped the Division of Elder Affairs form the Worcester Partnership for Quality Elder Mental Health Care, a joint venture of the senior center, local doctors and hospitals working toward encouraging help and finding services for seniors with mental health problems.

The current system of care is much too complex, Ms. Connell said.

"You have to stop and think," she said. "If I was an elder and I was depressed, where would I start?"

In August 2006, Ms. Connell's knowledge of the mental health care system was put to the test when her 89-year-old father James exhibited symptoms of depression. After complications arose from his fifth hip replacement surgery, he suffered what

doctors told Ms. Connell was a "cardiac event." After that hospital stay his condition became readily apparent.

"Something was missing from him when he came out of that," she said.

Her father was placed in a rehabilitation program, but it was soon obvious that it was too difficult for him. Ms. Connell said her father would weep constantly while confined at the hospital. She knew enough about depression at that point to ask his doctors to conduct a psychiatric evaluation.

Prescribed an antidepressant, her father was able to come home under 24-hour care, but Mrs. Connell and her children could see there still was something missing from him. For one thing, he no longer joked or bantered the way he used to.

"It was almost like watching someone melt," she said. "Like a snowman."

After additional treatment for depression, the father Ms. Connell knew returned.

"I remember at one point coming out of the nursing home and saying `He's back,'" she said, before Mr. Connell died of a strike in November.By helping educate seniors and their families on mental illness and the health care system, Ms. Connell hopes to help them avoid what she and her family experienced.

That education begins by listening to experts such as Dr. Gonzalez, who, speaking at the senior center, outlined the symptoms of mental illness in seniors, as well as the diagnosable disorders and available treatments. The list on the whiteboard included nine symptoms of major depressive disorder, one of the most commonly diagnosed psychiatric disorders that cause depression. Among its symptoms are depressed mood, lack of interest, loss of energy and feelings of worthlessness or guilt. Other diagnosable conditions include dysthymia, a more chronic condition, and adjustment disorder, a reaction to some major change in the patient's life.

Dr. Gonzalez, who works for Community Healthlink, said bereavement over the loss of a friend or family member is often the catalyst for depression resulting from adjustment disorder.

Aging itself, the psychiatrist stressed, is not a direct cause of depression. "As someone gets older, they're more likely to suffer the kinds of losses that lead to depression," he noted.

Ms. Connell said she has seen the problem of ageism in the treatment of mental illness as well as in commonly held opinion.

"People would say `Well, you know he's 89,'" she said, when talking to others about her father's depression. "I know! That's no reason not to treat someone."

Our society, Ms. Connell believes, has moved away from valuing its older generations. She noted that the seeming majority of volunteers at polling places, where much of their time is devoted to assisting seniors, and nearly all the volunteers at the senior center are seniors.

"We're losing some of our greatest minds and hearts," she said.

The Division of Elder Affairs has prepared pamphlets on healthy aging and a resource guide listing places for treatment and therapy in Central Massachusetts. In Worcester, UMass Memorial Medical Center - University Campus has developed a pilot program to create a collaborative care network connecting primary care physicians for seniors to geriatric psychiatrists.

Dr. Gary S. Moak, a geriatric psychiatrist involved with the program, says it addresses "the pervasive problem of mental health disorders of the elderly and the failure of our system to meet the needs of these patients." He said that unlike in youth, depression is the No. 1 predictor of suicide in seniors.

"We need to do a better job of finding these cases and intervening," Dr. Moak said.

William H. O'Brien, executive director of UMass Memorial Behavioral Health Services, said the program is a different way of supporting the primary care sector that involves many different aspects of the health care system.

"It's really an exciting meld," he said.

UMass Memorial hopes that the program will develop the confidence of primary care physicians in diagnosing mental health needs. Because of a national shortage of geriatric psychiatrists, primary care physicians often deal with these needs by default.

Mr. O'Brien said that the best use of resources is in short-term support of physicians.

For many seniors, the stigma of mental illness prevents them from getting the diagnosis or treatment needed.

"Their world and cultural understanding is very different," Dr. Gonzalez said. He pointed out that in the past, mental disorders were often considered personal flaws rather than medical issues.

Changing that stigma is one of the main goals of the educational programs put together by the Division of Elder Affairs. Mrs. Connell said that she hopes to see more and more seniors able to make the connection between mental and physical health.

"It's not a character flaw," she said. "It's not a personal fault. You can't wish it away, any more than you could wish cancer away."

ART: PHOTOS; CHART

CUTLINE: (1) Elizabeth H. Connell, assistant director of Worcester's Division of Elder Affairs, is shown with a computer image of her late father, James, and an image of him when he was younger, at right. (2) Dr. Scott H. Gonzalez, a geriatric psychiatrist, says aging itself is not a direct cause of depression in seniors. (CHART) Facts About Depression In Older Adults

PHOTOG: (1) T&G Staff/CHRISTINE PETERSON (2) T&G File Photo/MARK C. IDE