*Article written by: Heitor Ferreira Silva, Julia Santos Silva, Karoline Guimarães and Letícia Ramos Siqueira.

Life doesn’t stop at 60

The transition into old age can be a challenge for some, but it does not have to be faced alone.

11 per cent of Brazilian older people aged between 60 and 64 have been diagnosed with depression, according to a survey by the IBGE (Brazilian Institute of Geography and Statistics). This age group accounts for the largest proportion of the 11.2 million Brazilians with the condition.

According to the WHO (World Health Organisation), Brazil ranks second among countries in the Americas in terms of the number of people with depression, behind only the United States.

Neglect as one of the causes

Among older people, those living in care homes or geriatric care facilities are the most vulnerable to the disease, due to the drastic changes in their lives, having to adapt to new rules and timetables, and being separated from relatives and acquaintances.

You don’t have to face this alone

, the British Charitable Foundation (), is one of the NGOs carrying out projects to combat depression in the elderly. According to Ricardo Rosado (31), the organisation’s Institutional Development Co-ordinator, loneliness can lead to mental health problems amongst people in this age group. “Loneliness is something that takes a heavy toll on the health of the elderly over time, we admit them here so they can take part in activities free of charge, because we understand that this is very beneficial at this age; they arrive, make friends, start taking part in events, and their mental health improves significantly as they emerge from a situation of isolation and loneliness”, he explains.

Since the 1940s, the organisation has been helping those most in need with social issues. In the past, Helen Stacey saw a way to help former war veterans who wanted to seek refuge in Brazil. In her home in Jardim Europa, Helen took them in, with each person living in their own room. As time went on, the residents grew older and, naturally, the NGO began to to devote itself to the cause of the elderly.

Over the years, the Foundation has undertaken a range of initiatives. Currently, there is the ‘’ Community Centre for Older People , which has become a venue for activities throughout the day, including theatre, English lessons, yoga and, most notably, dance, which was developed by volunteers Victoria de Paula (23), an events producer, and Taiane Almeida (27), a dance teacher.

They realised that there aren’t many projects aimed at older people, so they came up with the idea of creating an activity that could help this group. “We decided to pool our We’re working on a specific project for older people, because we feel that this is a group that is sorely lacking in projects that speak directly to them, there are very few places in society that these people can go to that help dispel the idea that older people have to do crochet, stay at home with their grandchildren and so on,” says Victoria.

Depression in older people and the risks of the condition at this stage of life

As people get older, difficulties can accumulate or arise at short intervals, according to the Centres for Disease Control and Prevention According to the Centre for Disease Control and Prevention (CDC), depression affects up to 5 per cent of older people living in the community in the United States. These figures double for those admitted to hospital (11.5 per cent) and for patients in homecare (13.5 per cent).

The progressive ageing of the population is an important factor to be taken into account; according to the World Health Organisation (WHO), the proportion of people aged over 60 will almost double by the year 2050, rising from 12 per cent to 22 per cent of the total (from 900 million to 2 billion people).

Depression is one of the mental health conditions that most commonly affects older people, According to Fabio Armentano, coordinator of the psychogeriatric team at AME. According to psychiatrist Dr Jandira Mansur, in an interview with the website of the São Paulo Association for the Development of Medicine () , the prevalence of the condition and how it manifests itself can vary depending on the older person’s circumstances.

“For those living with their families and integrated into the community, the prevalence of depressive symptoms stands at around 15 per cent of the elderly population,” she explains.

“This figure can double when we consider elderly people in care, who are in nursing homes or care homes. In patients “Among those hospitalised for health problems, the prevalence is as high as almost 50 per cent,” continues Armetano.

The specialist divides people with depression in old age into two groups.

• Those who have never had depression before and are now experiencing it.
• Those who already have a history of lifetime pattern of depression.

In the first case, the hereditary component is smaller; the condition is much more closely linked to difficulties arising from ageing itself, such as cognitive problems, loss of social role and limitations caused by physical illnesses. The second group comprises patients with a history of previous depressive episodes, whether treated or not, and who may exhibit characteristics of chronicity.

Apathy and negativity

Geriatric psychiatrist Eduardo Nogueira, in an interview with *Correio Braziliense*, says that sadness is not always present in elderly people with depression; there are other characteristics that warrant attention, such as apathy, reduced social contact and negativity. “In situations like this, it is not uncommon for depression to occur without sadness, which makes it less noticeable to the patient, their family and healthcare professionals. In other words, pay attention to those elderly people who are very quiet,” he advises.

The condition does not have a specific cause and may be triggered by a combination of psychological and social factors. In addition to these reasons, depression in older people can be triggered by a range of issues associated with old age, such as separation from family, the loss of one’s social role following retirement, and the death of a spouse.

This was the case for 79-year-old pensioner Heloisa Carvalho de Abreu. A very cheerful and fun-loving person, she recounts the story of her great losses and her diagnosis with the condition.

“I lost my husband, my brother and my mother, one after the other. It was very hard. My husband and my mother were very important to me. I didn’t realise it, but my son said that after my mother died, I became a different person. Then my brother fell at home and died. Finally, my husband, who had a serious heart condition, Parkinson’s disease and lung problems. It was a terrible struggle. My son used to say I wasn’t the same person anymore. I went to see doctors “and I was diagnosed with depression,” she says.

Another example is Cleide Terra Ultramari, a 72-year-old retired housewife, whose life changed after she discovered her mother’s illness and began looking after her for two years running until her death. “I spent two years looking after my mum full-time; she had Alzheimer’s, and I was caring for her because she could no longer walk. My husband helped me too. Then she passed away and I didn’t want to leave the house anymore. My children would ask me to go out, but I didn’t want to; I just stayed indoors,” says the elderly woman.

Treatment

Treating depression in the elderly is also However, according to psychiatrist Carlos Galduróz speaking to *Correio Braziliense*, they require more care than a teenager or an adult. It is essential to have a detailed understanding of the condition of organs such as the liver and kidneys. This is because they can be affected by antidepressants. “We have to be careful with the dose, because older people’s metabolism is slower and these drugs are metabolised in the liver. If we give an excessive dose, the medicine will remain in the bloodstream for too long, which isn’t good,” explains Galduróz

The condition of the brain also influences treatment. “The elderly person’s brain is in a degenerative phase. The number of neurons decreases as the years go by. It even affects the prognosis, and it may be that a very elderly person cannot manage without the medication due to a lack of neurons,” adds the psychiatrist.

Prevention
Research carried out by the Australian organisation “Beyond Blue” (Treatments for Depression)
reveals that some simple habits improve the quality of life for older people and can help prevent depression, such as:

• 
  Getting a good night’s sleep:
  The better the night’s sleep, the lower the risk of developing the disease.
• 
  Exercise:
  30 A few minutes of moderate physical exercise increases the levels of substances linked to a sense of well-being.
• 
  Meditating:
  Meditation activates areas of the brain linked to happiness; it is also an important tool in combating anxiety and depression.
• 
  Managing blood sugar levels:
  The body and mind are closely linked. Drops and spikes in blood sugar levels (hypoglycaemia and hyperglycaemia) can affect your mood. If this happens repeatedly, it can lead to a worsening of the condition.

Dance in later life

Since 2012, the Brazilian population aged 60 and over has been growing. Today, the number of older people in the country exceeds 30 million, according to the PNAD (Continuous National Household Sample Survey), published by the IBGE.

Recognising the In response to a lack of programmes for older people, Victoria and Taiane developed an initiative designed to support both physical and mental well-being. Studies by the Federal University of Santa Catarina (UFSC) linking dance and older people show that the activity contributes to physical and mental health, particularly in developing strength, agility, flexibility, rhythm and balance. Physical exercise, when done regularly, slows down the progression of illnesses that can affect people of this age.

For Heloisa, the activities offered by the charity have helped her overcome major traumas. “Someone I met recommended this Centre to me – it’s a wonderful thing. I take part in lots of activities, such as Pilates and dance. My son told me not to stay at home, but to go out and do some exercise. He wants to see me out and about, not at home (laughs). This place is a blessing from God in my life,” says the pensioner.

The practice Dancing helps keep the brain fully active, as it boosts blood flow to dormant areas of the brain. The stimulation provided by this activity increases neural connections, which improves older people’s learning, reasoning and memory skills. These exercises reduce stress and anxiety, boost self-esteem and ward off symptoms of depression.

Aware of these benefits, Victoria and Taiane teach a variety of dance styles at the Foundation. In their classes, they are not ‘rule-imposing’ teachers, as the aim is to encourage these people. “We aren’t strict about things; we’re always cracking jokes. They have fun and have a laugh, because they’re already people who are here looking for a distraction from their worries, so it makes no sense at all for them to come here and be faced with teachers who demand too much. Most of them are suffering from depression, or have experienced a great loss in the family,” she explains. Victoria.

The role of the State in this matter

The text of the 1988 Federal Constitution provides a social security model for all citizens. Social assistance is understood as a right rather than philanthropy; it is therefore the duty of the State to ensure it. In 1993, the enactment of the Organic Law on Social Assistance (LOAS) recognised the provision of social protection to socially vulnerable groups as a matter of public policy, irrespective of any prior contributions. And since then, with the introduction of Law 10.741 of 2003, the ’s Statute on Older People has also become a duty for the whole of Brazilian society.

In response to one of the questions, Heloisa said she did not see the Government playing an active role in this cause. “Completely absent,” she stated.

It is clear, therefore, that the mere existence of legal provisions is not enough; there must be a well-defined strategic agenda in the field of public policy. The decentralisation of this responsibility enables local authorities and states to work alongside the public authorities to develop policies aimed at supporting and ‘empowering’ older people.

Life goes on

For ageing to be a positive experience, a longer life must be accompanied by ongoing opportunities for good health, participation and security. According to life expectancy figures calculated by the IBGE, anyone born on Sunday (3 November) is expected to live, on average, to at least 74 years of age. This reality is shaping a new profile of the Brazilian population.

Another consequence of this progress is the improvement in the quality and longevity of life for older people, who are becoming increasingly active and driving forces in the economy. According to data released in 2015 According to the IBGE, 27 per cent of Brazil’s older population (aged 60 and over) were in work in 2012.

Also according to IBGE data, from the 2030s onwards, Brazil will have more older people than children and teenagers up to the age of 14.

With this in mind, the FBB cites the example of Joana Barbosa de Lima, a 63-year-old pensioner who says in her testimony that her life has never stopped, even as she has entered old age. “My life has always been good; I have nothing to complain about. I don’t have any illnesses, thank God. I travel, go for walks, stay at home if I feel like it, and if I don’t, I go out. I used to work in a bank. I’m retired now,” she says.

An initiative that helps

Keen to encourage its beneficiaries to reflect on the cause they are involved in, the NGO devised an initiative that would bring them together. It involves a play that explores the transition into old age and how they felt upon joining this group, assigning each participant a character or role that encourages them to develop critical thinking on the subject, thereby fostering greater independence, creativity and a sense of purpose amongst older people.

The aim of the British Charitable Foundation is to show older people that life does not stop at 60. The NGO organises activities that even younger people take part in, such as dancing, theatre and English lessons. This demonstrates that older people also have the ability to do everything that a young person does even with the limitations associated with old age.

Logbook

About the NGO (Group)

We got to know the NGO, the British Charitable Foundation, and were delighted with the approach to working with the elderly proposed by the volunteers and representatives.

During the interviews We met four women who attend the charity and take part in the activities there: Cleide, aged 72; Heloisa, aged 80; Joana, aged 63; and Suzanne, aged 72. Chatting with them was simply moving and inspiring; we had never realised just how much good the work provided by the organisation was doing for these women. Activities such as English lessons, drama, IT, dance, yoga and fitness. They tell us with great joy that they take part in almost all of them, and that these activities contribute enormously to their health.

The FBB does wonderful work for the social development of older people. Many might otherwise be at home, sitting on the sofa all day, knitting or just doing housework, but the encouragement to keep learning motivates them more and more each day to take part in activities that contribute greatly to their ability to live life to the full and be happy.

Lessons learnt

Julia

The FBB has changed my view of NGOs working on issues relating to older people; I had always thought that organisations working with older people ran activities that were fairly standard, such as crochet, bingo, playing cards and so on. Having had the experience of Through this NGO, I realised that it goes far beyond that and has completely changed my way of thinking.

When it came to the issues facing older people, I had absolutely no idea what directly affected them. With APS, I learnt about topics that would never have crossed my mind – for example, how depression can affect people of that age. I now understand that life goes far beyond the age of 60.

Letícia

After we got to know this NGO, I realised that my view of the cause of older people was limited, as I used to think that care homes – which I’ve now learnt are called ILPIs – simply looked after older people, not I’d imagined there would be a variety of activities. Older people are much more active and take part in activities that even I’d like to join in with.

I realised that older people are very lonely and that the charity helps them to address this issue as well. After interviewing the older people, I realised that we need to value them more and listen to their life stories, because we would gain so much from it, yet unfortunately we are neglecting this.

Karoline

‘Deconstructed’ is the word. The fact that ageing can be a difficult process for some, and that a feeling of helplessness is linked to it, both both from the Government and from their families, touched me deeply. But even so, everyone there is striving for their independence and their own way of carrying on with life. I went to interview them and learnt a valuable life lesson. Despite the many fears surrounding old age, there is still a will to live within them, and that is inspiring.

The work carried out by the FBB and everyone involved is incredible. They look out for those who have taught us so much and who are now being overlooked. I feel much more motivated to turn my attention to this cause, which makes such a difference to the lives of so many people.

Heitor

I’ve always wondered what my life would be like when I turned 60. As a young person, I always viewed the older generation – with their slow pace and white hair – as a group that would face countless difficulties in maintaining their mobility and mental faculties compared to someone aged between 18 and 30. I thought that upon reaching that age, life would be as difficult as it could possibly be.

In this Community Health Centre, we focused on this group of people, often referred to as ‘the golden years’. I was very curious to find out a little about their daily routines, how they interacted with one another and how they kept their minds active.

The British Charitable Foundation for the Elderly does wonderful work to support the development the social life of older people. The encouragement to keep learning motivates them more and more each day to take part in activities that contribute greatly to their quality of life and happiness.