Barbara pulled a stack of old photos from under the coffee table. They were all photos taken of her—a young, lithe, strong ballerina with a confident smile. Now 68 and obese, her earlier life seemed irretrievable.
"I would always leave our meetings with a feeling of hope."
To avoid an abusive husband, she spent 20 years moving from shelter to shelter, trying again and again to restart her life. The emotional wounds led to overeating, which caused weight gain, diabetes, and other health problems that she must now manage.
Although Barbara had suffered from serious depression in the past, her depression had become "more typical of older people." She was lonely, struggling financially, and dealing with serious health problems. All those problems added up. "It sort of globs together into a general malaise," she said. "You get to feeling, 'This is sort of the way it is.'"
Her latest round of sad feelings began after a recent trip to Colorado to visit family. She had been thinking of moving there to be closer to them, but said she ended up feeling humiliated and rejected instead.
"Because of my weight they didn't want me to sit in chairs. I was going to break things. I felt helpless and powerless. They left me feeling really bad about myself, that I wasn't fit to be around respectable people."
Upon returning home to Seattle, Barbara stopped attending meetings of a movie and discussion group that she had loved to attend in the past. The group was a dynamic a crowd of senior, native New Yorkers who love to talk about culture and music and who always seemed upbeat. "I began to be ashamed of myself, conscious of my appearance," she said. "I love the people so much in my group. I couldn't stand to think they were just tolerating me." She began staying at home and neglecting her health.
Barbara discovered the PEARLS program through her state-assigned case manager. An analytical person, she connected with its method of separating problems and finding solutions one-by-one. "It's not general misery but something specific," she reflected.
For Barbara, those problems boiled down to not taking her medicine on time, not exercising, and not reaching out to socialize with people. With her counselor, she came up with solutions.
"I developed a schedule that I would follow from the moment I got up," she said. "Take my blood pressure, check my blood sugar, and take my medications."
She tries to remember that her schedule was not really a choice; if she didn’t do the log and remember her medications, she experienced pain and deteriorating health. One week's goal was, "Do not get distracted and get motivated."
Barbara began a regimen of medicine, acupuncture and Chinese herbs, and noticed that her blood pressure dropped. She joined Overeaters Anonymous and tried to eat healthy meals. From another program for seniors, she was able to get exercise equipment for her home. PEARLS encourages clients to come up with pleasurable activities, and Barbara‘s list included reading and playing the piano.
One session away from completing PEARLS, Barbara said she was optimistic about rejoining her movie group, and she was thinking about exercising at a new senior center. "We started identifying solutions, advantages and disadvantages," Barbara said. "It tended to focus on the same basic problems, but every week I would focus on a different aspect of the problem. I always would leave our meetings with a feeling of hope."
This story is adapted from “PEARLS Gives Seniors with Minor Depression New Hope” (January 2007). Centers for Disease Control and Prevention, Prevention Research Centers.