Dear Family Advisor

My mother says she's lonely, and it's heartbreaking for me to hear her crying at night. What can I do to help her?

My father died seven years ago, and for quite some time my mother -- who is 90 years old and has a heart condition -- seemed to be coping pretty well. But since she was sick for two months last year, she has seemed lonelier. For the last two to three months, she has been crying frequently and saying how lonely and tired she feels. I don't know what to do except to sympathize. I'm reluctant to try to medicate her feelings away, but I hear her crying at night two or three times a week. She lives in her own house with a hired caregiver during the week, and I'm there from Friday to Monday. The caregiver has also noted her distress. Any insights or suggestions would be welcome.

Unfortunately, elder depression is a sad reality. Your mom has sustained a lot of losses, and her age and physical condition make it especially hard for her to cope. There really is no easy fix to this situation, but here are a few ideas that may help.

Your mom sounds like a good candidate for adult daycare or an assisted-living facility. As wonderful as it is that you spend your weekends with her, seeing only you and a caregiver may not be enough stimulation for her, nor is it a substitute for making new friends and being active. By meeting other people her age, she could strike up new friendships and get involved in new activities. Many assisted-living facilities have different levels of assistance, so she could live with people who have similar issues and capacities, which might also make her feel less lonely.

There's no guarantee that she will take well to either of those environments, but don't give up if she resists at first. Take her several times to places that she shows any interest in -- it may just take her time to get over her fears and feel comfortable in a social environment again.

While getting your mom involved with people and activities may be preferable to getting her to take antidepressants, they can also be a big help. Antidepressants don't have the stigma they used to, and alleviating her depression may be the push she needs to reengage with the world around her. See a gerontologist or psychiatrist who is familiar with how various antidepressants interact with the medications she is taking; this doctor may do better at fine-tuning her dosage than a general practitioner. Also ask about the side effects of the medications she's currently taking -- depression might be one of them. Go with her to her doctors' appointments as her advocate, in case she forgets or is too timid to talk about her feelings.

When you're with your mom, pay attention to what makes her perk up. And if you can visit her on a weekday, try to get a feel for how she and her caregiver interact. The caregiver may be meeting her physical needs, but that isn't the same as having a relationship with her. Conversation, joking, and sharing pleasures are things we need at any age! You might need to encourage the caregiver to take a more active, cheery role in your mom's care and brainstorm with her about how to lift your mom's spirits. If she isn't willing or able to help with this, find someone who is.

Your mom needs to feel that in some way she's part of the life that's going on around her. Dressing and eating three meals a day isn't enough. Are there other family members (especially children) who can visit her as well? Have you planned her next birthday party or family reunion? Is she religious? Maybe she has been unable to attend services since your father's death. If religion was part of her life in the past, consider making it part of her life again, as older people often miss attending religious services.

Change and stimulation are also important. As caregivers, we tend to zone out into routines that become too familiar. Try changing your weekend routine. Get her out for a walk or a drive, put on music, bring her fresh flowers. Can you take a short weekend trip or bring her to your house for a change? How about doing a simple home makeover with new paint colors, throw pillows, and other easy changes that will freshen up the place? Does she get her hair done weekly? Would she like to? How about treating her to a manicure or pedicure?

I know that all this sounds like work, and it is. But if you try not to look at it as "one more thing to do," and if your mom is receptive, it won't feel that way. Most people are lonelier than they want to admit. By making your mom's life more interesting, colorful, and fun, you'll be improving your life with her and your satisfaction as a caregiver.

In the meantime, be on the lookout for danger signs. If she says she feels hopeless and helpless, stockpiles pills, withdraws more, or exhibits bizarre behavior, she may have truly lost her will to live and could be a danger to herself. Then it's time to seek help immediately.

In the end, you might need to accept that even your best efforts can't stop her downhill descent. Sometimes people can't bounce back. Although it's painful to watch, you can't make your mother's choices for her. Understanding this now will prevent you from being wracked with guilt if she doesn't respond to your efforts. In the meantime, keep your own life on track. Learn from your mother. Sometimes our parents teach us about life by showing us what not to do.