Dealing with Depression in Older Adults

Depression in older adults is not the same as sadness, though it can be triggered by the sadness caused by loss (e.g., loss of a loved one, loss of hearing), stress or major life change (e.g., retirement, moving). Depression can also be caused by some medical conditions, such as chronic pain, thyroid problems, stroke or Alzheimer’s disease. Certain medications and alcohol use can cause depression as well. Depression may also develop for no apparent reason.

People who are depressed cannot just “get over it.” Depression is a biological illness caused by a chemical imbalance in the brain. It affects thoughts, feelings, behaviour and physical health.

Older adults who are depressed may have had episodes of depression throughout their lives, or they may have their first episode late in life.

Is Depression in Older Adults Different From Depression in Younger Adults?

Depression affects older people differently than younger people. In older people, depression often goes along with other medical illnesses and disabilities and lasts longer.

Depression in older adults is tied to a higher risk of cardiac diseases and of death from illness. At the same time, depression reduces an older person’s ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been linked with increased risk of death after a heart attack.

Older adults are at increased risk. We know that about 80% of older adults have at least one chronic health condition, and 50% have two or more. Depression is more common in people who also have other illnesses (such as heart disease or cancer) or whose function becomes limited.

Older adults are often misdiagnosed and undertreated. Healthcare providers may mistake the symptoms of depression in older adults as just a natural reaction to illness or the life changes that may occur as we age, and therefore not see the depression as something to be treated. Older adults themselves often share this belief and do not seek help because they don’t understand that they could feel better with appropriate treatment.

For that reason, it’s important to make sure that an older adult you are concerned about is evaluated and treated, even if the depression is mild.

What Are the Risk Factors for Depression in Older Adults?

Things that raise the risk of depression in older adults include:

• Being female
• Being single, unmarried, divorced, or widowed
• Lack of a supportive social network
• Stressful life events

As mentioned earlier, physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer, dementia, and chronic pain further increase the risk of depression in older adults. Additionally, these risk factors for depression are often seen in older people who are dealing with:

• Certain medicines or combination of medicines
• Damage to body image (from amputation, cancer surgery, or heart attack)
• Dependence, whether through being hospitalized or needing home health care
• Disability
• Family history of major depressive disorder
• Fear of death
• Living alone, social isolation
• Other illnesses
• Past suicide attempt(s)
• Presence of chronic or severe pain
• Previous history of depression
• Recent loss of a loved one
• Substance abuse

What Are the Symptoms of Depression in Older Adults?

How do you know if you or your loved one may have depression? Does depression look different as you age? Depression in older adults may be difficult to recognize because older people may have different symptoms than younger people. For some older adults with depression, sadness is not their main symptom. They could instead be feeling more of a numbness or a lack of interest in activities. They may not be as willing to talk about their feelings.

The following is a list of common symptoms. Still, because people experience depression differently, there may be symptoms that are not on this list.

• Feeling confused and having difficulty in concentrating, remembering, or making decisions
• Not enjoying activities they used to and loss of interest in pleasurable activities, including sex
• Having a change in weight or appetite
• Enduring aches and pains
• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, guilt or worthlessness
• Irritability, restlessness, or having trouble sitting still
• Decreased energy or fatigue
• Moving or talking more slowly
• Difficulty sleeping, waking up too early in the morning, or oversleeping
• Thoughts of death or suicide, or suicide attempts
• Loss of interest in socializing
• Increased use of alcohol or other drugs.
• Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene).

Depression raises the risk of suicide, especially in older white men. The suicide rate in people ages 80 to 84 is more than twice that of the general population. In addition, advancing age often comes along with the loss of social support systems due to the death of a spouse or siblings, retirement, or relocation. Because of changes in an older person’s circumstances and the fact that older people are expected to slow down, doctors and family may miss the signs of depression. As a result, effective treatment often gets delayed, forcing many older people to struggle unnecessarily with depression.

If your loved one has several of these signs and symptoms and they last for more than two weeks, talk with a doctor. These could be signs of depression or another health condition. Don’t ignore the warning signs. If left untreated, serious depression in older adults may lead to death by suicide.

Using a series of standard questions, a primary care doctor can check for depression, allowing for better diagnosis and treatment. Doctors are encouraged to routinely check for depression in older adults. This can happen during a visit for a chronic illness or at a wellness visit.

If you are a health care provider of an older person, ask how they are feeling during their visits. Research has shown that intervening during primary care visits is highly effective in reducing suicide later in life. If you are a family member or friend, watch for clues. Listen carefully if someone of any age says they feel depressed, sad, or empty for long periods of time. That person may really be asking for help.

How to Support Aging People with Depression?

The very nature of depression interferes with a person’s ability to seek help, draining energy and self-esteem. For depressed seniors, raised in a time when mental illness was highly stigmatized and misunderstood, it can be even more difficult—especially if they don’t believe depression is a real illness, are too proud or ashamed to ask for assistance, or fear becoming a burden to their families.

If an elderly person you care about is depressed, here are a few things you can do:

• you can make a difference by offering emotional support. Listen to your loved one with patience and compassion.
• You don’t need to try to “fix” depression in older adults; just being there to listen is enough.
• Don’t criticize feelings expressed, but point out realities and offer hope.
• You can also help by seeing that your loved one gets an accurate diagnosis and appropriate treatment.
• Participate in activities the person likes to do.
• Depression in older adults is less likely when people’s bodies and minds remain active. Ask if the senior wants to go for a walk, participate in a group activity, making a trip to the movies. anything that provides mental or physical stimulation can be great for boosting mood.
• Schedule regular social activities. Group outings, visits from friends and family members, or trips to the local senior or community center can help combat isolation and loneliness. Be gently insistent if your plans are refused: depressed people often feel better when they’re around others.
• Plan and prepare healthy meals. A poor diet can make depression worse, so make sure your loved one is eating right, with plenty of fruit, vegetables, whole grains, and some healthy protein at every meal.
• Encourage the person to follow through with treatment. Depression in older adults usually recurs when treatment is stopped too soon, so help your loved one keep up with their treatment plan. If it isn’t helping, look into other medications and therapies.
• Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

Depression in older adults is a true and treatable medical condition, not a normal part of aging. However older adults are at an increased risk for experiencing depression. If you are concerned about a loved one, offer to go with him or her to see a health care provider to be diagnosed and treated.