Depression in older adults is common, but should not be considered a normal part of aging. Seniors with depression often feel sad or lose interest in things that they would typically enjoy. Other symptoms may include physical pain, fatigue, memory issues, and refusal of care. Ways to start feeling better include counseling, medication or a combination of the two.
Depression is one of the most common mental health disorders in the United States. An estimated 17.3 million adults in the United States had at least one major depressive episode—that is 7.1% of all adults in the United States.1 If you or a loved one is exhibiting some of the signs and symptoms of depression, it may be helpful to talk to a therapist.
What Is Geriatric Depression?
Geriatric depression is a type of depression impacting adults aged 65 and older. Due to their older age and likely lower quality of life due to illness, familial deaths, or decreased ability to function independently, older adults are a unique population that can be impacted by depression in specific ways. Life changes such as death of a spouse, retirement, and personal medical issues can all contribute to an older adult experiencing depression.
How Many Older Adults Are Depressed?
Depression is not a normal part of the aging process, and the good news is that the majority of older adults are not depressed. Estimates of the prevalence of depression in the older adult population range from 1%-5% overall, but are higher in homebound older adults (13.5%) and in hospitalized older adults (11.5%).9 Older adult women are at higher risk for depression, and this may be due to biological factors, such as hormonal changes which occur, or psychosocial factors, such as maintaining social relationships, caregiving. Widowed and unmarried older adults are also at a higher risk for depression.7
Older adults are at increased risk for depression because depression is more common in people who have other illnesses, such as cancer or heart disease. Approximately 80% of older adults have at least one chronic health condition, and it is estimated that 50% are affected by two or more.9
Why Does Depression in Seniors Often Go Undiagnosed?
Depression in older adults is often undiagnosed or misdiagnosed. Depression in older adults may not present in the same way that it does in younger adults. When people think of depression, they think of feeling sad. Sometimes, in older adults, there are other symptoms that occur, such as refusing care, pain or weight loss, that suggest depression but may be thought to be a result of other ailments or life events.4 Many people, even physicians, can mistake symptoms of depression for symptoms of other illnesses.
Another reason depression often goes undiagnosed in older adults is because there is the false belief that the symptoms of depression are a normal part of the aging process. For example, a depressed older adult may feel aches and pains and have difficulty remembering things. These symptoms may seem like they are a normal part of aging, but they are not.
Signs & Symptoms of Depression in Older Adults
Depression is a mood disorder which affects how you feel, think and behave. Signs of depression include hopelessness, irritability, and losing interest in previously-enjoyable activities. The symptoms of depression are serious and can be debilitating. Depression can occur one time or multiple times, and it can be chronic and persistent.
Depression in older adults is common and there are several signs and symptoms which are more prevalent in older adults:3,4
- Weight loss/Geriatric Anorexia
- Memory impairment
- Insomnia
- Slowed reaction times/psychomotor retardation
- Difficulty paying attention and focusing
- Preoccupation with somatic symptoms
- Change in functioning
- Refusal of care
Depressed Older Adults Might Not Feel “Sad”
It’s common for those with depression to experience bouts of sadness as part of their symptoms, however that is not necessarily true for the elderly. Their symptoms may be related to physical symptoms such as aches, pains, and low energy.
How Is Insomnia Related to Depression in Older Adults?
Those struggling with insomnia are more likely to struggle with depression, and this is very true in the elderly population. In one study, nearly half of the elderly participants with insomnia continued to have depression for 6 months compared to less than a quarter of elderly participants without insomnia. Depression and insomnia have a cyclical relationship and insomnia is also linked to higher suicidal ideation.13
Is It Grief or Depression?
The prevalence of loss as we age increases as our peer group is also aging, so we lose partners, siblings, and friends along the way. Depression and grief can sometimes be intertwined. However, given the prevalence of depression, it’s important to consider how they differ: Those in grief are still able to recall and enjoy activities, however if grief symptoms continue, over time it can develop into complex grief or depression.
Dementia vs. Depression
There can be similarities between dementia and depression for the elderly population, however it’s important to consider that depression and dementia are two distinct conditions. Dementia leaves individuals with short-term memory issues. For those with depression, memory issues are typically more related to concentration and recalling a memory. Dementia develops over time, while depression can be a more sudden noticeable difference.
What Are the Risk Factors for Geriatric Depression?
There are a number of risk factors that can lead to geratirc depression, including issues like:
- Social isolation
- Death of loved ones
- Health issues
- Low quality of life
- Lack of purpose
- Fear about mortality
- Complicated grief
Medical Conditions That Can Cause Elderly Depression
Examples of medical conditions that can lead to elderly depression include:
- Alzheimer’s Disease
- Parkinson’s Disease
- Dementia
- Cardiac disease or Stroke
- Cancer
- Lupus
- Multiple Sclerosis
- Thyroid dysfunction
- Diabetes
- Vitamin B12 deficiency
- Complicated grief or bereavement
Geriatric Depression as a Side Effect of Medication
There are side effects to medications which can lead to symptoms that mimic depression. Older adults are more prone to certain side effects as older bodies are not able to metabolize medications the same way. If you started a new medication or are on a variety of medications and experiencing depression symptoms, consider discussing this with your physician.
Self-help for Elderly Depression
If you’re struggling with depression as an older adult, these four tips can help:
1. Stay Connected
Continue to engage socially with friends, family, or others in the community. Maintaining social ties, even when you’re feeling sad, can be helpful to elevate mood.
2. Exercise & Eat Well
Physical activity and eating nourishing foods can help with mild and moderate depression.
3. Give It Time
It may take time for medication, talk therapy, and lifestyle changes to begin to work and for you to feel better. Improvement in your mood may be gradual. Keep your expectations realistic and acknowledge that it may take some time to feel better.
4. Don’t Give Up
There is no one-size-fits-all treatment for depression. It could take time to find the right medication, or figure out the best approach in psychotherapy. It may take a few tries to find a good connection with a mental health provider. Stay focused on small, achievable goals and don’t give up hope.
Treatment of Depression in Older Adults
Even in severe cases, depression can be highly treatable. There is no one-size-fits-all method of treatment for depression because people are affected by depression differently. Medication, talk therapy, or a combination of the two are the most common treatments for depression.
Psychotherapy for depression, also called talk therapy or counseling, is an effective treatment option. There are many evidence-based approaches that can be used, including Cognitive Behavioral Therapy (CBT), Solution-Focused treatment, and Acceptance and Commitment Therapy (ACT).
It is important to seek professional assistance if you or your loved one are experiencing some of the signs and symptoms of depression and functioning is impaired. A professional, such as a primary care physician or mental health provider can help by assessing, providing formal diagnosis, and providing recommendations for treatment.
What Are the Consequences of Untreated Depression in Older Adults?
There can be serious consequences for untreated depression in older adults. Untreated depression may lead to cognitive decline and physical illness.7 Depressed older adults may have changes in eating habits, overeating or not eating enough, which can lead to other health issues, and they may experience higher rates of insomnia and memory impairment.3 Untreated depression can affect behavior and may put an older adult at a greater risk of self-neglect.
Depression in seniors is common, and it is associated with negative health outcomes, disability and costs.6 It may complicate or exacerbate existing mental or physical health problems, or create new issues.3
The Stigma of Depression Among Seniors
Older adults are more likely to seek help for other medical issues than they are for depression.7 This may be due to a perceived stigma associated with mental health issues. Older generations may still perpetuate incorrect stereotypes and discriminate against people with mental health issues. They may believe people with mental health issues are “crazy,” “dangerous,” or “insane,” and older people with mental health issues as “incompetent” or “weak.”
The stigma associated with mental health continues to negatively influence older adults’ willingness to seek treatment. Some research indicates this is the number one reason why older adults do not seek help for mental health issues, including depression.8
How to Help an Older Adult With Depression
Getting help for depression is often difficult because a person who is depressed may lack the energy or motivation to be able to seek support. It is also possible that the person does not recognize they are depressed. There may be fear of judgment or stigma associated with having a mental health issue and it may be perceived as a sign of weakness. There might be worry about being a burden on loved ones.
Here are four ways to reach out and get help if you think that you or your loved one may be depressed:
1. Consult a Trusted Physician
A medical professional can assess symptoms and provide recommendations for treatment. You may also receive information about possible medications that can help, and/or a referral to a mental health professional.
2. Talk to Someone Who Is Supportive About How You Are Feeling
It can be incredibly helpful to know that you have someone who will listen to you about how you are feeling. This person may also be able to help you in other ways, for example, they could make calls on your behalf to schedule an appointment, or accompany you to an appointment.
3. Learn More About Depression
Understanding the causes, symptoms and treatment of depression can help to eliminate any stigma and misunderstanding, which are common barriers to receiving treatment.
4. Talk to a Mental Health Professional
Psychologists, Psychiatrists, Licensed Professional Counselors and Licensed Clinical Social Workers are all trained to assess and treat depression. Typically, therapy has been done in an office setting. However, there is now the option to meet virtually, and online therapy may be a great option if you are not sure about counseling or have difficulty leaving your home.
