Although some older adults may assume that sadness or depression is just a part of growing older, feeling “the blues” consistently for several weeks, months, or longer is not a normal part of ageing.
Nearly 15 percent of people aged 65 and older have been diagnosed with depression by a health professional, according to America’s Health Rankings from the United Health Foundation. Further, rates of depression among older adults worsened significantly during the height of the COVID-19 pandemic due to factors like social isolation, according to a study published in July 2022 in Health Policy.
Unfortunately, many older adults aren’t getting help for their symptoms. One reason: Depression in older adults hasn’t received the attention it deserves. In fact, despite the high incidence and impact of depression among older adults, knowledge about how to address the problem is limited, according to an article published in the May 2020 issue of Psychiatry.
There are many other reasons depression may go unnoticed both by older adults themselves and the people closest to them, says Jessica Bozek, a licensed professional counsellor and director of older adult behavioural health services at Jewish Family and Children’s Service in Scottsdale, Arizona. Some examples:
- They may assume their feelings are normal or they have a good reason to feel down.
- They could be isolated, which in itself may lead to depression. And if an older adult lives alone, there may be no one around to notice their distress.
- They may not realise that certain physical symptoms they’re experiencing could be signs of depression.
- They may be reluctant to talk about their feelings or ask for help.
What Does Depression Look Like in an Older Adult?
Depression can look a little different and therefore be harder to spot in an older person compared with someone younger, since their everyday activities are different, explains Dawn Carr, PhD, an associate professor of sociology at Florida State University’s Pepper Institute for Aging and Public Policy in Tallahassee.
“For a [retired] person who doesn’t have a schedule that’s consistent, it’s easy to kind of get into a rut and for people to not notice,” Dr. Carr says.
Social isolation is a common trigger and sign of depression among older adults, she adds. “It’s often initiated as a consequence of not having a sense of meaning and purpose, so it might even be caused by lack of social engagement and meaningful engagement with others on a regular basis,” explains Carr.
Depression may show up physically too, says Sheila Babendir, PhD, a licensed professional counsellor and the director of counselling at the University of Phoenix in Arizona. “The person’s appetite may decrease, they may want to sleep more, and they don’t have any motivation,” Dr. Babendir explains. “With others, whilst they may not feel sad or blue, depression might manifest as feeling less energised.”
According to the Mayo Clinic, in addition to other classic signs of depression such as listlessness, difficulty sleeping, and recurrent thoughts of death or suicide, older adults may also experience:
- Personality changes
- Memory problems
- Physical aches or pain
- Often wanting to stay at home, rather than socialising or going out to do things
Research published in February 2017 in the journal International Psychogeriatrics also showed a relationship between depression and hoarding, characterised by difficulty discarding or parting with possessions regardless of their actual value, among older adults.
What Are the Most Common Causes of Depression in Older Adults?
Many factors can contribute to depression among ageing adults, such as a family history of depression, lack of physical activity, sleep problems, and medical conditions like stroke or cancer, which are more common in older adults, according to the National Institute on Aging.
For older adults in particular, loss is another common challenge that can lead to or worsen depression.
“Losses can also trigger adjustment reactions that worsen into major depressive episodes,” says David Merrill, MD, PhD, an adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Brain Health Center in Santa Monica, California.
Types of loss that commonly affect older adults, Dr. Merrill explains, include:
- Loss of a spouse, an adult child, or another loved one
- Loss of a role in the workplace
- Loss of previous personal health
- Loss of prior capabilities like running or playing sports or games that they used to love
How to Help an Older Adult With Depression
If you’ve noticed signs of depression in an older person who is close to you, try talking to them about your concerns.
“The most important thing is to be able to develop a relationship where you can talk through and normalise the depression symptoms,” Carr says. Bozek agrees.
“One of the biggest challenges to getting the conversation started may be that the person grew up at a time when admitting to having a mental health problem was considered to be a character flaw,” he says.
“It’s a huge taboo topic for our older population, with many seeing behavioural health as being ‘sick in your head’ and there’s a stigma associated with that thinking,” says Bozek.
“So, we have to really change that mindset.”
With that in mind, avoid starting the conversation by asking directly, “Do you feel depressed?”
Instead, Carr suggests asking about the person’s social interactions.
“Essentially, speaking about the symptoms of depression is more accessible than simply saying, ‘You seem depressed,’ because that can be confrontational for some people,” says Carr.
You might ask, for example:
- Are you enjoying spending time with others?
- What activities have you looked forward to lately?
- You don’t seem like yourself today. What’s on your mind?
If your loved one opens up that they’re feeling depressed, encourage them to talk to their doctor about how they’ve been feeling. If their doctor diagnoses them with depression, they can then refer them to get professional treatment.
The most effective treatments for depression include psychotherapy (aka “talk therapy”) and antidepressant medication. A combination of the two can be especially effective for older adults, according to the National Institute on Aging.
That said, it’s important for older adults to tell their doctor about all the medications they’re taking, as they have a higher risk of drug interactions due to aging-related changes in how the body absorbs medication (which may make the drugs less effective or potentially harmful), per the National Institute on Aging.
How to Prevent Depression in Older Adults
Older adults can lower their risk of depression by:
- Trying to stay physically active and maintain a healthy diet, which can help reduce the risk of other illnesses that could lead to disability or depression
- Getting seven to nine hours of sleep every night
- Avoiding isolation and staying connected with friends and family
- Doing activities that make them happy
- Telling family, friends or a healthcare provider if they’re developing depressive symptoms. Depression is easier to treat before it escalates.
SOURCE: Everyday Health