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Spotting Depression in Older Adults

by Amanda Z. Naprawa  

Depression in older adults is a serious and under-recognized problem. The CDC reports that a total of 7 million adults age 65 or over—or about 17 percent of that age group—are affected by the condition. A significant number of them experienced their first episode of depression after age 60. Sadly, older adults also have the highest rates of suicide of any age group.

Symptoms of depression in older adults tend to be somewhat different than in younger people, and often get attributed to normal aging. Because of this, many older adults and their family members do not recognize these signs and fail to seek treatment. Here’s the better news: Once diagnosed, depression in seniors (as in other age groups) is very treatable. Indeed, most older adults see an improvement once they start treatment.

Depression looks different after 60

Many people equate depression with sadness, and while it’s true that a persistent feeling of sadness is a common symptom of clinical depression, many seniors who have depression don’t feel particularly sad. Common symptoms in older adults include irritability, restlessness, loss of interest in activities, fatigue, difficulty concentrating, changes in appetite, memory loss or confusion, and chronic pain that persists despite being treated. These complaints can mimic those of other conditions, notably dementia. Further complicating matters, many older adults are reluctant to discuss their feelings and may perceive more of a stigma related to mental health problems than younger people. This makes diagnosing depression particularly difficult in this age group.

Causes of depression in older adults

Many physical and social factors contribute to the development of depression in seniors. Among them:

Personal or family history of depression. A person who had at least one previous episode of depression or who has a family history of the illness may be more vulnerable to it as he or she gets older.

Declining health. Chronic illnesses or other health problems can also contribute to depression—particularly if those conditions limit daily functioning. Roughly 80 percent of older adults have at least one chronic health problem, according to CDC data, and about two-thirds live with multiple chronic ailments. In one study published in Aging Research Reviews, factors associated with increased risk of depression among older adults included stroke, loss of hearing, poor eyesight, heart disease, diabetes, and chronic lung disease. And health problems that limit physical abilities can decrease a person’s ability to participate in his or her community, leading to the social isolation that itself is a risk factor for depression (see next section).

Stressful life events and social isolation. The loss of a spouse, family members, or longtime friends can have a lasting impact beyond the expected sadness that comes with grieving. Such losses also disrupt a person’s social structure; with fewer companions in the community, he or she can become increasingly isolated, which can trigger or exacerbate depression. Conversely, evidence has shown that older adults who have strong social ties and a sense of community are less likely to experience depression and tend to be physically healthier too.

Treating depression in older adults

The first step in getting treated for depression is to see a healthcare provider—either a primary care doctor or a mental-health professional, such as a psychologist, psychiatrist, or licensed counselor or social worker. He or she can determine whether the symptoms are from depression or another cause, such as a side effect from medication.

If depression is diagnosed, treatment options include antidepressants, psychotherapy, or a combination of both. In addition to conventional treatments, exercise has been shown in numerous studies to help combat depression, in part by boosting the levels of neurotransmitters that affect mood and providing an activity outside the home. Other lifestyle changes, such as eating a healthier diet and adopting a more regular sleep schedule, can also help. It’s also a good idea to limit consumption of alcohol. While many older adults use alcohol to mask or cope with depressive symptoms, alcohol actually exacerbates depression, creating a vicious cycle.

Bottom line: Depression in older adults is a serious problem that can have a significant impact on the person and his or her family. Remember, depression is not a normal part of aging. If you or a loved one has symptoms of depression, see a healthcare provider. And if you are in crisis and are thinking of hurting yourself or someone else, go to the nearest emergency room, dial 911, or call the toll-free, 24-hour National Suicide Prevention Lifeline (1-800-273-TALK; TTY: 1-800-799-4TTY).

Also see Are Antidepressants Overprescribed? and Dealing with Depression Without Drugs.