Depression & Older Adults

Depression is NOT normal with aging and can be effectively treated. Unfortunately, depression in older adults often goes undetected and untreated largely due to the false belief that with age it’s normal to have a mental health problem. The good news is: depression is highly treatable in older adults.

This guide will provide an overview of depression in older adults and how to help.

  1. What is depression?
  2. How common is depression in older adults?
  3. What are the signs of depression in older adults?
  4. What causes depression in older adults?
  5. Why does depression often go untreated in older adults?
  6. What happens if depression is not treated in older adults?
  7. Do older adults REALLY benefit from treatment for depression?
  8. What are the treatments for depression in older adults?
  9. How to Help an Older Adult See a Mental Health Provider?

What is depression?

Depression is a medical condition that impacts more than 7 million adults over the age of 65. Depression can affect mental, physical, emotional and spiritual well-being.
Depression is not normal with aging. Most older adults will not develop depression, but depression is one of the most prevalent mental health conditions among older adults and is highly treatable.

Often family members are the first to notice signs of depression in older adults have an important role in encouraging an older adult to see a professional.

How common is depression in older adults?

Depression is less common in older adults than in younger adults, but deserves special attention in older adults. According to Fiske, A., Wetherell, J. L., & Gatz, M. (2009), older adults experience major depression at the following rates:

  • 1-5% of people 65 and older living in community
  • 10-12% of older adults in the hospital
  • 13.5% of people who require home health care
  • 14 to 42% of residents living in long-term care communities

If you’re caring for older adults with medical problems and who receive home health assistance for medical problems, or are in the hospital or have recently been in the hospital, it’s important that you are aware of the signs and symptoms so that you have the tools you need to help older adults get the care they need.

What are the signs of depression in older adults?

Here’s a checklist of depression symptoms.

  • Persistent sadness or crying a lot
  • Feeling worthless or helpless
  • Feeling slowed down
  • Excessive worries about finances and health problems
  • Weight changes (due to changes in appetite- like gaining weight or losing weight)
  • Restlessness (like pacing and fidgeting), or the opposite, being unusually still.
  • Changes in sleep, like sleeping too much or too little.
  • Difficulty concentrating
  • Physical symptoms such as pain or GI problems.
  • Withdrawal from regular social activities

If you checked 2 or more of these symptoms or are concerned about your loved one’s mental health and wellbeing, it’s important to seek professional help to uncover what is causing these symptoms. Start by getting your loved one to their primary care provider to rule out any medical causes for mental health changes. Download this free mental health workbook to fill out and take with you to the doctor.

What causes depression in older adults?

As we age we more often experience changes in our health and their lifestyle. These changes can be risk factors that make an older adult more vulnerable to becoming depressed. In fact, more than half of major depression among older adults occurs for the first time in older adulthood (this is called late onset depression).

Risk factors for depression can include:

Changes in physical health or functioning:

  • Presence of a new or chronic physical disorder, such as diabetes, or development of multiple chronic physical disorders
  • Stroke, bypass operation, or hip fracture
  • Poor health, physical or functional disability, and sensory impairment
  • Severe and chronic pain

Changes in mental health

  • Prior episode of depression
  • Family history of major depression
  • Cognitive impairment
  • At-risk drinking, alcohol abuse, or illicit substance abuse

Medication Issues

  • Medication misuse or abuse
  • Side effects of some medications
  • Changes in medications or newly prescribed medications for other disorders

Changes in circumstances or social support

  • Income changes, such as retirement or financial difficulties
  • Recent loss of a loved one
  • Living alone or social isolation
  • Diminished social network

Depression and Anxiety commonly occur together in older adults

In older adults, anxiety and depression often occur together. Older adults experiencing both anxiety and depression often have more severe symptoms of both depression and anxiety. It’s important to tell your physician if you’re experiencing symptoms of either condition.

Why does depression often go untreated in older adults?

Depression often goes unrecognized and untreated in older adults largely due to:

  • The false belief that with age it’s normal to have depression. This belief may be held by older adults, family members, health care providers and mental health providers, resulting in older adults not getting the mental health care they need.
  • Stigma, or negative beliefs around what it means to need mental health care, is also a barrier. For example: the idea that depression is shameful or a moral weakness may also keep people from asking for help.
  • Ageist beliefs are negative attitudes about older adults and can influence a person’s willingness to engage in care or belief in the idea that care will be helpful to them. For example: “I’m old. What’s the point?”

What happens if depression is not treated in older adults?

Untreated substance abuse and mental health problems among older adults, according to the National Council on Aging, are associated with poor health outcomes, such as:

  • More frequent use of the healthcare system
  • Increased complexity of the course and prognosis of many medical problems
  • Increased disability and impairment
  • Diminished quality of life
  • Increased caregiver stress
  • Increased mortality
  • Higher risk of suicide

 

Do older adults REALLY benefit from treatment for depression?

According to the CDC, 80%-90% of the cases of depression in older adults are treatable! The same rate as adults of younger ages, making depression one of the most treatable conditions. Depression is also treatable in the context of dementia disorders.

At any age older adults can make changes in their mental health & well-being

 

What are the treatments for depression in older adults?

There are several effective treatments for older adults with depression they include the following:

Talk Therapy

Talk therapy, counseling or psychotherapy are all terms used to refer to a treatment that helps with emotions, thoughts, and behavior. More than just “blowing off steam” or “airing grievances,” working with a trained mental health therapist can help someone better understand their thought patterns, cope with stress, and make change. Studies have shown that engaging in a well-researched psychotherapy is a critical part of recovering from depression and preventing depression relapse.Here is a list of some of the evidence-based talk therapies for depression among older adults:

  • Cognitive behavioral therapy
  • Problem-solving treatment
  • Interpersonal psychotherapy
  • Reminiscence therapy

 

Antidepressant medications

Depression is a medical illness and medication may play a part in treatment. There is no one “best” medication for depression because each person has different symptoms, history, and responses to medicines. There are several different classes of medication that may be used to help treat depression. A medical professional can help you determine ways to get started with medication or make adjustments to what you are currently taking.

We recommend meeting with a mental health professional to identify which treatment(s) may be right for you or your loved one.

How to Help an Older Adult See a Mental Health Provider?

DO NOT ignore signs and symptoms of mental health concerns. It can help to remember that mental health conditions are highly treatable in older adults. So, lean in, share your concerns, and help your older loved one get connected to providers. Here’s how:

  • Talk with our older loved one about what you’ve been noticing in a straightforward, yet compassionate and concerned way. Here are some ideas:
    • “I’ve been noticing that you haven’t been yourself lately. You seem to be staying in bed a lot and more down than usual. I’m concerned about you.”
    • I’ve been worried about you. Can we talk about what you are experiencing? If not, who are you comfortable talking to?
    • It seems like you are going through a difficult time. How can I help you to find help?
  • Encourage them to see their primary care provider to rule out any medical concerns that may be causing these symptoms. Offer to accompany them to the appointment.
  • Help them get connected with a mental health provider who specializes with older adults. Here’s how!

Or, if you’re ready, we can help you find a professional to evaluate mental health conditions, like a Psychiatrist or a Therapist who specialize with older adults.

If you or someone you know is in crisis or struggling with thoughts about harming yourself or others, please reach out to the National Suicide Prevention Lifeline at +1 800-273-8255

References:

  • Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Atlanta, GA: National Association of Chronic Disease Directors; 2008.
  • Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual review of clinical psychology, 5, 363–389. https://doi.org/10.1146/annurev.clinpsy.032408.153621
  • Substance Abuse and Mental Health Services Administration. The Treatment of Depression in Older Adults: Selecting Evidence-Based Practices For Treatment of Depression in Older
  • Adults. HHS Pub. No. SMA-11-4631, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2011.

Ready to gain clarity about the mental health or memory changes in your older loved one?

Download the Memory and Mental Health Guide to get help with the first steps.