What Depression in the Elderly Looks Like & How to Get Help

What Is Depression? How Does It Affect the Elderly?

Also, you should know this: Anybody can get depression. It doesn't discriminate. And older adults can get it for no apparent reason. People with depression tend to feel powerless to get rid of it.

In older people with depression, loneliness often plays a big role. However, that isn't the case for everyone. Clinically depressed people (of every age) are usually impacted by five or more of the following effects for at least two weeks:

• General unhappiness
• Sleep problems
• Feelings of worthlessness or guilt
• Inability to concentrate or make decisions
• Loss of interest or enjoyment in activities
• Weight loss or anorexia
• An impaired or agitated mental state that may cause unusual movements or behaviors
• Thoughts of suicide

Keep in mind that a lot of seniors with depression don't experience sadness as a primary symptom. The effects of their depression may be seen mostly in physical problems instead. For example, issues like chronic headaches, pain without an obvious cause, unintended weight loss, or persistently low energy or motivation may indicate that they're depressed. In addition, older adults tend to be affected by depression a little differently than their younger counterparts. Older people may have the condition for a longer time. And they often have it in conjunction with other health issues.

Estimates vary, but depressive disorders are thought to affect about 10 to 20 percent of older people worldwide. In the U.S., the numbers vary based on factors like treatment settings and the specific kinds of depression. According to the American Academy of Family Physicians (AAFP), between 17 and 37 percent of elderly patients in primary health care environments have been recognized as having depression. Here are some of the most common types of depressive disorders in older adults:

• Minor depression: People with this condition have just two to five of the symptoms above, which are often mild or moderate. The symptoms also tend to last fewer than two years. Minor depression is thought to be more common in the elderly than major depression. According to the AAFP, minor depression affects nearly a third of nursing home residents. Some people with minor depression eventually develop major depression.
• Major depression: This condition is characterized by several symptoms (such as those listed above) that are severe enough to interfere with most everyday situations. It can be very debilitating. And it can last anywhere from two weeks to two years or longer. The Centers for Disease Control and Prevention (CDC) says that major depression may affect up to five percent of the general senior population in the U.S. However, that number increases to 11.5 percent of seniors in hospitals and 13.5 percent among seniors receiving home health care. The AAFP says that the condition tends to be most common in adults over the age of 70 who have medical illnesses and are hospitalized or reside in other kinds of care institutions.
• Persistent depressive disorder (PDD): Also known as dysthymia, this condition generally involves symptoms that last longer than major depression but aren't as severe. PDD is a chronic disorder that often goes undiagnosed since the people who have it may think their depressed mood is just part of their personality.

Regardless of the type of depression you or a loved one may have, it's important to seek treatment. Geriatric depression can increase the risk of death from other medical conditions such as cardiac disease. It can also make it more difficult to recover and rehabilitate after illness, injury, or surgery.

The Differences Between Depression, Grief, and Dementia

You aren't alone if you've ever found it difficult to know whether someone was depressed, exhibiting dementia, or simply grieving over a loss. But it's essential to understand the differences so that you can seek appropriate help. Here's what you need to know:

Grief vs. depression

Although grief is certainly one of many risk factors for depression, it isn't a depressive disorder itself. Instead, grief is a healthy and normal response to any painful loss. For example, we grieve when we lose people we love. We may grieve if we lose a long-time home, health, mobility, or independence.

With grief, our sadness may last for a while, but moments of joy will often temporarily replace it. In contrast, depression takes hold and doesn't usually allow for periods of happiness. A clinically depressed person will tend to consistently feel hopeless and empty.

It's difficult or impossible for people with depression to genuinely smile, laugh during humorous moments, or enjoy other things that other people would normally find pleasing or uplifting.

Dementia vs. depression

The differences between these two conditions can be a little harder to recognize. Mental sharpness declines in people with dementia, but it can also decline in people with depression.

Here are the main distinguishing factors:

Dementia tends to be characterized by slow mental decline, confusion, noticeably impaired motor skills, and trouble with short-term memory.

In contrast, depression may cause more rapid (but also more limited) mental decline, manifesting as problems with concentration and energy. People with depression also may consciously notice that they're having difficulties with memory. However, people with dementia often remain unaware of (or indifferent to) their memory problems.

Risk Factors for Elderly Depression

All kinds of different things can increase the odds of an older adult developing depression. The more risk factors a person has, the more likely it is that this condition will someday impact them. For starters, depression tends to be more common in women than men, so being female is considered a risk factor. But many other physical, psychological, and social factors can also increase the risk.

According to the AAFP, as many as 15 percent of adults whose spouses have passed away develop depression that lasts at least a year after becoming widowed? Other personal and emotional risk factors include:

• A personal or family history of depression
• Persistent grieving due to events such as:
  • The death of a friend or family member
  • Retirement from a cherished career
  • An unwanted change of residence
• Traumatic experiences such as accidents or elder abuse
• Financial problems
• Social isolation (including living alone)
• Fear of dying
• Past or current substance abuse (including alcoholism)

A huge range of physical risk factors has been linked to the development of depression. That's often why some people seem to get this condition all of a sudden. Depression can go unnoticed because of physical problems that share some of its symptoms. In some cases, physical issues cause people to feel a loss of control, leading to depressive disorders. In other cases, they cause biological changes that lead to chemical imbalances in the brain and, ultimately, depression. According to CDC, those facts are especially relevant for older adults since about 80 percent of seniors have one or more chronic health issues.

From disabilities to chronic diseases, some of the most common physical risk factors for depression in the elderly include:

• Hearing loss
• Failing eyesight
• Chronic pain
• Sleep problems
• Loss of mobility
• Stroke
• Cancer
• High blood pressure
• Heart disease
• Diabetes
• Parkinson's disease
• Alzheimer's disease
• Rheumatoid arthritis
• Vitamin or mineral deficiencies
• Hypoglycemia
• Thyroid disorders
• Hepatitis
• Multiple sclerosis
• Electrolyte imbalances
• Lupus

Some medications have also been linked to the risk of developing or worsening depression, especially in older people who take multiple drugs. Examples include certain kinds of prescription medications such as:

• Tranquilizers
• Sedatives and sleeping pills
• Painkillers
• Anti-inflammatory drugs
• Beta blockers
• Steroids
• Antipsychotic medications
• Drugs for high cholesterol
• Estrogen replacers
• Ulcer medications
• Drugs for high blood pressure
• Calcium-channel blockers
• Chemotherapy drugs

Signs, Symptoms, and Effects of Depression in Elderly People

Unless you know what to look for, it isn't always easy to recognize depression in older adults. That's particularly true for the physical effects of depression, which can masquerade as other health conditions. So it's important to keep a full range of possible symptoms in mind, understanding that red flags may be hidden behind inaccurate assumptions about how depression is "supposed" to look.

Everybody affected by this condition displays a different combination of symptoms. Some of the most common signs of depression in seniors include:

• Persistent sadness or despair
• Lack of self-esteem
• Frequent self-loathing
• General apathy
• Insomnia
• Over-sleeping
• Frequent forgetfulness
• Inability to concentrate
• Slower-than-normal speech or movement
• Loss of interest in previously enjoyed activities
• Social withdrawal
• Persistently low energy
• Unexplainable aches and pains
• Poor appetite
• Neglect of personal hygiene
• Grumpiness and short temper
• More frequent use of alcohol or other substances
• Suicidal thoughts

When evaluating seniors who may be depressed, geriatric mental health professionals often ask several questions designed to illuminate the red flags. Older adults with depression often provide answers that show they suffer from many of the following things:

• Frequently feeling bored
• Experiencing a lack of excitement in life
• Rarely, if ever, feeling happy or in good spirits
• Having difficulty beginning new projects
• Abandoning favorite hobbies and interests
• Frequently feeling fidgety or high-strung
• Having difficulty making decisions
• Frequently getting angry over small stuff
• Feeling generally unsatisfied with life
• Believing that most people are better off than they are
• Avoiding social get-togethers
• Resisting getting out and trying new things
• Feeling that something bad is about to happen
• Feeling hopeless about the future
• Feeling empty or helpless
• Frequently feeling the urge to cry
• Frequently worrying about the past or future
• Having difficulty concentrating
• Feeling that right now is a bad time to be alive
• Disliking getting up each morning
• Feeling worthless to other people
• Experiencing troubling thoughts that won't go away
• Believing that they have more trouble with memory than most people
• Feeling less mentally sharp than they used to be

It's also important to consider some of the common differences between men and women who have depression. For example, men are sometimes more likely to feel tired, frustrated, and irritable. Depression can also make men more likely to abuse substances like alcohol, display reckless behavior, lose motivation for their hobbies, or avoid conversation.

Risk of Elderly Suicide

According to the Geriatric Mental Health Foundation, seniors represent the age group with the highest risk of suicide. Over 25 percent of America's suicides occur in people over the age of 65. Even though depression is more common among older women, many more older men die of suicide. In particular, white males over the age of 80 have the highest risk of dying by suicide. They are about six times more likely to kill themselves than people in the general population.

That's why it is essential to communicate with depressed (or potentially depressed) seniors and listen for clues of suicidal thinking. Ask them how they feel about life. Find out if they ever think that life isn't worth living or if they ever plan or imagine harming themselves. If their answers are affirmative, make sure you find help for them right away, such as from doctors or mental health counselors.

If you feel that you or someone you love is in imminent danger of suicide, call 911 or go to a nearby emergency room. You can also call the toll-free National Suicide Prevention Lifeline at any time of day: Call 1-800-273-8255 (or 1-800-799-4889 for TTY service).

Why Depression Is Often Overlooked in the Elderly

Many older people don't receive the help they need and end up suffering unnecessarily from the full effects of depression. There can be all kinds of reasons for this. For example, depending on the individuals involved, elderly depression can be overlooked or go untreated because:

• People may mistakenly believe that a consistently depressed mood is a normal part of aging or a normal reaction to stressful circumstances.
• The symptoms may be more physical than emotional.
• Older adults may see mental illness as a social stigma and try to keep it hidden.
• Doctors, caretakers, or family members may miss or mistakenly rationalize away certain signs or symptoms.
• The effects of multiple medications or various illnesses may mask symptoms or make it difficult to perform accurate evaluations.
• Depressed seniors are sometimes misdiagnosed with dementia or suspected of being hypochondriacs.
• Substance abuse (including alcohol abuse) can make it difficult to sort out various symptoms and their causes.
• Poverty can make it more difficult for low-income seniors to get the help they need, so they choose not to report their symptoms to anyone.
• Older adults with depression may offer various excuses for not wanting to participate in daily activities rather than directly explaining the symptoms they're experiencing.
• Some seniors are too isolated for anyone to notice their symptoms.
• Seniors who are depressed may mistakenly think that help isn't available.

Help and Treatment for Seniors With Depression

Overcoming depression is more than possible. Most elderly patients with depression can be treated, and most are able to recover. So, regardless of your age, the potential to feel happy again is very real. Nobody should view depression as anything other than a treatable illness. But ignoring it can have serious consequences, including disability or premature death. Treatment is a must.

The earlier a senior's depression is recognized, the better. Many doctors routinely screen their elderly patients for depressive disorders; however, that isn't something you can always count on. You may have to ask. A doctor may order various lab tests such as a urinalysis, an EKG, or blood tests. Abnormal results can sometimes help diagnose a condition that may be linked to depression.

Mental health professionals are also good at recognizing the signs of depression in older people. Many communities have drop-in centers where seniors and their families can find experts and resources. They can be good places for initial screening and guidance.

Treatment for geriatric depression often involves a combination of medication, therapy, and lifestyle modifications. Other forms of treatment, such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), are also sometimes used in very severe cases. Depression is often treated alongside other medical or psychological conditions that may be at the root of the depression or somehow contribute to it.

If you don't have insurance and need help finding affordable health services in your area, check out the Health Resources and Services Administration (HRSA). The HRSA website maintains a national database of health centers where you can get services and only pay what you can afford.

Counseling and Psychotherapy

Therapy often works well for older adults with depression. Many seniors get better results from psychotherapy than younger people do. It helps them work through the underlying issues that may be causing or contributing to their depression. And it can enable them to change their habits and patterns of thinking so that they cope better with difficult emotions. The outcome is often a better quality of life.

For older adults with mild or moderate depression (and no other complicating illnesses), therapy may be as effective as antidepressant medication. Cognitive-behavioral therapy (CBT), in particular, is often very beneficial for seniors with depression. Most psychotherapy sessions take place in private settings on a one-to-one basis. But some people also derive benefits from various forms of group counseling, especially if they need extra support while dealing with grief, illness, or loneliness.

Antidepressants

Along with psychotherapy, many elderly people with depressive disorders are prescribed antidepressant medications. Such drugs tend to be just as effective in older adults as they are in younger people. However, there can be some important differences. For example, the therapeutic effects of antidepressants sometimes take a little longer to kick in when taken by seniors. And older people often need to take antidepressants for a longer time. Seniors also need to be more aware of potential adverse reactions with the other medications they may be taking.

In general, a senior with depression may need to be on an antidepressant for as many as six weeks until it takes full effect. But since antidepressants can sometimes make you feel a little worse before you start feeling better, some people quit taking their medications too early. The AAFP says that as many as seven out of 10 older adults on antidepressants stop taking their medication within the first four weeks. So it's important to have a personal support system, especially during the early stages of pharmaceutical treatment.

It's also essential to keep in mind that different people respond differently to different medications. If one antidepressant doesn't work, then a different one might. In some cases, it takes a few rounds of different prescriptions before finding one that is effective and doesn't cause problematic side effects. The same is true for finding the most effective dose of a particular drug.

The most common types of antidepressant medications prescribed for late-life depression include:

• SSRIs (selective serotonin reuptake inhibitors): This class of drugs represents the typical first line of pharmaceutical treatment for older adults with depression. They work by raising the amount of serotonin in a person's brain. Serotonin is an important neurotransmitter (i.e., a chemical messenger).
• SNRIs (selective serotonin-norepinephrine reuptake inhibitors): Like SSRIs, these drugs are commonly prescribed as a first-line treatment. In addition to raising serotonin levels, they raise levels of the neurotransmitter, norepinephrine.
• TCAs (tricyclic antidepressants): These drugs are usually only prescribed when SSRIs and SNRIs aren't effective or physically tolerated by elderly patients. In most cases, doctors avoid prescribing them. But for some people, they can be an option. They are an older class of drugs that work by blocking one type of neurotransmitter (acetylcholine) and increasing two others' levels (serotonin and norepinephrine)
• MAOIs (monoamine oxidase inhibitors): Like TCAs, these medications are usually only prescribed when patients don't respond well to other types of antidepressants. They work by preventing a specific enzyme in the brain from removing serotonin, dopamine, and norepinephrine.

Lifestyle Changes

Seniors with depression should always consult their doctors before making any big changes to their lifestyles. But developing new habits is often a critical part of getting better and preventing relapses after recovery. Although depression can make it difficult to find the motivation to make changes, support is often available to help nudge you in the right direction. Many people can start making changes after their antidepressants take effect. Here are some of the most beneficial changes you can make:

• Get more physical activity: Exercise is known to have a powerful effect on depression, especially for people with mild to moderate forms of depression. By moving your body as often as possible, you can reap many positive benefits, including improved mental health. And it doesn't have to be difficult. Find opportunities to do more walking or to get up and take part in simple activities like housework. Or consider learning yoga. Even if you use a wheelchair, there are many ways to perform safe, simple exercises.
• Eat a healthier diet: Nutrition often plays a large role in how seniors feel, mentally and physically. So strive to eat a more balanced diet. Consume plenty of fresh fruits and vegetables. Find lean sources of protein. Eat foods rich in omega-3 fatty acids. And lower your consumption of sugar and refined carbohydrates. Make an effort to eat a healthy snack or small meal every few hours so that you stay energized and avoid becoming too irritable.
• Prioritize good sleep: Getting seven to nine hours of deep rest every night can help ensure that your depression doesn't get any worse. Try to go to bed at the same time each night and get up at the same time each morning. If you have problems falling or staying asleep, your doctor may be able to prescribe a sleeping medication.
• Avoid alcohol: Drinking alcohol can make your depression worse over the long run or cause adverse reactions when taking antidepressants or other medications. It also tends to interfere with deep sleep.
• Socialize more: You may feel like isolating yourself, but it's important to resist that urge as much as possible. Interacting with friends or family can help you see different perspectives and maintain a sense of the bigger picture. As humans, we're all social animals. We need face-to-face contact with each other to feel our best. We need to laugh and swap stories. Regardless of your age, it's always possible to make new friends and connect with people who have common interests. Volunteering is often an effective way to meet new people while doing something that makes you feel good about yourself.
• Get out and about: Like socializing, regularly getting away from your place of residence can be a good way to prevent your depression from worsening. Visit local parks or museums. Do some window shopping. Have lunch with a friend or loved one. Or adopt a dog and take it for regular walks. Anything that gets you out, even for a short time, is likely to have a positive impact.
• Pursue the hobbies you previously enjoyed: You might feel some internal resistance at first, but doing activities that used to bring you joy can sometimes help you feel some of those positive feelings again. Try it, even if you're skeptical.
• Learn a new hobby: Trying something that you've always wanted to do can be a powerful way to engage your imagination and stimulate positive feelings. Creative pursuits can be especially beneficial since they help you express your feelings differently. Consider learning a new skill in the arts, such as painting, drawing, pottery, jewelry making, or playing a musical instrument.

Electroconvulsive Therapy (ECT)

For elderly people with severe depression that worsens or persists despite other treatments, ECT is often a safe and effective way to reverse the symptoms. While under general anesthesia, a brief seizure is intentionally triggered in a patient by passing small electrical currents through their brain. The result is frequently a positive change in brain chemistry.

Despite misconceptions among the general public and some health care providers, ECT has been used for several decades and has an excellent track record with elderly patients. ECT has been shown to be especially beneficial for people with depressive disorders who have a family history of depression, wake up too early each morning, have delusions, or have slowed psychomotor abilities. The most common side effects are short-term memory loss and confusion.

Self-Help Books for Depression

Check out this list of books, which are available for purchase through the following Amazon affiliate links:

• Feeling Great: The Revolutionary New Treatment for Depression and Anxiety
• The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness
• Trust Your Intuition: 100 Ways to Transform Anxiety and Depression for Stronger Mental Health
• The Happiness Plan
• The Power of Now: A Guide to Spiritual Enlightenment

How to Help an Elderly Loved One Who Has Depression

First, keep in mind that your loved one may put up some resistance, mostly out of fear or resentment. (We are often afraid of the actions we'll have to take to get better. And nobody likes to be seen as having a mental illness. Personal pride sometimes gets in the way of our better judgment.) Your loved one's depression may also make him or her feel hopeless, ashamed, or like a burden to you. All of those feelings can make it very difficult for your loved one to find the motivation to accept help and follow through with appropriate actions.

As you move forward, consider the following tips:

• Be sensitive, patient, and respectful: Listen to your loved one with the sole intention of understanding what he or she is going through. Offer some gentle encouragement and emotional support without judging, criticizing, or trying to fix his or her depression. Instead, acknowledge and validate the person's feelings while gently offering reasons for hope. Respect the fact that your elderly loved one will likely have different preferences than you when it comes to the timing and other aspects of what to do going forward.
• Help arrange visits with doctors or mental health specialists: Your loved one will need to be properly evaluated by one or more professionals in order to receive a correct diagnosis and the best treatment. Try to make this part of the process as easy as possible for your loved one by helping them find the right professionals, scheduling appointments, and attending those appointments in order to provide support and take accurate notes about what was said. If you can't attend appointments yourself, ensure your loved one has reliable transportation or see if somebody else can go in your place.
• Keep track of treatments and ongoing appointments: Older people with depression often have memory lapses and cannot think as clearly as they normally would. Ensure your loved one has an easy way of organizing and remembering to take daily medications, such as using a weekly pillbox or pill dispenser. It's also a good idea to set reminders for your loved one's appointments so that none of them are missed. Recovery from depression requires consistent dedication to treatment. Interruptions in treatment can lead to worsening and prolonged symptoms.
• Assist with lifestyle changes: Make it easier for your loved one to engage in beneficial habits by arranging activities or preparing healthy meals. Invite them to lunch or dinner, suggest that you go on walks, take yoga or art classes, attend live events, or go on other outings together. If you encounter resistance, remain patient but gently persist. And stay mindful of your loved one's limitations when it comes to his or her physical abilities.
• Watch for hazardous behaviors or signs of suicidal thoughts: Your loved one may exhibit slower responses and reaction times when performing certain tasks. So be aware of potential dangers if your loved one drives, cooks, prepares his or her own medications, or does other things that require complete focus and attention to detail. And never overlook any comments by your loved one related to suicide or harming oneself, even if they seem like jokes.

Depression in the elderly doesn't have to be a long-term problem. With help and persistence, almost anyone can get better, regardless of their age. Don't give up. Always remember that there are plenty of reasons to remain hopeful. Move forward gently, but with real purpose. With time, the light will probably return.