Common, but not normal
The National Institute on Aging (NIA) is clear that depression is a common problem among older adults but not a normal part of aging. NIA also notes that most older adults feel satisfied with their lives, even when they have more illnesses or physical limits than younger people. Feeling persistently low, worried or empty is not the price of getting older. It is a health problem, and NIA says that for most people it gets better with treatment.
That matters because many older adults, and their families, assume low mood is just what happens after a loss, a diagnosis or retirement. MedlinePlus notes that depression in older adults is often not recognized or treated.
Why it can be hard to see
Depression later in life often looks different. NIA notes that sadness may not be the main symptom. Instead a person may feel emotionally numb, lose interest in activities, or simply be less open to talking about feelings than a younger adult would be. In some cultures depression shows up mostly as physical complaints such as aches, headaches or digestive problems.
MedlinePlus points out another reason it gets missed: common symptoms such as fatigue, poor appetite and trouble sleeping can also come from aging or a physical illness, so they get put down to something else. Signs worth noticing include:
- Giving up a standing card game, church group, garden or walk without a clear reason
- Saying "what's the point" about plans, meals or medical care
- Sleeping much more or much less, or waking very early
- Slower speech and movement, or trouble making decisions
- Drinking more than usual, or relying on sleep aids
- New irritability, worry or fearfulness, including about money or health
- Unexplained aches that do not improve with treatment
Anxiety can sit alongside depression or on its own. MedlinePlus lists feeling unusually worried or scared, and withdrawing from people and activities, among the warning signs of mental health problems in older adults.
What raises the risk later in life
NIA and MedlinePlus list a mix of medical, social and life-change factors. None of them causes depression on its own, but they add up:
- Illnesses such as stroke, heart disease, cancer, Parkinson's disease, thyroid problems or dementia
- Chronic pain, or loss of independence such as giving up driving
- The death of a spouse or close friends
- Moving out of a longtime home
- Caring for a spouse or relative who is seriously ill
- Sleep problems, physical inactivity, and social isolation or loneliness
- Alcohol use, and some medicines, which NIA groups under substance- or medication-induced depression
Isolation deserves its own mention. NIA notes that loneliness and social isolation are associated with a higher risk of depression. Loneliness, Isolation and Depression looks at that link and at ways to rebuild contact.
Men deserve particular attention. MedlinePlus notes that men make up most suicides among older adults, and that divorced or widowed men are at the highest risk. An older man who has recently lost his wife, stopped seeing friends and says little about how he feels may need someone to ask directly how he is doing.
Depression, memory and dementia
This is one of the most confusing areas for families. MedlinePlus notes that in severe cases depression can resemble dementia. NIA adds that depression is common in people with Alzheimer's disease and related dementias, that dementia can cause some of the same symptoms, and that depression can be an early warning sign of possible dementia.
The practical point: memory or concentration problems in someone who also seems low should be evaluated, not assumed to be one thing or the other. A doctor can look at both.
Start with a checkup
MedlinePlus describes the first steps of treatment as treating any illness that may be causing the symptoms and reviewing medicines that may be making them worse. Overuse of alcohol or certain medicines, such as sleep aids, can deepen depression. Never stop a prescribed medicine on your own; talk with your prescriber before changing anything.
To get the most out of the appointment, bring:
- A list of every prescription, over-the-counter medicine and supplement
- Dates of recent losses, moves, diagnoses or hospital stays
- What has changed in sleep, appetite, energy and interest, and for how long
- A family member, if you want one, to add what they have noticed
If depression is confirmed, treatment usually means talk therapy, medication or both. MedlinePlus notes that providers often start older adults on lower antidepressant doses and raise them more slowly. Therapy can help with grief, role changes such as retirement, strained family relationships and the fear that often comes with illness. MedlinePlus also notes that outcomes are usually better for people with family, friends and social services that help them stay active and engaged.
Support in Michigan
Practical help can lift some of the weight that feeds low mood. The Michigan Department of Health and Human Services (MDHHS) directs older adults and caregivers to their local Area Agency on Aging to learn about aging services in their area, from in-home help to caregiver support.
Dr. Lehmann, a licensed clinical psychologist in Franklin, sees adults of any age for depression therapy and anxiety, in person or by telehealth for clients located in Michigan. Telehealth can help if driving has become difficult. If you are worried about a parent, Caring for an Aging Parent: Stress, Anxiety and Depression speaks to the caregiver's side, and coverage questions are covered in Does Medicare Cover Therapy for Anxiety and Depression?