Depression can occur in the elderly, but it is not a normal part of aging. While most people experience periods of sadness at times, depression is a treatable medical condition.
Prevalence of depression among older adults According to the Centers for Disease Control and Prevention (CDC), depression affects about 1%-5% of the general elderly population, 13.5% in elderly who require home healthcare, and 11.5% in older hospital patients.1
Older adults are at risk of misdiagnosis and lack of treatment because some of their symptoms can mimic normal age-related issues. Symptoms can also be mistakenly attributed to other illnesses, medications, or life changes.2
Elderly patients might also be reluctant to talk about their feelings or fail to understand that physical symptoms can be a sign of depression. For elderly people living independently, isolation can make it difficult to reach out for help.
Symptoms of depression in older adults The essential feature of a major depressive episode is a period of at least two weeks when the person experiences either depressed mood (most of the day, nearly every day) or loss of interest or pleasure in nearly all activities.3 According to the American Association for Geriatric Psychiatry, the most common symptoms of depression in the elderly include:
Persistent sadness Feeling slowed down Excessive worries about finances and health problems Frequent tearfulness Feeling worthless or helpless Weight changes Pacing or fidgeting Difficulty sleeping Difficulty concentrating Somatic complaints (unexplained physical pain or gastrointestinal problems) Withdrawal from social activities 4 Medical conditions and depression Medical problems, including chronic medical conditions, can trigger, or worsen the symptoms of, depression in elderly patients. Any medical condition, especially those that are painful, debilitating, or life-threatening can result in symptoms of depression, including:
Cancer Parkinson’s disease Stroke Heart disease Lupus Diabetes Dementia and Alzheimer’s Multiple sclerosis Medication and depression Certain medications are associated with depression in older adults. These medications include: cardiovascular drugs, chemotherapeutics, antipsychotic drugs, antianxiety medications and sedatives, anticonvulsants, anti-inflammatory/anti-infective agents, stimulants, hormone drugs, and other drugs. 5
Elderly patients who experience depressive symptoms when taking medications should report symptoms to the prescribing physician immediately.
Depression and dementia Depression and dementia share several symptoms, making it difficult to distinguish between the two. It helps to how the common symptoms manifest in each disease.
Depression
Mental decline is rapid Patients can state the correct date, time, and they are Patients have difficulty concentrating Language and motor skills are slow but normal Patients notice and worry about memory problems and confusion Dementia
Mental decline is slow Patients become confused and disoriented and may get lost, confuse dates, or wonder where they are Patients struggle with short-term memory Writing, speaking, and language skills are impaired Patients don’t notice or seem to care about memory problems 6 Treatment of depression in older adults Effective treatment of depression in older adults can require more than one approach.
Psychotherapy: Ongoing, talk therapy can be a source of support for elderly patients. Short term, solution focused therapy (Cognitive Behavioral Therapy) can also be effective in helping elderly patients eliminate thinking patterns and behaviors that contribute to depressive symptoms. Research shows that making adjustments for older patients to include addressing physical health and religious/spiritual beliefs improves treatment outcomes. 7
Support groups: Groups designed to connect older adults experiencing similar issues (depression, medical conditions, bereavement, etc.) are beneficial in establishing social support and providing a safe space to talk.
Medication: Antidepressants can be prescribed to relieve the symptoms of depression. Antidepressants can have significant side effects, and elderly patients are sensitive to medications. Medication should be closely monitored.
Lifestyle changes: Daily exercise, healthy eating habits, and increasing social support are all important in helping elderly patients with depression. Friends and family members can help by doing the following:
Schedule group outings Establish a weekly visit Assist with transportation to medical appointments Cook and freeze healthy meals for easy preparation Help create a system to ease with taking medication regularly Suicide risk There is always a risk of suicide with major depressive disorder. According to the latest data (2015), the second highest suicide rate in the United States (19.4) occurred in people 85 years or older. The highest rate (19.6) was among adults between 45 and 64 years of age. 8 Though a past history of suicide threats or attempts remains the biggest risk factor, most completed suicides are not preceded by unsuccessful attempts. If an elderly patient shows any signs of suicidal thoughts or behaviors, it is important to seek immediate assistance.
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