Depression After 60: Your Questions Answered

The facts about seniors and depression are distressing, but perhaps not surprising. As many as one in five seniors experience depression, and that number is significantly higher among seniors in hospitals and long term care facilities.  Studies indicate that older women are nearly twice as likely as men to suffer from depression. At the same time, statistics indicate that approximately half of older adults with depression or some other mental disorder do not receive mental health services.1

If you are aged 60 or older and think you may be suffering from depression, or if you are caring for an older adult who is experiencing symptoms of depression, the first step to wellness is to become educated about how depression impacts older adults, and how it can be effectively managed. Here, we address a number questions commonly asked by patients and caregivers about later-life depression.

Isn’t depression just a fact of life as you grow older?

Many people assume that feeling depressed is a normal part of growing older. That’s just not the case.  Regardless of age, no one is destined to suffer the symptoms of depression.  Effective, proven treatments are available to improve the quality of life for patients at all stages of life, including seniors.2

I think my dad may be depressed. How can I know for sure?

When it comes to diagnosing depression, it’s important to work with a qualified healthcare professional.  By asking specific questions and/or using proven screening tools, he or she can determine whether symptoms are pointing to an episode of depression. Specifically, here are a few things a clinician will be looking for: a loss of interest or pleasure in all activities for a period of at least two weeks, or a depressed mood that lasts most of the day nearly every day, combined with at least four of the following:

Can our family doctor diagnose depression?

Yes. Many patients feel more comfortable discussing emotional issues with someone they already trust, such as a family doctor.  But it’s important to be aware of certain factors that can get in the way of a family doctor arriving at an accurate diagnosis when working with an older patient.  Other chronic issues, such as diabetes or heart disease, tend to be the primary focus of a doctor visit, leaving little time to discuss emotions. Older adults may also underreport their symptoms, seeing these symptoms to be weaknesses or thinking them to be unimportant in comparison with urgent issues such as pain from arthritis or trouble breathing due to respiratory problems.  Also, since depression shares many common symptoms with other illnesses and often occurs along with other conditions (called co-morbidity), it’s easy for both the patient and the doctor to attribute the symptoms of depression to another condition.       

Keeping those factors in mind, it’s good to prepare in advance to discuss concerns about depression with your primary care physician. This worksheet may be a helpful starting point.  If after having an initial conversation with your healthcare provider you feel additional resources are needed, don’t hesitate to ask for a referral to a specialist.

My mother already takes so many medicines for her other health problems. Can’t we just let her depression run its course? 

There are serious consequences to leaving depression untreated in patients of any age. For older adults, untreated depression can accelerate loss of function and overall decline.3 Depression can also worsen other disabilities. And clearly, unmanaged depression can have a marked effect on an individual’s quality of life.  Moreover, it’s important to recognize that depression is a real brain illness, and is just as debilitating as any other health issue a senior may face. Left untreated, depression will not simply pass over time.

I’m a senior citizen, and I went to my doctor with problems she’s diagnosed as depression. She prescribed an antidepressant, but it didn’t work. What’s wrong with me?

Don’t give up on getting help for your depression.  In many patients, and particularly in seniors, it’s common to need to try more than one medication before arriving at an effective course of treatment.  Talk to your doctor about what other options you can pursue, such as using a different medicine, or combining medicine with psychotherapy, also known as talk therapy.

My father has been diagnosed with depression. Does that mean I’m destined to develop it too?

Not necessarily. Although science points to a link between genetics and depression, the specific relationship remains unclear. When it comes to depression in older adults like your dad, one factor to consider is whether this is his first incidence of depression (called late onset depression) or whether he has had prior bouts of depression (called early onset depression).  Research indicates that early onset disease is more likely related to a family history of the disease than when depression first occurs later in life.4

My aunt was always such a happy, well-adjusted person.  But now that she’s older, she’s developed depression. How does that happen?

A number of factors can lead to depression developing later in life (late onset depression). Some diseases, including cardiovascular disease, diabetes, cerebral vascular disease (stroke) and Alzheimer’s disease can increase the risk of depression.5  Developing poor lifestyle habits and behaviors, such as poor diet, lack of exercise, or insufficient sleep, can also increase one’s risk of developing depression. Behavioral or psychological factors can contribute to depression.  For example, people who have a tendency to ruminate over issues or problems are more likely to become depressed.  Finally, stressful life events such as financial concerns, the loss of a loved one, the appearance of a new illness in oneself or in a loved one, or a change in living arrangements have all been shown to contribute to the development of depression.6  

My mom is showing signs of depression, and I’ve noticed that her memory and concentration are also growing worse. Is she depressed, or is this the first sign of Alzheimer’s, or both?

Depression can be an early symptom of Alzheimer’s disease or dementia.  Also, research indicates that patients with depression may be at greater risk of developing dementia. For patients experiencing a combination of symptoms such as those you’re describing, arriving at a reliable diagnosis can be challenging.  Begin by making an appointment with your mother’s doctor to discuss your concerns.  He or she may wish to provide a referral to a specialist, such as a neuropsychologist, to help determine the problem and chart a course of action.

My mother is having trouble sleeping, and she’s asked me to speak to her doctor about sleeping pills. I’m concerned – won’t they put her at increased risk of falling?

That’s a valid concern.  Often in our eagerness to “fix” a sleep problem, we rush to prescribe a sleep aid, or to reach for an over-the-counter aid, both of which could cause grogginess and increase risk of falling.  Fortunately, there are many simple strategies your mother can try to sleep better.  Unknown to her, she may have developed habits that sabotage a good night’s sleep.  Visit the section of this website devoted to sleep and read about sleep strategies.  If after trying these, the problem persists, have a talk with your mom’s doctor.

My father recently passed away and we moved my mother into an assisted living facility. Although she’s not currently showing signs of depression, we’d like to keep her healthy and happy. Is there anything we can do to prevent depression from accompanying these life changes?

You’re wise to be proactive.  Depression doesn’t have to be the result of loss or life change, but statistics indicate that people facing such significant milestones are at greater risk.  Experts recommend intervening early to prevent depression or reduce its severity, and studies show that early intervention can ward off up to 25% of new occurrences of depression.7 You might want to consider finding a grief and loss support group that your mother could attend. Also, if your mother does develop trouble sleeping or managing stress, it’s recommended that these be addressed as soon as they’re identified, before they lead to depression.   And if your mother suffers from a chronic illness such as diabetes or cardiovascular disease, make sure that she – and everyone who cares for her—becomes educated about the role nutrition, sleep and physical activity can play in managing these conditions and warding off depression.

Finally, don’t neglect your own emotional health.  You’ve experienced a loss too. 

Contributions to this article were provided by Sara Wright, Ph.D., clinical lecturer in the University of Michigan Department of Psychiatry and staff psychologist at the Ann Arbor VA Healthcare System.

References

1 WHO World Mental Health Consortium, 2004 
2 Fiske et al, 2009, depression in older adults, Annual Review of Clinical Psychology
3 Elderkin-Thompson, et al, 2005
4 Kendler, Gatz, Garnder, & Pedersen, 2005
5 Li et al., 2008, Carney and Freedland, 2003, Wright & Persad, 2007
6 Nolen-hoeksema and Ahrens, 2002
7 Schoevers et al, 2006

 

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