Depression in the Elderly

Let's begin with a caution — if you or a senior you care for have experienced suicidal thoughts, call 988, the Suicide and Crisis Lifeline, which offers help from trained representatives who speak English and Spanish. If you're a veteran, dial 988 and then press 1. Counselors are available 24/7 to help you understand what you're feeling and going through.

Depression in the elderly is common. According to the Centers for Disease Control, about 4% of older adults live with chronic depression, though a far higher percentage may experience symptoms of depression at times. Fortunately, there is help for those who are experiencing the condition. In this article, we take a look at depression's causes, signs in older adults, and ways you or your senior loved one can find relief from this common mental health challenge.

Depression affects many in our society, with the National Institute of Mental Health estimating that 21 million adults in the U.S. have experienced at least one major depressive episode. Depression is considered a mental health illness with many causes, including biological factors and social, psychological, and medical considerations. 

Depression can be challenging to diagnose since its symptoms can mimic common feelings of sadness or other emotions. Simple feelings of sadness or grief alone may not indicate depression, especially after a sorrowful event such as the loss of a partner or friend.

Stress plays a role in depression, making caregivers and seniors susceptible. In addition to mood changes, depression can cause a loss of interest in activities, changes in sleep patterns, and feelings of worthlessness, among other symptoms. 

Senior depression can manifest in many ways. It is not, however, the same thing as simple feelings of sadness. Sadness is an expected response for seniors who have lost loved ones,  experienced illness, or faced changes to their lifestyle. 

Depression is more common in people who are experiencing serious medical conditions like heart disease, as well as those for whom daily functioning has become limited. Be alert for these additional signs of depression in elderly people:

• Avoidance of activities they previously enjoyed
• Significant changes in weight or any marked change in appetite
• Insomnia, or, conversely, sleeping too much
• Feelings of irritability, frustration, or restlessness
• Lack of energy, an overwhelming sense of exhaustion
• Feelings of worthlessness or guilt
• Difficulty remembering things or concentrating
• Thoughts of suicide or a sense that they wish they'd never been born

Consider consulting a medical professional if these feelings persist for more than two weeks.

 

Research into the causes of depression is ongoing. The condition is complex, and although chemical changes in the brain probably play a role, there are likely multiple reasons why depression in the elderly is so common. Genetics may matter, for example, and stress can also contribute to symptoms. 

Knowing the potential causes of your loved one’s depression can help determine the proper medical course for alleviating the condition. As a caregiver, monitor your loved one for any of the following possible causes of depression.

• Death Of A Friend Or Loved One: Although grieving is natural after a loss, it can also morph into an extended period of depression that persists after the loss.
• Retirement: Many people define themselves by their work. When they retire, they may lose their sense of purpose and the companionship of coworkers. 
• Health Problems: Old age often comes with increased physical challenges. As seniors experience illness, they may mourn the loss of independence or the presence of chronic pain. 
• Social Isolation: A senior's world may slowly contract as they lose loved ones and friends. Perhaps they no longer drive or participate in physical activities such as sports. The loneliness and isolation that ensues may lead to depression.
• Medication Side Effects: Drugs taken for common senior illnesses, such as Parkinson's disease, high blood pressure, and high cholesterol, may cause depression as a side effect. 
• Financial Difficulties: Older adults may have less income than they did while working and could find it challenging to manage the non-inconsiderable costs of assisted living or other types of senior care. Financial challenges can seem insurmountable, leading to feelings of helplessness and depression.
• Caregiver Stress: Caring for a loved one can be stressful, which can further affect seniors, who may feel that they are an undue burden on those they care about.

As noted above, old age can be marked by losses of many kinds: a spouse or partner, friends, independence, and/or good health, which can contribute to depression. Fortunately, several organizations can help seniors battle feelings of isolation and loss in various ways. 

If you care for a senior who lives alone, ensure that they can care for themselves despite any losses. In some cases, it may warrant a discussion with your loved one on whether they should consider another type of residence that will allow them to remain more connected to others. 

They may thrive in an independent living or assisted living residence, for example. If their health is seriously compromised, a nursing home or memory care facility may be a better choice.

Amid loss, many seniors may face feelings of isolation, especially when they reach a point where driving is no longer possible. According to a report from the National Institute of Health (NIH), 43% of adults aged 60 and over feel lonely and experience social isolation. The NIH report notes that social isolation can bring with it an increased risk of premature mortality, dementia, and other illnesses.

Older adults can fight feelings of isolation in several ways, including adding a pet to their household. There are multiple benefits for seniors in owning a companion animal, and studies show that people with pets have a lower risk of illnesses such as heart attacks and depression. Adopting an older dog or cat can be highly rewarding for those who might not be able to handle a lively puppy.

If a pet is not an option, there are tactics to consider to help your senior loved one avoid isolation. Weekly trips to the library, for example, offer them an easy activity associated with reduced stress and increased social connections. 

Many seniors face declines in their physical health, which may also leave them more susceptible to depression. Medical conditions as simple as vitamin deficiencies or as intensive as cancer can make it harder for seniors to manage their lives, and lost independence may trigger depressive episodes. Illnesses that affect the brain, such as cerebrovascular disease, may affect the brain's blood flow and cause mood changes. 

Seniors with chronic illnesses are also more likely to lead sedentary lives, unable to take walks or exercise. Although research continues to evolve, some studies indicate that those who are mentally or physically passive and sedentary could have an increased risk of depression. 

First and foremost, clinical depression is a medical condition and thus has medical treatments involving therapists, doctors, and tailored prescription regimens. Start by consulting with your or your senior loved one's medical team to find the correct treatment to ease the depression symptoms. The list below contains treatments that have the potential to improve depression-like states of grief or sadness.

Here are some of the possible treatments for people living with depression:

• Medication: There are many types of medication available for the treatment of depression. Selective serotonin reuptake inhibitors are often the first option, as they have fewer side effects. These include Paxil and Zoloft, among others. 
• Psychotherapy: Talk therapy can help seniors adjust to the difficulties they face and help them explore new and healthy ways to live. 
• Mindfulness-Based Cognitive Behavior Therapy: CBT is increasingly used in a therapeutic setting as it helps people monitor and change damaging behaviors and thought patterns. This therapy stresses developing coping skills to help counter the negative patterns of depression.
• Exercise: Many medical professionals recommend a daily routine of exercise for those experiencing depression. Although the medical link isn't totally clear with depression, exercise seems to improve mood by releasing endorphins and helping patients gain confidence, coping skills, and social interaction.
• Residential Treatment: Patients may be able to improve severe depression with an inpatient stay at a hospital or treatment center. This option may best suit people who are a danger to themselves or others. 
• Electroconvulsive Therapy: This therapy has proven helpful for those who do not respond to medication. ECT works by passing an electrical current through the brain to stimulate neurotransmitters.
• Transcranial Magnetic Stimulation: Similar to ECT, this treatment sends magnetic pulses through the brain that stimulate the nerve cells involved in mood regulation.

As a caregiver, it can be frustrating and worrisome for a loved one to experience depression, and you may feel unsure of how to help. If they are truly dealing with depression, it won't do any good to urge them to "cheer up" or "look at the bright side" — depression is not the same thing as simply feeling sad. It can be chronic, long-lasting, and likely to require medical intervention. 

Here are some steps you can take to help your senior loved one manage their depression:

• Encourage your senior loved one to set up an appointment with their primary care physician. Start by determining that there is no physical cause for their depression, such as an untreated ailment that is causing them pain or a medication with unwelcome side effects.
• Work with your senior's medical team to determine their best treatment plan. These options may include medication, talk therapy, and other modes of treatment.
• Be patient with your loved one. Their depression may cause them to be irritable, forgetful, or restless. They may not have reasons for these feelings, and you may need to accept that and just listen compassionately.
• Help your senior to keep medical appointments. Offer to help with driving or simply check in to make sure your loved one makes their appointments. People with depression often wish to withdraw and may forget or be reluctant to attend therapy sessions, so a helping hand may be necessary to get them to follow through.
• Listen for changes in their behavior. Pay attention to what they say and how they act, especially for any signs of potential self-harm. Consider the symptoms highlighted above and watch for them when you're with your senior loved one.
• Encourage them to exercise. Ask your loved one if they would like to go for a walk, enjoy a bike ride together, or exercise in tandem. Schedule social activities and help them follow through. Gently insist if they are hesitant — they may feel better after the event.

Depression is a serious clinical illness that affects millions of Americans. Older adults may struggle with depression due to several causes, including grief over the loss of a loved one and/or a genetic predisposition to the condition. Helping your loved one face depression can take many forms, although a good first step is to encourage a visit to their primary care physician to rule out physical causes.

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