Depression and Aging
Learn about the issue of depression in older adults...
Depression affects more than 6.5 million of the 35 million Americans aged 65 years or older, according to the National Alliance on Mental Illness. Unfortunately, depression often coincides with physical ailments, and symptoms are often overlooked in older adults. The reality is that depression can have devastating – and sometimes deadly – effects on our lives.
Gerontology Resources
Depression in older adults arises from a number of reasons. Lifestyle changes like retirement or loss of home often contribute to a sense of hopelessness, leading to depression. Loss of a spouse or loved one trigger feelings of loneliness and grief that may eat into our daily lives. When physical illness strikes, older adults may be lost in doubt and confusion about their futures, causing mental distress.
Health is defined by both physical and mental wellness, so it is important for older adults to take their mental health seriously. Older adults with depression will be happy to know that treatments for depression are widely successful, and it is possible for them to live lives free of depression. Statistics from the Centers for Disease Control and Prevention show that 80% of depression cases are treatable.
Normal Grief vs. Depression
Since older adults often experience the loss of loved ones and friends more frequently than younger adults, they can go through more periods of grief. Grieving is a normal feeling that associated with loss, and often is accompanied by depressive symptoms. Many older adults who are grieving are incorrectly diagnosed as with clinical depression, also called major depressive disorder, (see article on Types of Depression.)
When we lose a loved one, it is normal to have feelings of emptiness and sadness, symptoms of clinical depression as well. If these feelings associated with grief begin to encompass your life, however, and persist past the normal grieving period, an older adult might become clinically depressed. Clinical depression causes more severe reactions to grief, such as a person looking at the loss of a loved one as a punishment, and feeling guilty or having anger directed inward. By recognizing the symptoms of depression and seeking clinical and psychiatric assistance, older adults will prevent their health from slipping into more serious conditions – and living their later years depression free.
Symptoms of Major Depressive Disorder (Clinical Depression)
The following are some of the common signs of depression according to the National Institute on Aging:
- An “empty” feeling, ongoing sadness, and anxiety
- Tiredness, lack of energy
- Loss of interest or pleasure in everyday activities, including sex
- Abnormal sleeping habits
- Eating more or less than usual
- Crying too often or too much
- Aches and pains that don’t go away when treated
- A hard time focusing, remembering, or making decisions
- Feeling guilty, helpless, worthless, or hopeless
- Being irritable
- Thoughts of death or suicide; a suicide attempt
Depression Can Be Deadly
Suicide is a deadly outcome that can result from severe depression. Older adult men are the highest group of all ages to commit suicide, making correct diagnosis and treatment of depression critical. Men aged 85 and older account for 20% of all suicides despite making up only 13% of the population, according to the American Psychological Association.
It is important to understand that suicide is not a normal outcome of depression or stress. Those who commit suicide have previous depressive symptoms, that, if treated successfully, could prevent a suicide attempt. The National Institute for Mental Health (NIMH) lists a number of risk factors that could contribute to a suicide attempt including history of substance abuse, history of a mental disorder, family history of suicide, family violence, incarceration, prior suicide attempts, and firearms in the home.
Difficulties with interpersonal relationships also factor into why an older adult commits suicide, as well as loneliness. Physical illness sometimes drives older adults to commit suicide especially when severe pain or debilitating diseases cause disability, furthering depressive symptoms.
Depression and Physical Illness
Physical illness impacts the ways we perform everyday activities. Things we take for granted like walking to the store, going for a run, or using the stairs. Individuals spend most of their lives performing these activities without much thought, but when illness takes away some or all of their mobility, depression often follows.
Depression associated with physical illness then – indirectly – worsens the physical illness, according to R. Smyth, writing in The Journal of the Royal College of Physicians of Edinburgh . In the article, “Depression in Physical Illness,” Smyth writes that several factors contribute to the depression-physical illness cycle, including interference with compliance and rehabilitation, poor diet, lack of exercise, and overall poor self-care.
Smyth lists a number of risk factors regarding depression and physical illness:
- Severe or life-threatening illness
- Chronic, debilitating, disfiguring, or painful illness
- Unpleasant and demanding treatment
- Lack of family or social support
- Co-morbid alcohol or drug misuse
- Drug treatments that cause depression as a side effect
- Illnesses affecting the neurological systems
Treating Depression
There are a number of different ways to treat depression, but a combination of medication and psychotherapy is the most successful, according to NIMH. Antidepressant drugs affect neurotransmitters in the brain, altering levels of chemicals like serotonin, a a substance that helps regulate mood.
Psychological help can be instrumental to defeating serious depression in older adults. Short-term therapy can be especially useful for changing negative perceptions of self-image and self-defeating thoughts. Some older adults find that group therapy settings are more beneficial to treating depression, as it allows them to interact with older adults experiencing similar problems.
Treating depression in the physically ill not only improves the mental outlook of a patient, but also the physical outlook. Patients successfully treated for depression are more likely to participate in rehabilitation, and comply with the recovery process. Practical interventions such as educational instructions for those who suffer physical illnesses also help ameliorate unrealistic worries. Unfortunately for patients with physical illness, organizing group therapy is often difficult because of the physical limitations of many patients.
Preventing Depression in Old Age
Perhaps the most effective way to halt depression in older adults is to prevent it from happening in the first place. In The Medical Journal of Australia, there are a few strategies outlined by Michael Bird and Ruth Parslow in “Potential for Community Programs to Prevent Depression in Older People.”
One way to prevent depression is to increase knowledge about depression for people who treat older adults. Many older adults who need treatment for depression do not receive it. This would be targeting mostly at practitioners to explain the high prevalence of depression in older adults. Explaining that depression is not an inevitable part of aging, and teaching practitioners how to treat depression in older age is essential to preventing depression.
Regular exercise prevents older adults from living sedentary lifestyles, and improves their outlook on life. According to Bird and Parslow, exercise does not need to involve lifestyle changes, but might simply involve a walk each day. Exercise also helps prevent heart disease and maintains functional mobility
For more information on careers that focus on depression and aging, contact schools that offer degree programs in gerontology.
Alcohol Abuse in Older Adults
Studies have shown significant correlation between older adults, depression, and abuse of alcohol. Alcohol exaggerates feelings, both good and bad, and is often used as a coping mechanism for depression. With nearly 6.5 million older adults experiencing depression in the United States, alcohol abuse is a significant contributor to depressive feelings in older adults.
Older adults who are depressed are three to four times more likely than adults who are not depressed to have alcohol-related problems, according to a study titled “Older Adults, Alcohol, and Depression” funded by Health Canada. The study names two forms of depression older abusers of alcohol typically experience.
Transient Depression
Transient depression occurs when older adults who have been drinking for a long time experience short-term depression either due to intoxication or withdrawal. Transient depression usually subsides in time after drinking stops or the individual completes withdrawal symptoms.
Underlying Depression
Those with underlying depression have usually dealt with depression at earlier points in their lives, and may drink to cope with stresses in life. Underlying depressions may not be discovered until after a person quits drinking and continues to exhibit symptoms of transient depression past withdrawal stages.
Negative Effects of Alcoholism on Older Adults
Drinking too much alcohol over a long time can:
- Lead to some kinds of cancer, liver damage, immune system disorders, and brain damage
- Worsen some health conditions like osteoporosis, diabetes, high blood pressure, and ulcers
- Make some medical problems hard for doctors to find and treat.
- Cause some older people to be forgetful and confused. These symptoms could be mistaken for signs of Alzheimer's disease.
Treating Alcoholism in Older Adults
Older adults who abuse substances may have turned to alcoholism because of life's stresses, so strong family support is critical for treating the disease. Family members can start help by seeking medical attention for the older adult and provide support during detoxification. After detoxification, older adults can seek further treatment at inpatient programs, day treatment, outpatient therapy or community-based groups.