Depression is more common in the elderly than in any other age group, affecting 20% of those living in the community and 40% of those who are living in care homes, according to the Mental Health Foundation statistics on mental health. Older people are less likely to complain of feeling sad or of having low moods and instead, will often complain of physical aches and pains. It can be difficult to diagnose depression in elderly people because the physical symptoms will often accompany other medical conditions and many will attribute any aches and pains either to illness or will consider them a natural part of growing old and not as a result of any underlying depression.
The elderly are more likely to have to cope with existing health problems on a daily basis, will often have to endure social isolation perhaps due to a disability or lack of opportunity to socialise, as well as having decreased mobility and increased dependence on others, and possibly suffer from economic difficulties too. They may make the mistake of thinking that any symptoms of depression they might have are perfectly normal under these circumstances, which just isn’t the case. It is also more common amongst the elderly population to view depression as a sign of weakness or an inability to cope and so will be less likely to seek help. All these factors combined contribute to an increased risk of suicide in older people and so it is essential that any signs or symptoms of depression are taken seriously and are not just attributed to old age.
Symptoms of elderly depression
Although the symptoms of depression are more or less the same for all ages, there are some differences in the way any depressive illness might manifest itself in the elderly. All of us can feel sad, lonely and fed up on occasions, without being depressed, but when persistent low moods continue beyond two weeks or more and are severe enough to interfere with ordinary daily activities and routines, then it is no longer considered normal no matter what age you are.
Confusion and memory lapses are relatively common symptoms in the depressed elderly, which they may mistake for the onset of dementia, but which are actually a result of an underlying depression. This in itself can cause a great deal of worry and distress. Some of the most common symptoms to watch out for that might indicate depression in the elderly include:
o Anxiety and worry
o Physical aches and pains
o Problems with memory
o Confusion, delusions and hallucinations
o Concentration difficulties, inability to focus
o Social withdrawal and lack of interest in other people
o Appetite changes and weight fluctuations
o Sleep disturbances, insomnia or hypersomnia
o Irritability, anger and dark moods
o Demanding behaviour
o Neglect of personal care
o Feelings of guilt and hopelessness
o Grief that continues long after bereavement
o Agitation and restlessness
o Feeling a burden to others
o Lack of energy and fatigue
o Decreased interest in activities they previously enjoyed
o Thoughts or talk of death, suicide or suicide attempts
What causes elderly depression?
There is no one cause of depression in any demographic group but a combination of psychological, physical, biological and environmental factors can trigger a depressive episode and in the elderly this includes:
o A previous history of depression
o Fear of dying or death or of losing someone close
o Frustration with disability or slowing down of mental faculties
o Loss of loved ones
o Major life events e.g. retirement, living alone, moving into a nursing or retirement home
o Loneliness and isolation
o Lack of support
o Decreased mobility
o Existing physical illness and pain
o Dependency on others
o A pessimistic view of the future
o Vascular changes in the brain
Treatment options include medication, some form of psychotherapy and counselling, and in more severe cases of depression or where other forms of treatment have proved ineffective, possibly ECT (Electro Convulsive Therapy).
If antidepressants are prescribed it is important that the doctor is aware of exactly what medications the individual is currently taking, both prescribed and over the counter preparations, to avoid any adverse interactions that might occur with antidepressants. The newer SSRIs (Selective Serotonin Reuptake Inhibitors) have fewer side effects so may be a more favourable option for the elderly as older people tend to be more susceptible to the effects of any medication.
Many elderly people are reluctant to accept they might be depressed believing there is a stigma attached to mental illness, others may not even be aware they are depressed, and some may not bother to seek help because they feel there isn’t any point and think their situation is hopeless. This makes the elderly particularly vulnerable to the effects of depression as their depression can go undiagnosed and continue indefinitely. The risk of suicide is high amongst older people who are depressed so it is important to look out for any signs that might indicate the onset of depression and encourage them to seek help as soon as possible because with the right support and treatment, the depression can be lifted, and the elderly person will be able to regain a sense of joy in their lives.