Depression: More Common with Age, but not Inevitable
Clinical depression affects many people at least once in their lives. However, it becomes more common with age and, more importantly, both diagnosing and treating depression can be different in older adults than younger ones.
In general, the symptoms of depression can include:
- Fatigue or lack of energy; slowed speech and body movements.
- Impaired memory or ability to concentrate.
- Lack of motivation; difficulty starting new projects or making decisions.
- Lessened interest in being with people, participating in activities, or even leaving home.
- Feeling helpless, hopeless, or worthless; feeling like a burden.
- Sleep disturbances—either sleeping too little or too much.
- Appetite changes—either eating too little and losing weight, or overeating for comfort.
- Neglecting personal care; having poor hygiene or forgetting to eat.
In younger adults, fatigue, changes in appetite, and sadness can be the most obvious signs of depression. But older people often experience these things because of physical illness, medication, grief, or simply because they’re getting older. However, depression is not part of aging. Rather, depression is more common in older adults because of other things that are part of aging.
In older adults, symptoms of depression often come in the form of increased physical complaints, such as worsening arthritis pain, headaches, or digestive issues. Making diagnosis more difficult, typical symptoms of depression can be similar to symptoms of grief or mild cognitive impairment (NCI) or cognitive decline.
For example, losing loved ones, retiring, or losing health, mobility, or independence can all cause grief. Experiences like these can in turn cause symptoms such as fatigue, sleep disturbances, and poor focus, just as depression can. But where grief tends to come and go in waves and ease up in time, depression is constant and unrelenting. This does not mean there is no relationship between grief and depression. If Mom’s or Dad’s grief persists for longer than two months, it may be turning into depression and you should encourage them to seek help.
Depression also shares many symptoms with cognitive decline but, again, there are differences. Where a person experiencing depression may be frustrated by needing to pause to retrieve a word or remember directions, they are aware of their forgetfulness and likely to recall the word or get where they’re going. It will just take a bit longer.
The causes of depression can also be different in older and younger adults. Illnesses such as Parkinson’s disease, Alzheimer’s disease, diabetes, heart disease, cancer, B12 deficiency, lupus, multiple sclerosis, and thyroid problems can all cause depression. Ironically, many of the medications used to treat these conditions can also cause depression. Poor eating habits, chronic dehydration, chronic pain, worries about health or money, or an unsupportive relationship can also trigger depression. So can loss of work, loss of a well-loved pet, loss of body image due to surgery, injury, or illness, or loss of independence due to disability or having one’s driving privileges revoked.
Not all of the treatments for younger adults with depression are suitable for older adults, either. Studies have shown that SSRIs, a type of anti-depressant medication, increase the risk of fractures in older adults, and decreased mobility as a result of a fracture can increase depression and incidence of premature death. Moreover, no medication can be effective unless the source of the depression—such as the feeling that one is no longer useful—is also addressed.
In older adults, some of the simplest and most effective treatments for depression include:
- Exercise, which stimulates production of the same hormones as antidepressant drugs, especially if it involves going outdoors.
- Nutritional supplements, include omega-3, vitamins B and D, folic acid, St. John’s wort (an herb), and SAMe (all recommended by experts at the Mayo Clinic).
- Getting enough sleep, eating well, and spending time with people and doing enjoyable activities.
- Learning a new skill, becoming a volunteer (especially if it helps others), or caring for a pet.
- Spending time with people, particularly loved ones, doing any activity; depression may suggest it’s time to move into seniors’ housing.
- Reminiscing by going through photo albums or putting together memory books for younger generations.
- Massage therapy. Occupational therapy. Talk therapy, either in support groups or individually. Studies show cognitive-behavioural therapy to be particularly helpful.
You are the best person to watch out for signs of depression in your loved one, and the best person to respond to them. Spend time with them. Do things with them. Remind them to take their medications and help them get to medical appointments.
Above all, listen. Don’t judge, criticize, offer advice, push, or nag. Don’t change the subject, tell them everything will be okay, share stories of your own experiences, or get impatient if they don’t improve on your schedule. Don’t ignore or downplay their physical complaints, and don’t take it personally if they say negative or even hurtful things. Do remind yourself it’s the depression talking, not them, and listen.
Depression is an illness, like any other, and watching someone you love suffer with it is difficult. But with proper diagnosis and treatment, your loved one can get back to enjoying life—and you can get back to enjoying life with them.
