Depression in Seniors

For many older adults, the “golden years” are indeed golden. My parents, who are both over the age of 65, are enjoying their retirement here in Northern California. My father is supervising the building of their new house and my mother runs a website she created for senior women. They go to baseball games and symphonies, among other activities, and spend a lot of time taking their grandchildren to museums of all kinds. I think they probably would be a good commercial for vitamins marketed to seniors. 

Unfortunately, for some seniors, the golden years are more like leaden, especially if they’re living with depression. Not only can depression suck all the enjoyment out of life, as it can at any age, but depression can also be dangerous to an older adult’s physical health. 

Causes of Depression in Seniors

• Living alone or social isolation
• Lack of purpose after retirement, or if housebound
• Recent bereavement
• Living in a nursing home
• Chronic pain or illness
• Loss of independence
• Certain medications or combinations of medications
• Difficult financial circumstances

 All of these factors can all contribute to making an older person susceptible to depression. It should be noted that it is possible for depression to strike for the first time in later years. 

Symptoms 

Many depression symptoms can be mistaken for the normal signs of aging, among them insomnia, fatigue and weight loss, or they can be mistaken for other illnesses that may be common in the elderly. 

• Sadness
• Fatigue
• Difficulty concentrating or making decisions
• Loss of interest in hobbies or other pleasurable pastimes
• Social withdrawal and isolation
• Weight loss; loss of appetite
• Sleep disturbances
• Loss of self-worth
• Increased use of alcohol or other drugs
• Anxiety
• Fixation on death; suicidal thoughts or attempts

 Diagnosis 

There are a couple of factors that can conspire to keep both the depressed senior and those around him from recognizing his depression. One is the aforementioned similarity of some depression symptoms to those of aging or illness. In addition, older adults may be reluctant to consider the possibility of their having depression due to the stigma which has been erased, to some extent, in younger generations. 

But it is very important to detect and treat depression in seniors. First of all, depression is likely to hasten the move into a nursing home. A study published in the September 2007 issue of the Journal of Clinical Psychiatry found that among 3,000 seniors utilizing home health care, those with depression were 43 percent more likely to enter a nursing home in the next year. The study authors theorize that depression may affect depressed seniors’ physical health or it may affect their perception of their physical health. Second, depressed people are often negligent when it comes to their health, and this can be dangerous in older adults who have chronic conditions.

It should be noted that elderly white men have the highest rate of completed suicide in the United States. It’s believed that this is due in part to the fact that women tend to be more adept at creating and maintaining social contacts. When men are widowed, they often lose the social contacts that their wives created. Families are often scattered across the country, so older men can spend far too much time alone and without emotional support. It can also be extremely difficult for older men to get past the stigma attached to depression, as they see both the illness and the act of asking for help in dealing with it as signs of weakness. 

There are some sobering statistics about the elderly and suicide from the National Suicide Prevention Initiative. In 1998: 

• Adults over the age of 65 represented 13% of the population, but 19% of all suicide deaths
• Were more likely than any other group to visit a physician within 24 hours before their suicide
• Saw their rate of suicide rise as they age (from 13.1 per 100,000 at age 65-69 to 22.0 at age 80-84)

 Treatment 

Antidepressant treatment can be tricky in older adults. For one thing, the depression may be one of many ailments, including chronic conditions that require medication. The more medications you are taking, the greater the risk that one will make another ineffective or even dangerous. If possible, an older adult should be treated for depression by a psycho-pharmacologist, a doctor who specializes in psychiatric medications. He or she will have a more complete understanding of how medications interact than a general practitioner. 

Something else that should be noted is that older adults, according to a study published in the New England Journal of Medicine, have a high percentage of relapse if antidepressants are discontinued. Psychotherapy did not appear to be effective in preventing this. Since patients are often taken off antidepressants after six months to a year, this is something to keep in mind when a physician is prescribing a course of treatment for an older adult.