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Depression & Older Adults

Silver Hill Hospital

If you are responsible for caring for an aging parent or older relative, you may grow accustomed to their occasional grumpiness or glass half-full attitude, but don’t be so quick to chalk it up to the typical aging process. About six million Americans age 65 and older suffer from clinical depression and it’s often overlooked by family, friends and even health care providers. Depression is not a normal part of aging.
Aging brings many big life changes such as transitioning from work to retirement, death of loved ones and sometimes relocating. It’s normal for these types of life events to cause sadness and anxiety for a period of time, but for some people, these events trigger major depression. Some common risk factors for depression in seniors are:

  • Medications or combination of medications
  • Other illnesses (diabetes, cancer, heart disease)
  • Family history of depression
  • Fear of death
  • Living alone, social isolation
  • Chronic pain
  • Prior history of depression
  • Recent loss of a loved one

Symptoms of Depression in Seniors
One of the reasons depression is sometimes missed is that the symptoms can present differently in seniors. Common symptoms in this age group are:

  • New or worsening memory problems
  • Confusion
  • Social withdrawal
  • Vague complaints of pain
  • Insomnia
  • Irritability
  • Delusions (fixed false beliefs)
  • Hallucinations

It is especially hard to distinguish grief from depression. It is completely normal to feel sad and depressed for a period of time after losing a loved one, especially a spouse, child or childhood friend, but if these feelings don’t improve somewhat after about 3 to 4 months, it’s time to consult a doctor to see if medication and therapy might be helpful. Everyone grieves in a different way; there is no right or wrong way. Learn more about bereavement-related depression.

Diagnosis and Treatment
Diagnosing depression and determining the appropriate treatment is more complex in older adults. Before a diagnosis can be made, a physical examination, lab tests and an evaluation of current medications is necessary. Some physical problems, like thyroid disorders or vitamin B12 deficiency, present similar symptoms as depression so it’s important to rule out any physical causes first. The next step is to evaluate all medications being taken for other existing conditions because certain medications or combination of medications can cause symptoms of depression. If all physical problems are ruled out, you should get a consultation with a mental health professional (a psychologist, counselor, social worker, or psychiatrist). If possible, it’s best to find someone who specializes in caring for seniors.
The mental health professional will review the patient’s history, symptoms, potential triggers, and the length of time symptoms have been present. Once a depression is diagnosed, treatment will be determined. Treatment will be based on the individual situation. If a person takes numerous medications already, psychotherapy may be recommended as a first step instead of medication to avoid potential medication interactions. If antidepressants are recommended, it’s common to start a senior on a very low dose because they tolerate medication differently than younger people. Close monitoring and medication adjustments will be necessary in order to determine the appropriate therapeutic dose. A combination of medication and psychotherapy is usually the most effective treatment.

Importance of Treatment
Many older adults don’t think they need professional treatment for their depression. A Mental Health America survey found that only 42% of older adults with depression would seek professional treatment; They are more likely than any other age group to want to “handle it themselves.” Although it might be a bit of a fight to get your family member to agree to go to a doctor, it’s very important because older adults with depression are at higher risk for suicide. White men age 85 and older have the highest suicide rate in the United States. Never ignore a threat; always take it seriously because you can prevent suicide. If you or a loved one are in crisis, call 911, go to the nearest emergency room or call the Suicide Prevention Lifeline at 1-800-273-TALK (8255).

Resources

 “Depression in Older Adults: More Facts”, Mental Health America.
“Older Adults and Depression”, National Institute of Mental Health
“Depression is Not a Normal Part of Growing Older”, CDC
Geriatric Mental Health Foundation
“Depression Among Older Americans”,  AARP