Aging & Health A to Z

Depression

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.

As older adults live longer, they may have more than one chronic disease.  Or, they may have a health problem that can lead to another condition or injury if not properly managed.   The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home.  These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.

Older Adults and Depression

Men and women over the age of 65 appear to have lower rates of severe depression compared to the rest of the population but the true rate may be higher because a lot of older adults simply don’t like to talk about their depressed feelings. Your healthcare professional may not realize you are suffering from depression if you do not to mention your feelings of sadness or grief.

Common chronic medical conditions experienced by older people like diabetes, Parkinson’s disease, arthritis, congestive heart failure, cancer, heart attack or stroke can bring on depression. About one in four people with such a chronic medical condition develop depression that needs treatment at some point.  You will have a better chance of recovery if you tell your healthcare professional how you are feeling, so your depression can be properly managed along with your physical condition. 

Anxiety

Anxiety is characterized by excessive worry, apprehension, or fear about a variety of events or situations and may occur along with depression in older people. Uncontrollable anxiety can get in the way of your normal enjoyment of life. It can make you feel tired, restless, irritable, or on edge.

Treatment for anxiety is similar to those for depression. Non-drug treatments like psychotherapy (cognitive behavioral therapy or problem-solving therapy) and drug therapies with anti-anxiety medications can be very helpful.

Some drugs that are commonly prescribed to older people for depression can also cause anxiety as a side effect. These include:

• lithium
• antipsychotic medications
• antidepressant medications
• withdrawal from medications such as anxiolytics (anti-anxiety drugs) or sedatives

Dementia

Depression often occurs in older people who are suffering from dementia. In fact, about one of five people with Alzheimer’s Disease become severely depressed at some point. Other conditions that may result in dementia, such as multiple strokes or Parkinson’s disease, are also associated with depression. Depression may be the first sign that dementia is developing, or the depression may occur long after dementia has appeared.

Because depression and dementia share many symptoms, it may be hard for you or your healthcare professional to tell them apart at first. It’s important to identify depression in a person with dementia because there are very effective treatments that can help. Symptoms that are found in both conditions include:

• decreased ability to concentrate
• distractibility
• indecisiveness
• lack of motivation
• loss of interest (apathy)
• disorientation
• sleep problems
• memory loss.

Chronic Pain

Unlike gray hair and wrinkles, chronic pain is not a normal part of aging.  Getting older increases your risk for many illnesses and conditions that can cause chronic pain and lead to depression.  In fact, if you have chronic pain, you are four times more likely to develop depression than if you didn’t have pain.  If you become depressed because of chronic pain, the depression will make it even harder to find ways to cope with the pain itself.

Chronic pain is linked to:

• depression
• social isolation
• sleep disturbance
• poor functioning in activities of daily life
• malnutrition
• problems with thinking.

Treatment for Chronic Pain in Older Adults
Many approaches that are appropriate in younger people are also effective in older people with chronic pain.

Older adults use analgesics (pain relievers) more often than any other age group. Your healthcare professional may prescribe pain medications such as aspirin or ibuprofen (non-steroidal anti-inflammatory drugs or NSAIDs), acetaminophen (Tylenol), or—if the pain is very severe —narcotic or opioid drugs. 

Be aware of possible side effects from the stronger classes of drugs, which may cause confusion or more subtle decrease in mental function, especially in people who are already experiencing memory impairment, dementia or Alzheimer’s disease. Constipation is another common side effect of these drugs. Even familiar drugs like aspirin and acetaminophen (Tylenol) and ibuprofen (non-steroidal anti-inflammatory drugs or NSAIDs), have side effects that are occasionally life-threatening.

Non-drug treatments are often very effective and may preclude the need for pills in some cases. You may find that gentle massage or manipulation, moderate exercise, or applications of heat or cold make a difference. 

Tell Your Healthcare Professional
Many older adults tend to underreport pain, in the same way that they avoid talking about symptoms of depression. But talking about it is the only way to get the treatment you need. Your healthcare professional will use a pain scale questionnaire which can be very helpful in making him or her understand your pain experience, devise a treatment plan, and set realistic goals. Often, keeping a pain diary will help you keep track of what lifestyle and treatment approaches work best for you.

Updated: March 2012
Posted:  March 2012