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.  However, the true rate may be higher because a lot of older adults simply don’t like to talk about their depressed feelings, or they are not asked about them. Your healthcare provider may not realize you are suffering from depression if you do not to mention your feelings of sadness or grief. Fortunately, depression is a very treatable illness.

Depression can be triggered by common chronic medical conditions that older people often experience, such as diabetes, Parkinson’s disease, arthritis, congestive heart failure, cancer, heart attack, or stroke. About one in four people with such a chronic medical condition develops depression that may need treatment at some point.  You will have a better chance of recovery if you tell your healthcare provider how you are feeling, so your depression can be properly managed along with your physical condition. 

Managing Additional Health Problems in Older Adults with Depression

Anxiety

Often, depression in older adults presents with a mixture of depression and anxiety. Anxiety is characterized by excessive worry, apprehension, or fear about a variety of events or situations.  It 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 that for depression. Non-medical treatments like psychotherapy (cognitive behavioral therapy or problem-solving therapy) and anti-anxiety medications can be very helpful.

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

  • 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 or memory loss. In fact, about one of five people with Alzheimer’s disease becomes 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. Loss of interest in activities 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

Chronic pain is also associated with depression. 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 provider may prescribe pain medications.  Options for painkillers include such as aspirin or ibuprofen (also known as non-steroidal anti-inflammatory drugs or NSAIDs) or acetaminophen (Tylenol). If the pain is very severe, your provider may prescribe narcotic or opioid medications.

Be aware of possible side effects from the stronger classes of drugs. They may cause confusion or more subtle decreases in mental function, especially in people who are already experiencing memory problems.  Constipation is another common side effect of these medications. Even familiar medications like aspirin and acetaminophen and ibuprofen have side effects that are occasionally life-threatening.

Non-pharmacologic treatments are often very effective. In some cases, they may help enough that you may not need pills in some cases. You may find that gentle massage or manipulation, moderate exercise, or applications of heat or cold make a difference in your pain. There are specialized therapies for treatment of chronic pain.

Insomnia

Depression can cause significant problems with sleep. Sometimes people sleep too much. However, people with depression more often complain about worrying and not being able to sleep. It is important to discuss sleep difficulties with your healthcare provider because some antidepressants are more effective at treating this symptom than others.

Weight loss

Many older adults will also lose weight when they are depressed as they lose appetite.  Weight loss can be extremely serious in older adults because it makes them vulnerable to other stressors such as infections. 

 

Last Updated September 2020