Program & Services

Depression in Older Adults

Depression in older adults causes worry. It also causes people to suffer. It leads to problems with the body, the mind, and the way a person acts with others. It is often not seen and not treated. Many older patients do not get help for their depression. Many do not get enough help. Part of the problem is that depression in older people is hard to find. This is because other conditions also affect older people.

Depression's signs are different in older adults. Having a lot of signs together can be as serious as major depression. This is called minor depression.

Minor depression is also a big deal. It is common and has a big impact. Eight to 20 percent of older adults in the community show signs of it. Up to 37 percent in primary care settings show signs. Treatment does help. But it takes longer to help older adults.

Identifying Major and Minor Depression

Major depression includes:

• major depressive disorder
• bipolar disorder
• related conditions

Major depressive disorder is the most common type in adults. It can occur in people over and over again. It can include the following signs:

• sad mood
• loss of interest in activities
• major weight loss or gain
• trouble with sleep
• tiredness
• not feeling worthy
• not being able to concentrate
• thoughts of death or suicide

Major depressive disorder cannot be identified if the signs last for less than two months after a loss or other sad or painful experience.

Most older patients who show signs do not have major depression. Some are told they have minor depression. Minor depression is not yet seen as an official disorder.

Minor depression comes about more often. Minor depression can be:

• a group of conditions that might show an early form of major depression
• a mild form of depression that does not show all signs at once. This can be a constant feeling.
• a reaction to something that causes stress

Minor depression is more common. People with major and minor depression use more health care services and sometimes have a poor quality of life.

Late-Onset Depression

Depression identified after age 60 is called late-onset depression. This is not a diagnosis. This type of depression is similar to early-onset depression. But there are some differences:

• Problems with thinking might be more obvious
• Patients might have problems remembering or thinking.

The risk of depression coming back is very high in patients who are diagnosed after age 60.

Causes of this type of depression might include:

• Being a widow
• Having a problem with the body
• Having less than a high school education
• Drinking a lot of alcohol.

Problems in Identifying and Treating Depression

It is dangerous not to identify and treat depression. One study showed that only 11 percent of depressed patients got the right help. 34 percent had help that was not good enough. 55 percent got no help.

There are reasons why doctors might not see depression in older adults. People might think the signs are related to age. Older adults are also not as willing to tell doctors if they are not feeling well. They are not as willing to say they feel worthless. But these signs are important in finding depression.

Depression can make problems with the body worse. These problems can take attention away from the depression. Many older patients might not want to admit they have depression. Older men do this most often. They have the highest rates of killing themselves in later life.

Providers might not want to tell older patients that they have depression because they:

• are not sure the person has it
• do not want the patient to be ashamed
• are not sure about the best way to help
• are worried how the person will do with the medicine
• do not have easy access to care for depression
• are worried about the cost of treating it

Many people believe that depression will always happen in older people when:

• a loved one dies
• a person is not able to do everything he or she used to
• his or her role in life changes

Thinking about death is also thought of as a normal part of old age. Some doctors even believe these things. These wrong beliefs can lead to:

• not talking about signs of depression
• family members not trying to get help for older relatives.

Connections to Problems with the Body

Mental problems in older people can be related to problems with the body. 25 percent of older people with constant sicknesses have depression. This is the highest rate. These sicknesses can include:

• heart disease
• stroke
• cancer
• chronic lung disease
• arthritis
• Alzheimer's disease
• Parkinson's disease

Older people with one or more of these are more likely to have depression.

Not being able to sleep is another sign of depression in older patients. Problems with sleep are also related to:

• poor health
• a person not being able to do everything he or she used to do

Five to 10 percent of older adults have constant sleep problems. Doctors are not sure why sleep problems might cause depression in older adults.

Consequences of Depression

The worst result of depression in older adults is a higher risk of death. This can be from killing themselves. It can also be caused by problems with the body. This can happen if the treatment is not good. People over age 65 have the highest rate of killing themselves. This happens to people age 85 and older more than any other age group.

Older adults who kill themselves are most likely to have late-onset depression. That is more likely to be the only cause of this in older people. It is normal for older people to think about death. But older adults who think of killing themselves need help. This is not normal. It is also important to give older adults the right medicine for depression. It can help stop this from happening.

Depression can also lead to death from other diseases. These can include heart disease and cancer. Doctors are not sure why this happens.

Causes of Late-Onset Depression

Causes can include:

• Never being able to sleep
• Sadness after a loved one dies
• Problems that damage blood vessels.