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A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

What is Late-Life Depression—The Facts

Depression is a physical disorder of the brain that impacts over 20 million adults overall and affects more than 6.5 million individuals over the age of 65. Depression impacts a person’s whole being—mental health and physical health—and if left untreated can disable those who might otherwise be healthy individuals.

Symptoms

Depression can take on many forms. Mild symptoms may include loss of appetite or disturbed sleep. More severe episodes of depression may include unreal or strange thoughts including thoughts of suicide. A clinical depression is defined as a change in mood in which an individual experiences a drastic low that can also be accompanied by changes in sleep, appetite, energy, and the ability to maintain everyday life at home. The recognition of depression in the elderly is particularly challenging. Since many older adults have physical illnesses and/or do not have a strong social network, health care providers, family members, and patients themselves often incorrectly conclude that depression is a normal outgrowth of those problems. Depression is not a normal part of aging. The widely held belief that depression is normal makes this illness more often not diagnosed—and therefore, not treated.

The symptoms of depression for an older adult may differ from those for a younger person. For example, an older person is more likely to have sleep problems as compared to a younger person who experiences a more pronounced depressed mood. Depression tends to last for a longer period of time in older adults and may increase their risk for physical health problems or death. Depression in older adults is more likely to lead to suicide. The risk of suicide is serious. Elderly white men are at the greatest risk, and those ages 80-84 have a suicide rate more than twice that of the general population.

Causes

There is no one cause for depression and the onset of late-life depression can be attributed to genetic, biological, or neurological factors; life changes; illnesses; or a combination. Some older adults with depression have suffered from the illness for most of their lives. For others, their experience with depression may not begin until late life. An individual can be 70, 80 or even 90 years of age before he or she first experiences depression. Depression in late life is more common in women, widowed individuals, those who lack a supportive social network, and those with physical health problems.

Depression and Physical Health

Depression can also occur at the same time as another illness, especially after a bypass operation, hip fracture, or stroke. The mind and the body are not separate—physical illnesses such as heart disease and cancer may bring the onset of depression. The same is true in the reverse—depression impacts an older adult’s physical well-being. When an older adult suffers from depression as well as heart disease or diabetes, the recovery period for the physical illness is longer and the treatment for that physical illness may not be as effective. Late-life depression exaggerates any existing health problems and increases the risk of death.

Depression Among Nursing Home Residents

Although few large studies have been done to determine the rate of depression among nursing home residents, the studies that have been done conclude that depression among older adults in nursing homes is very common. Most studies to detect mental illness in nursing home residents have taken place in urban areas; relatively few rural facilities have been included in the studies. Study limitations have resulted in reports that vary widely in stating the percentage of residents with depression. What is agreed, however, is that the number of nursing home residents with depressive symptoms is significant and this illness impacts the resident’s quality of life. Depression can contribute to decreased appetite, weight loss, and lower resistance to infections, and have other side effects that can be associated with increased risk of illness. It is important that depression be diagnosed and treated appropriately in this setting.

Stigma

Stigma that society places on depression (and other mental illnesses) can discourage people from getting treatment. Some people are ashamed that they have depression—they feel that it is their fault or that they should be able to help themselves out of their depressed mood. The stigma associated with late-life depression has a chilling impact on individuals seeking treatment and recovering from depression. Only 10 percent of older adults receive treatment for their clinical depression.

Depression is not a weakness or a character flaw. Depression is an illness that can be successfully treated.

A Guide to Mental Wellness in Older Age: Recognizing and Overcoming Depression

© Geriatric Mental Health Foundation 2004
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
301.654.7850
info@GMHFonline.org
www.GMHFonline.org

Expert assistance was provided by Lissy F. Jarvik, M.D., Professor Emerita of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, School of Medicine; Susan Lieff, M.D., M.Ed., Assistant Professor, Department of Psychiatry, University of Toronto; and Stephen J. Bartels, M.D., M.S., Associate Professor of Psychiatry, Dartmouth Medical School.

The Geriatric Mental Health Foundation grants permission to print, photocopy, and distribute this material. Please cite the Foundation, including the address, phone and website.