Sally was feeling sad.  This wasn’t a new experience for her; depression had been a frequent visitor throughout life.  Having grown up with an alcoholic, physically abusive father and a mother who provided little care and blamed her for the family turmoil, she had little basis for positive feelings about herself.  Her mother had spent weeks doing little more than lie on the couch; years later, Sally realized her mother had been depressed.  Sally had had some successes in life—a career as a nurse and several long-lasting friendships, for example—but she also had some major disappointments, such as two failed marriages and chronic financial problems.  She struggled with self-blame and thoughts of herself as a failure.  Medication had been helpful, as had therapy.  Now age 70, Sally had done well for a number of years.  However, she felt a loss of meaning in her life when she retired last year, and felt more lonely after her brother, her only sibling, died and she moved away from friends.  Her mood gradually got worse, she lacked energy, and her appetite diminished.  She was even thinking that death might be welcome.  She recognized that she was slipping back into depression. 

I recently was asked to write an article on depression in older adults for a local paper.  I’m going to post exerpts from that article here.  The first is on the nature of depression in the elderly.

Here’s a good thing about depression in the elderly:  Most older adults never develop clinically significant depression.  In fact, depression is less frequent in the elderly than in the general population.

Here are some bad things about depression in the elderly: depressive symptoms (just not full-fledged cases) are more common, rates are elevated in some groups of elderly, and depression often goes unrecognized in late life.

As many as 20% of elderly people experience depression at some point.  Rates among those living in the community are relatively low—anywhere from 1 to 5 percent.  Rates increase to 10-15 percent among community residents needing assistance in living, and are as high as 30 percent among those confined to nursing homes.

Symptoms of depression can include feelings of sadness, lack of energy, decreased interest in things that would normally spark interest, weight loss or loss of appetite, sleep difficulties, withdrawal from others, feelings of worthlessness, preoccupation with death, or suicidal thoughts.  More so than younger individuals who are depressed, the depressed elderly may have problems with confusion or impaired memory.  Additional features common in the elderly can include increased physical complaints, deterioration in hygiene, irritability, and hopelessness.  A person with several of these characteristics may well be depressed even if he or she denies feelings of sadness.

Sometimes it is difficult for physicians or mental health providers to diagnose depression because certain behaviors can be either signs of depression or signs of normal aging—for example, feelings of detachment, loss of interest in some activities, or a decrease in social involvement are characteristic of both.  It is also difficult to distinguish depression from other medical conditions.  Are increased somatic complaints due to depression or actual illness?   Are problems with memory, concentration, and sleep due to depression or to early signs of dementia?  It’s important to consult someone with expertise in the mental health problems of the elderly to make the dianosis.

I’ll post next week on causes of depression in older adults.