Depression in the Elderly
Depression in the elderly is very common, although it is not a normal part
of aging. Late-life depression affects about 6 million Americans age 65 and
older, but only 10% receive treatment for depression. This is likely because
the symptoms of depression in the elderly are often confused with the effects
of multiple illnesses and the medicines used to treat them.
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Depression Symptoms
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Dennis Lee, MD
 Depression is a very common condition that is believed by many experts to be
the number one cause of disability in the world. In the U.S., 17% of people will
experience depression at some point in their lives. An estimated 19 million
people in the U.S. are currently suffering from depression. Depression is more
common in women then in men, with 25% of women suffering from depression severe
enough to warrant treatment at least once during their lifetime.
It's important to remember that depression is an illness
that affects both the body and mind. It is not something that we can just wish
away or "snap out of," nor is it a sign of a weak character. The good news about depression is
that almost everyone suffering from this condition can be helped with treatment,
so it is important to recognize the signs and symptoms of depression.
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How Does Depression in the Elderly Differ from Depression in Younger People?
Depression in later life frequently coexists with other medical illnesses
and disabilities. In addition, advancing age is often accompanied by loss of
key social support systems due to the death of a spouse or siblings, retirement
and/or relocation of residence. Because of their change in circumstances and
the fact that they're expected to slow down, doctors and family may miss the
diagnosis of depression in elderly people, delaying effective treatment. As a
result, many seniors find themselves having to cope with
symptoms that could otherwise be easily treated.
Depression tends to last longer in elderly adults. It also doubles their
risk to develop cardiac diseases and increases their risk of death from
illness, while reducing their ability to rehabilitate. Studies of nursing home
patients with physical illnesses have shown that the presence of depression
substantially increased the likelihood of death from those illnesses.
Depression also has been associated with increased risk of death following a
heart attack. For that reason, making sure that an elderly person you are
concerned about is evaluated and treated is important, even if the depression
is mild.
Depression in the elderly is more likely to lead to suicide. The risk of
suicide is a serious concern among elderly patients with depression. Elderly
white men are at greatest risk, with suicide rates in people ages 80 to 84 more
than twice that of the general population. The National Institute of Mental
Health considers depression in people age 65 and older to be a major public
health problem.
What are the Risk Factors for Depression in the Elderly?
Factors that increase the risk of depression in the elderly include: Being
female, unmarried (especially if widowed), stressful life events, and lack of a
supportive social network. Having physical conditions like stroke,
hypertension, atrial fibrillation, diabetes, cancer and dementia further
increases that risk. While depression may be an effect of certain health
problems, it can also increase a person's risk of developing other illnesses—primarily those affecting the immune system, like infections.
The following risk factors for depression are often seen in the elderly:
- Certain medicines or combination of medicines
- Other illnesses
- Living alone, social isolation
- Recent bereavement
- Presence of chronic or severe pain
- Damage to body image (from amputation, cancer surgery, or heart attack)
- Fear of death
- Previous history of depression
- Family history of major depressive disorder
- Past suicide attempt(s)
- Substance abuse
Persons who develop their first depression in old age are very likely to
have very small abnormal areas seen on head imagery that indicate tiny spots in
the brain that may not be receiving adequate blood flow. Consequent chemical
changes in these cells may enhance the likelihood of depression, apart from any
life stress.
Next: What types of treatment are available for older individuals with depression? »
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