For Seniors: Is It More Than the Blues?
Everyone has feelings of sadness or unhappiness now and then. When feelings of sadness or despair don't go away and interfere with daily life, depression may be the reason. Although anyone can suffer from depression, it is particularly common among older adults. Depression affects 15 out of every 100 adults older than 65, according to the National Institute on Aging.
Depression has an impact on all aspects of a person's life, taking a toll on physical and mental health. Depression is also dangerous: Suicide can be the devastating result if the illness is left untreated. In fact, the highest rate of suicide in the United States is among older people.
It's important to recognize that depression is an illness like heart disease or diabetes and that, like these illnesses, depression can be treated.
Causes and triggers
Depression appears to be linked to changes in brain circuits and chemical messengers called neurotransmitters, which carry information between brain cells. The production of these chemicals is under control of genes. Because of this genetic aspect, depression tends to run in families. Depression is not something a person can "snap out of."
Depression that occurs in older adults may be a relapse of depression that occurred earlier in life. If an older person has never experienced depression before, however, it may be brought on by a medical illness. Chronic or serious illness, such as cancer, Parkinson's disease, chronic lung disease, heart disease, stroke, or Alzheimer's disease, is a common cause of depression in older adults, according to the American Association of Geriatric Psychiatry (AAGP). However, although studies have connected depression and an increased risk for Alzheimer's disease, the National Institutes of Health says that researchers still aren't sure whether these conditions actually cause it. Sometimes, depression is not a direct result of a medical problem.
Besides a chronic illness, other factors can contribute to the development of depression. People who are depressed often point to one specific event that triggered the depression—the loss of a loved one, for example. As people reach old age, they experience more and more loss—of loved ones, of friends, of familiar surroundings. Besides the loss of a loved one, other losses that can trigger depression occur through retirement, changing place of residence, and the inability to get together with others because of failing health. A person may grieve the loss of home and possessions—and even a pet—when moving to a smaller or more institutional location. People in nursing homes and other long-term care settings are especially vulnerable to depression; up to half suffer from this illness, the AAGP says. A person also may grieve the loss of health, longing for good eyesight, sharp hearing, or a sound body.
Normally, people who feel down because of a change in life or health circumstances return to their usual level of functioning after two months, although waves of grief may resurface now and then. If feelings of sadness and hopelessness are constant and do not recede with time, it is a sign that depression has taken hold.
Personality also can play a role in depression. People with low self-esteem and a pessimistic outlook on life may be more likely to develop depression. Abusing alcohol or drugs can be another factor. Certain medications, especially those for heart disease and high blood pressure, may cause mood changes, too.
The domino effect
Left untreated, depression can lead to other health problems. It can cause a decreased attention span and poor concentration that can lead to disabling cognitive problems. A chronic illness may worsen for those who also suffer from depression. Eating habits can suffer, leading to poor nutrition. Depression can trigger substance abuse.
The greatest concern is that depression can lead to suicide. People older than 65 commit more than one fourth of the suicides in this country; this makes suicide more common in this age group than in any other, according to the AAGP. White men older than 80 are at highest risk: They are six times more likely to commit suicide. It is vital to recognize depression and seek help.
Know the signs
The following should be warning signs if they last more than two weeks or interfere with daily life:
Feeling worthless or helpless
Persistent sadness that lasts for more than two weeks
Difficulty concentrating or remembering; indecisiveness
Frequent tearfulness or crying spells
Withdrawal from regular social activities
Pacing, fidgeting, or irritability
Changes in appetite and sudden weight gain or loss
Physical ailments that don't appear to have another medical cause
Thoughts of death or suicide and/or suicide attempts (remarks about suicide should be taken seriously and reported to a doctor)
Often people who are depressed complain of body aches and pains for which there is no obvious cause.
Depression may be mistaken for dementia, because the diseases share common symptoms. In addition, a medication taken for an illness can cause a change in mood, and some chronic illnesses produce the same symptoms that depression does. Faced with these many health issues, older people, their family members and their doctor may not realize that they are depressed.
It's important to note that people older than 65 may experience depression differently from those who are younger. For example, an older person with depression may not feel especially sad or worthless but may have insomnia and difficulty remembering things or feel fatigued, listless, or apathetic.
Sometimes a person is so depressed that he or she may not be able to tell anyone about it. If someone has become debilitated for other medical reasons or is suffering from dementia, it may be difficult for that person to communicate his or her symptoms. And for many people, especially older men, there is a stigma about mental illness. They may be embarrassed or unwilling to admit that they have a mental health problem.
- Nelson, Gail A., MS, APRN, BC
- newMentor board-certified, academically affiliated clinician