Depression in Older Adults. What Families Should Know (and Watch For).

An Interview with Dr. Sandra Petersen
Senior Vice President of Health and Wellness, Pegasus Senior Living

Depression in older adults is a serious but treatable condition that is often misunderstood as a normal part of aging.  But, in contrast to a popular belief, depression is not an inevitable consequence of growing older. While aging does bring about physical and cognitive changes, most older adults are not depressed. However, when seniors face illness, frailty or functional limitations, their risk of depression increases significantly.

Several biological, psychological and social factors contribute to depression in seniors. These include chronic medical conditions (like stroke or cancer), a personal or family history of depression and stressful life events such as retirement or the loss of a spouse. Isolation and reduced social interaction are particularly potent triggers. Caregiver stress and substance use can also play a role. Importantly, depression can sometimes arise without a clear cause, making awareness and proactive care essential. It is thought that serotonin levels in the brain may significantly decrease with aging; this could also contribute to a higher incidence of depression in older adults.

Depression in older adults can manifest as persistent sadness, fatigue, irritability, sleep disturbances, and loss of interest in activities. It may also appear differently than in younger people. For example, older adults may sleep more rather than experience insomnia.  We also know from recent research that untreated depression may lead to significant cognitive decline, as well.

In this article, Dr. Sandra Petersen, Senior Vice President of Health and Wellness, Pegasus Senior Living, highlights the signs, causes and risk factors of depression in older adults and emphasizes how aging can increase risks due to factors like isolation, health changes, or loss of loved ones. She also offers practical solutions, including how senior living communities provide emotional support, socialization, access to counseling and regular activities to help combat depression.

Key Takeaways 

• Depression isn’t part of normal aging
• Warning signs of depression include fatigue, withdrawal, irritability and memory issues.
• Depression isn’t always just sadness and may show up as physical complaints or confusion.
• An aging brain sometimes means lower serotonin and dopamine.
• Chronic illness, pain, medications and stress raise risk.
• Grief fades; depression persists and impairs function.
• Caregiver stress can lead to burnout and depression.
• Screening tools like GDS, PHQ-9, and Cornell Scale are commonly used.
• Therapy, meds, activity and social support help.
• Senior living boosts connection, purpose and access to care.

Q: What are some common signs of depression in older adults that families often miss or mistake for “normal aging”?
A: Depression in older adults is a complex and often misunderstood condition. While it is not a normal part of aging, it frequently goes undetected or misattributed to the natural aging process.  Families often miss signs of depression in older adults because they can mimic or be mistaken for “normal aging.” For some individuals, withdrawal from social activities is a critical indicator of depression. The depressed person may gradually decline social engagements and begin to isolate. Others exhibit fatigue or low energy and there may be changes in appetite or sleep patterns.  Memory problems or increased confusion can also be prevalent in a depressed individual. Changes in appetite or sleep patterns can indicate depression in some, while still others become irritable and restless.  All these signs are frequently attributed to aging or chronic illness rather than recognized as potential indicators of depression.

Q: How Does Depression Manifest Differently in Seniors?
A: Unlike younger adults, older individuals may not express sadness as their primary symptom. Instead, they may present with non-specific physical complaints such as headaches or digestive issues. Others may seem more forgetful or cognitively slower when they are depressed.  Slower speech and movement may present as indicators of depression; lack of motivation, too, can be a harbinger of worsening depression. All these atypical presentations can lead to underdiagnosis or misdiagnosis.

Q: How Do Biological Changes Increase Risk?
A: Aging also brings about changes in brain structure and function, including reduced levels of neurotransmitters like serotonin and dopamine. These changes can increase vulnerability to depression. Additionally, vascular changes and inflammation in the brain may contribute to late-life depression, as well.

Q: Do chronic illnesses and Medications Cause Depression in Older Adults?
A: Chronic conditions such as heart disease, diabetes, and arthritis are common in older adults and are strongly linked to depression. Pain, disability and the stress of managing illness can all contribute. Moreover, certain medications—like corticosteroids, beta-blockers, or sedatives—can have depressive side effects, too.  Older adults may be taking as many as 14 to 28 medications per day, so they must be reviewed regularly by a medical professional to ensure they are necessary and to eliminate any that are not.

Q: How Can You Tell the Difference Between Grief and Clinical Depression?
A: Grieving is a natural response to loss that many experience at some point during the aging process.  Typically, grief involves waves of sadness interspersed with positive memories. Clinical depression, however, is persistent and impairs daily functioning. When grief becomes prolonged, intense and accompanied by feelings of worthlessness or suicidal thoughts, it may evolve into clinical depression. Untreated, clinical depression not only affects mental health but can exacerbate chronic diseases as well.

Q: How Does Caregiving Impact Mental Health?
A: In considering caregivers, especially spouses or adult children, we find that they are at high risk for depression due to emotional and physical exhaustion. The constant demands of caregiving can lead to feelings of isolation, guilt and helplessness, which may spiral into depression if not addressed.

Q: What Are Some Screening & Detection Tools?
A: There are several effective depression screening tools, including:

• Geriatric Depression Scale (GDS)
• PHQ-9 (Patient Health Questionnaire )
• Cornell Scale for Depression in Dementia 

Routine screening during medical visits and open conversations with family members can help identify depression early. Early treatment and counseling are critical to preventing the damaging effects of depression.

Q: Are There Treatment Options?
A: The most effective approach is often a combination of pharmacological and non-pharmacological solutions:

• Therapy: Cognitive Behavioral Therapy (CBT) is particularly effective and teaches coping strategies for dealing with depression.
• Medication: Antidepressants, carefully chosen to avoid interactions with other medications, can be of great assistance in “balancing” neurotransmitters and relieving depression.
• Lifestyle Interventions: Regular physical activity, social engagement and a healthy diet are “natural” ways to treat depression.

Tailoring treatment to an individual’s needs and medical profile is essential.  Generally, a combination of therapy, medication and lifestyle changes are helpful for most people.

Q: Why is there a Reluctance to Discuss Mental Health?
A: Many older adults grew up in a time when mental health was stigmatized. Building trust, using non-judgmental language and framing treatment in terms of improving quality of life can help. Involving a trusted physician or peer can also encourage openness about feelings and life challenges.

Q: Does Living in a Senior Living Community Help Reduce the Risk of Depression in Older Adults? 
A: In my experience, senior living communities are “just the ticket” for many older adults.  The key benefit I see is “re-engagement” in life.  New friendships are formed through common experiences.  New purpose in life is gained.  Sometimes it’s as small as showing up for an activity so another isn’t alone or sharing a meal, but it can make a huge difference in one’s outlook on life.

The lifestyle offered in a senior living community can improve mental health by:

• Reducing isolation
• Providing structured activities and engagement with others
• Ensuring access to healthcare and mental health services
• Offering caregiver support of and the support of peers to create a real sense of belonging

Q: What to Look for in a Senior Living Community ?
A: Families should seek communities that offer:

• The availability of on-site mental health professionals
• Regular wellness checks and depression screenings
• Support groups and counseling services
• Programs that promote socialization and purpose

Senior living communities offer critical emotional and social support that can help prevent and/or manage depression. As people age, their world becomes smaller, often leaving them isolated and alone. Senior living environments are designed to combat many of the risk factors, like lack of socialization, that are associated with depression. These communities provide structured opportunities to mingle, regular activities and access to mental health professionals.

Residents benefit greatly from the companionship of others, reduced isolation and wellness programs that promote physical, cognitive and emotional health. Counseling services and group therapy sessions are often available, helping seniors process grief, adjust to life changes and maintain a sense of purpose in life.

Read more about healthy aging – mind, body, and spirit – here.

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Where You Live Matters is powered by the American Seniors Housing Association (ASHA), a respected voice in the senior housing industry. ASHA primarily focuses on legislative and regulatory advocacy, research, and educational opportunities and networking for senior living executives, so they can better understand the needs of older adults across the country.