Depression in older adults
Depression is a mental illness with the following main symptoms: sadness, loss of interest, depressed mood, social withdrawal, hopelessness, desire/plan to harm self, fatigue, insomnia, excessive guilt, and unworthiness.
According to CDC, 1-5% of older adults living at home in the United States are experiencing depression. This rate goes up to 13.5% when seniors need professional help at home such as home healthcare. Older adults are at high risk for depression because they experience multiple medical conditions, which limit their functioning. Yet many seniors are not getting treatment for depression. Depression is a treatable condition—Once they start to receive treatment, there is a good chance that they will feel better. So what stops them from getting the treatment they need?
(1) Depression manifests differently in older adults
The typical picture of a depressed person may not fit when you are talking about a senior who is experiencing depression. Most of young people would describe depression with sadness (depressed mood), lack of interest, and low energy as the main symptoms. However, when seniors are experiencing depression, their first complain is often related to physical symptoms—fatigue, pain, and insomnia. When there is an unexplained physical symptom in seniors, depression should be the first factor to be explored by medical professionals. They may become paranoid and accuse a family member for stealing things. They may tell you that they have been more forgetful. These symptoms can be easily misdiagnosed as other conditions often seen in senior population such as physical problems, delusional disorder, or dementia. When a person gets a wrong diagnosis, he or she doesn’t get the right treatment for depression.
(2) Depression in older adults is often misdiagnosed as dementia
Depression can affect one’s ability to concentrate. This is a symptom of depression that can be seen in anyone regardless of their age. But when older adults express concern over their ability to concentrate, this is often misdiagnosed as dementia. You may find the chart in the following link to be helpful: http://geropsychiatriceducation.vch.ca/docs/edu-downloads/dementia/3D_comparison_VIHA.pdf It also lists characteristics of delirium, another condition that is often misdiagnosed in older adults. In the real life setting, these three conditions look remarkably similar—the reason why it’s important to seek an assessment and treatment from professionals who specialize in mental health treatment of older adults.
(3) The society portrays older adults as “unhappy”
If you look at TV shows and movies in the American society, you can find a plenty examples of how media portrays older adults as “grumpy” and “unhappy,” insinuating that there aren’t much to look forward to in life when one grows older. This stereotype contributes people to see depression as an acceptable and expected condition for older adults. Some older adults end up believing the same stereotype to be true, and they don’t seek treatment for it because they think it’s part of the aging process and they don’t think they can get better.
(4) Older adults hesitate to seek mental health treatment due to stigma
According to the study conducted by Conner et al in 2011, the public stigma about getting mental health treatment affects older adults’ attitude about the treatment and the willingness to seek treatment. The negative impact of the stigma is more impactful in African American older adults than Caucasian older adults.
Why am I spelling out these barriers? I am writing them here, wanting you to know that there is a very good reason why older adults should seek treatment despite these barriers: Depression is a treatable condition, and this is true for older adults as well as any other people. Once an accurate diagnosis is made, there is a light at the end of the dark tunnel. You don’t have to put up with the symptoms alone—there is a help out there. To get the accurate diagnosis and appropriate help, it is important to look for a psychiatrist or a therapist who specializes in older adults
I love the title of the brochure made by SAMSA—“Good mental health is ageless” (see https://store.samhsa.gov/shin/content//SMA15-3618/SMA15-3618.pdf), because it is so true. Yes we lose many things as we age, and this can feel depressing to some. But there are different ways to think about what we lose and how we age. That’s what therapy is about. Just last week, my 77-year-old client decided to stop seeing me for therapy after 4 months of bi-weekly therapy. Why did she stop coming? It’s because….she felt better! In her words, “I feel so much happier inside.”
Center for Disease Control and Prevention. “Depression is not a normal part of growing older.” Retreived on 7/15/18 from https://www.cdc.gov/aging/mentalhealth/depression.htm
Conner, K. O., Copeland, V. C., Grote, N. K., Koeske, G., Rosen, D., Reynolds, C. F., & Brown, C. (2010). Mental Health Treatment Seeking Among Older Adults with Depression: The Impact of Stigma and Race. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 18(6), 531–543. http://doi.org/10.1097/JGP.0b013e3181cc0366
McInnis-Dittrich, K. (2014). Social work with older adults (4th ed.). Boston, MA: Pearson.
Substance Abuse and mental health services administration (2015). Good mental health is Ageless. Retrieved on 7/18/18 from https://store.samhsa.gov/shin/content/SMA11-4631CD-DVD/SMA11-4631CD-DVD-KeyIssues.pdf
Vancouver Island Health Authority. THE 3 D’s: Comparison of Depression, delirium, and dementia. Retreived on 7/16/18 from http://geropsychiatriceducation.vch.ca/docs/edu-downloads/dementia/3D_comparison_VIHA.pdf