While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time (weeks, months or even years) and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious condition that has an impact on both physical and mental health.
On average, one in six people (one in five women and one in eight men) will experience depression at some stage of their lives. The precise rates of depression in older people are not yet known. However it is thought that between 10 and 15 per cent of Australians over the age of 65 experience depression. Rates of depression among people living in residential aged care facilities are believed to be much higher than the general population – around 35 per cent.
Depression is often not well recognised or detected in older people. Symptoms such as sadness, sleep and appetite problems or mood changes may be dismissed as a ‘normal’ part of getting older. These symptoms may also be confused with other conditions such as dementia.
Older people are at greater risk of developing mental health conditions because of the cumulative effect of numerous risk factors, including chronic illness and isolation. However, there is no evidence that ageing itself is a risk factor for depression later in life.
Depression can damage a person’s quality of life and their relationships with friends and family. Severe depression can be life threatening as a risk factor for suicidal thoughts and suicide.
Recognising depression in older people
Symptoms of depression that would cause concern in a younger person, such as insomnia or social withdrawal, may be disregarded in older people as ‘just getting older’. People also sometimes assume that problems with memory or concentration are due to age-related changes in thinking, rather than being due to depression. Older people may also find it difficult to talk about feeling sad or depressed. Depression can affect memory and concentration, particularly in elderly people.
Symptoms of depression in older people
Depression affects how people feel about themselves. They may lose interest in the things they normally enjoy. They may lack energy, have difficulty sleeping or sleep more than usual. Some people feel irritable and some find it hard to concentrate. Depression makes life more difficult to manage from day to day.
An older person may be depressed if, for more than two weeks, they have felt sad, down or miserable most of the time or have lost interest or pleasure in most of their usual activities, and have also experienced several of the signs and symptoms across at least three of the categories below.
Behavioural symptoms include:
- general slowing down or restlessness
- neglecting responsibilities and self-care
- withdrawing from family and friends
- decline in day-to-day ability to function, being confused, worried and agitated
- inability to find pleasure in any activity
- behaving out of character
- denial of depressive feelings as a defence mechanism.
Thoughts may be affected by:
- loss of self-esteem
- persistent thoughts about suicide
- negative comments such as ‘I’m a failure.’, ‘It’s my fault.’ or ‘Life is not worth living.’
- excessive concerns about financial situation.
Feelings may include:
- moodiness or irritability, which may present as anger or aggression
- sadness, hopelessness or emptiness
- feeling overwhelmed
Physical symptoms include:
- sleeping more or less than usual
- feeling tired all the time
- slowed movement
- memory problems
- unexplained headaches, backache or pain
- digestive upsets, nausea, changes in bowel habits
- agitation, hand wringing, pacing
- loss or change of appetite.
It’s important to note that everyone experiences some of these symptoms from time to time and it may not necessarily mean that the person is depressed. Equally, not every person who is experiencing depression will have all of these symptoms. Additionally, older people may use different language to refer to their depression. Instead of describing ‘sadness’, for example, they may talk about ‘their nerves’.
People at risk of depression
While the exact cause of depression isn’t known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of recent events and other longer-term or personal factors.
Some factors that might be associated with the development of depression include:
- serious physical health problems
- abusive or uncaring relationships
- family history of depression
- past experiences
- personality factors (for example if the person is self-critical or negative, worries a lot, is a perfectionist)
- drug and alcohol use.
In older people, depression may occur for different reasons, but physical illness or personal loss are common triggers.
Factors that can increase an older person’s risk of developing depression include:
- an increase in physical health problems or conditions such as heart disease, stroke, Alzheimer’s disease or cancer
- chronic pain
- side-effects from medications
- losses such as relationships, independence, work and income, self-worth, mobility and flexibility
- social isolation or loneliness
- significant change in living arrangements such as moving from living independently to a care setting
- admission to hospital
- particular anniversaries and the memories they evoke.
Treatment for depression
Different types of depression require different types of treatment, which may include:
lifestyle changes (such as diet and physical exercise) for preventing and treating mild symptoms of depression
medical treatments for moderate to severe depression.
The reality is that depression is unlikely to simply go away on its own. In fact, if ignored and left untreated, depression can go on for months, sometimes years, and can have many negative effects on a person’s life.
The good news is that there is a range of treatments, health professionals and services available to support people with depression. There are also many things that people with these conditions can do to support themselves.
Psychological treatments for depression
There are many types of psychological therapies that have been found to be effective for depression in older people. These include therapies such as behaviour therapy, cognitive behaviour therapy (CBT) and interpersonal therapy (IPT). Reminiscence therapy also appears to be an effective approach to treating depression in older people.
Psychological treatments support people with depression to change negative patterns of thinking and improve their coping skills so they are better equipped to deal with life’s stresses and conflicts. Psychological therapies may not only support a person to recover, but can also help to prevent the depression from reoccurring.
Psychological treatments can be conducted one-on-one with a professional, in groups, and sometimes online.
Medical treatments for depression
For moderate to severe depression, antidepressant medication may be prescribed along with psychological treatments. Sometimes, antidepressants are prescribed when other treatments have not been successful or when psychological treatments are not possible due to the severity of the condition or a lack of access to the treatment.
There is a lot of misinformation about antidepressant medication and while there is no simple explanation as to how it works, it can be very useful in the treatment of moderate to severe depression. There are many different antidepressants, and a decision about which type to use is one that needs to be made by a qualified health professional, after careful assessment and consideration, and in consultation with the person concerned.
Where to get help
- Your doctor
- Your local community health centre
- Australian Psychological Society – Find a psychologist service Tel. 1800 333 497 (outside Melbourne) or (03) 8662 3300 (in Melbourne)
- Social workers in mental health
- Occupational therapists in mental health
- Mental health nurse practitioners
- Aboriginal and Torres Strait Islander mental health workers
- beyondblue Support Service Tel. 1300 22 4636
- SANE Australia Helpline Tel. 1800 18 SANE (7263), Monday to Friday, 9am to 5pm
- Lifeline Tel. 13 11 14
- SuicideLine Victoria Tel. 1300 651 251 – for counselling, crisis intervention, information and referral (24 hours, 7 days)
Things to remember
- There is no evidence that ageing is a risk factor for depression later in life.
- Older people are at greater risk of developing mental health conditions due to the numerous risk factors, including chronic illness and isolation.
- Depression is treatable and support is available.