Elderly Depression

Signs, Symptoms, Treatments and More

Elderly depression is a common illness that is often difficult to identify or diagnose. It is not a normal part of aging and should be treated if recognized.

Elderly will often exhibit typical signs and symptoms of depression as listed below, but at times depression may manifest as physical ailments in what can be considered hidden elderly depression. You can learn to identify signs of depression and help your loved ones remain happy and vivacious as they age.

Unfortunately, losses seem like a normal part of the aging processes. Seniors may lose their spouse or friends as they age. Friends may pass away or they may relocate. Even small moves between communities can be impacting as travel may not be a possibility due to loss of driving privileges or simple lack of confidence for traveling even short distances. Seniors may feel sadness in relation to other loss of independence related to physical limitations or decreased mobility.

Poor health can contribute to difficulty participating in activities due to debility or chronic/severe pain. The medications used to treat medical illnesses may even trigger or worsen depression. A sense of purposelessness and loss of identity may creep in due to retirement or inability to engage in previous activities due to physical limitations. A senior citizen may have anxiety over their health issues, financial situation or may have a fear of death or dying.

It can be difficult to determine if an elderly person is suffering from a depressive disorder that should be treated as opposed to an understandable reaction to poor health or other cumulative losses that may come with advancing age.

Signs and Symptoms

Grieving losses is normal and these feelings may last for weeks or months. Losing all hope and joy is not normal and may indicate elderly depression.

The following are signs of elderly depression:

• Hopelessness
• Loss pleasure in usual or favoured activities
• Social withdrawal
• Feelings of anxiety, fear or constant worrying
• Difficulty eating and weight loss
• Loss energy
• Fatigue
• Difficulty sleeping
• Crying spells
• Pessimism
• Headaches and dizziness
• Difficulty carrying out daily living activities (grooming, bathing, dressing, etc.)
• Loss interest in hygiene or grooming (if this is a change from previous behaviour)
• Sad mood
• Feelings of excessive guilt or worthlessness
• Apathy or lack of motivation
• Change (increase or decrease) in sleep, appetite, weight, energy, sexual desire
• Decline in attention, concentration, memory
• Thoughts of death or suicide

Diagnosing elderly depression with late-stage dementia is very difficult but here are some signs to look out for:

• Tearfulness
• Behavioural disturbances
• Lack of energy
• Appetite loss, weight loss
• Agitation, hand wringing
• Slow movement and speech
• Lack of reactivity to please events
• Multiple medical complaints
• Daytime and nighttime variation in mood
• Anxiety
• Worrying
• Easily annoyed
• Thoughts of extreme pessimism and suicide

Depression vs. Dementia

If decline in attention, concentration and memory is one of the symptoms of elderly depression your loved one is experiencing, this can be mistaken as normal part of the aging process or mistakenly identified as dementia or Alzheimer's disease. The depression could go undetected and, therefore, untreated.

There are a few ways to tell the difference between cognitive (ex. Attention, concentration, memory) changes in dementia versus those that might be present in depression. The cognitive changes related to dementia will generally be gradual in onset over a period of years and the person will often be unaware of the deficits or attempt to minimize them.

Cognitive/neuropsychological testing in dementia will show definite impairments in a number or areas. There will be more issues with day-to-day functioning and the impairments will become worse over time.

If cognitive changes are a symptom of depression in the elderly person, the onset is generally more sudden and coincides with the onset of other depressive symptoms. The elderly person is much more likely to report difficulties with their memory or thinking.

Cognitive/neuropsychological impairments are usually less severe and show up in less number of areas and you will not see the same difficulty in day-to-day functioning. The reports of cognitive difficulties related to elderly depression usually do not become severe and will lift with the depression is treated.

Elderly at Higher Risk

• Inadequate support system
• Isolation
• History depression in family
• Failing health
• Substance abuse problems

Suicide

Untreated elderly depression can be more serious than an elderly person feeling hopeless or sad for a long period of time, suicide is also a risk. The risk of suicide in older adults is estimated as nearly three times greater than the risk in the younger population.

Passive suicide is a risk for seniors and includes behaviours such as refusing to eat, refusing medical treatment, failing to take medications or over medicating.

Elderly at Higher Suicide Risk:

• Previous suicide attempts or threats
• Presence of depression
• Recent major loss of a loved one
• Single or widowed status
• Medical illness
• Intense feelings of hopelessness
• Previous mental illness
• Alcohol or drug abuse
• The individual has a "plan" for how to commit suicide

All threats of suicide, particularly if the person has a "plan", should be taken seriously.

Hidden Depression in Elderly

Often seniors will exhibit the typical symptoms of depression listed above. Sometimes, though, they will only present with symptoms of physical illness without the accompanying emotional, behavioural or cognitive signs of depression.

They will show up at their doctor's office with medical complaints rather than saying that they feel sad or hopeless. Your loved one may complain about joint pain, back pain, muscle pain, weakness or abdominal pain. Or they might complain of anxiety symptoms such as changes in appetite, weight, sleep, energy levels, sexual function, difficulty concentrating, irritability or fatigue. These complaints may well be manifestations of depression and can be referred to as hidden depression.

This type of hidden or somatic depression and the elderly is more likely to be seen in individuals who experience their first episode of depression after the age of 65. If detected, this type of depression responds well to treatment.

Treatment

Depression and the elderly should be considered like other illnesses such as diabetes: chronic and treatable. Accepting treatment can be a challenge for some seniors as, in the past, depression was often viewed as a sign of weakness. Unfortunately, this view persists; particularly in the senior population.

Many seniors deny depression and ask questions such as "Wouldn't you be depressed if you had my life?" or "What do I have to look forward to?". Or they do not want the stigma attached to mental health issues or seeking treatment such as psychotherapy. You can help by reinforcing the importance of treating depression, perhaps even being insistent for your own peace of mind.

Common Treatments for Elderly Dementia:

• Prevention and early intervention of depression and the elderly
• Active, involved seniors usually have a greater life satisfaction, higher morale and lower incidence of depression than those who are isolated, withdrawn and inactive. Though some seniors are content with solitary or inactive lifestyles, increasing the amount of meaningful activity and involvement reduces the depressive symptoms in many others.
• Participation in volunteer, vocational, leisure or social activities (the activities need to be interesting and meaningful to the senior citizen. This may take some exploring before pushing this person into any activity)
• Awareness of the triggers of depression, risk factors and common symptoms
• Knowing how to seek help that will lead to formal assessment, diagnosis and development of treatment plan for depression
• Attempts to increase functional ability (ie. safety equipment, community access through handy-dart, taxis, buses; dressing aids, participation in exercise programs, etc.)
• Finding new friends or activities, encouraging engaging in or rejoining social activities (this advice may sound simple, but does work and is one way to treat depression without medications)
• Accessing community programming for seniors through seniors centres, health programs or church programs
• Good nutrition
• Exercise
• Psychotherapy
• Antidepressants (take time to work and often have side effects; check side effects that you might need to watch for with your physician)

Common Side Effects of Antidepressant Medications:

• Sleep disturbances and/or nightmares
• Confusion and disorientation
• Blurred vision
• Agitation/nervousness
• Dry mouth
• Urinary retention
• Constipation
• Increased blood pressure
• Change in heart rate
• Nausea
• Fatigue
• Weight gain

If your loved one is experiencing these side effects after beginning antidepressants, a visit to their doctor to review these side effects, medication and possible change to medications is necessary.

Medications may take a while to work. Frail elderly are often started on low doses. If your parent does not notice any changes, have them speak to their doctor. The doctor may increase the dosage and ask that you wait 4 – 6 weeks after this to evaluate whether this mediation is working.

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