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 older adults 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 depression may not fit when you see an older adults who experiences depression. People often report sadness (depressed mood), lack of interest, and low energy as the main symptoms of depression. However, when older adults are experiencing depression, their first complaint is often related to physical symptoms—fatigue, pain, and insomnia. When there is an unexplained physical symptom in older adults, depression should be one of the first factors to be explored by medical professionals.
(2) Depression in older adults is often misdiagnosed as dementia
Older adults 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 older adults such as physical problems, delusional disorder, or dementia. When a person gets a wrong diagnosis, he/she/they doesn’t get the right treatment for depression.
Depression can also affect one’s ability to concentrate. This can be a symptom of depression 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: https://www.islandhealth.ca/sites/default/files/2018-05/delirium-3d-difference.pdf
In addition to depression and dementia, the above chart 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 watch TV shows and movies in the American society, you can find 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 stereotypical belief contributes to people's misinformed perception that depression is as an acceptable and expected condition for older adults. Some older adults end up believing this harmful belief to be true, and they don’t seek treatment because they think depression is part of their 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 stigma over getting mental health treatment affects older adults’ attitude about treatment and their willingness to seek treatment. The negative impact of the stigma is more impactful in African American older adults than Caucasian older adults.
I want you to know that there is a very good reason for older adults to seek treatment: 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 SAMHSA—“Good mental health is ageless” --because it is so true. Yes we may lose many things as we age, and this can feel depressing to some. And 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.” https://www.cdc.gov/aging/depression/
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. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-3618.pdf
Vancouver Island Health Authority. THE 3 D’s: Comparison of Depression, delirium, and dementia. https://www.islandhealth.ca/sites/default/files/2018-05/delirium-3d-difference.pdf