Resource Guide for Family Caregivers
Mental health with normal aging and identifying symptoms of depression

Despite the longstanding misconceptions about aging - that growing old would lead to despair and depression - the vast majority of individuals do not experience mental health problems such as depression in later life. Thus, mental health difficulties are not part of normal aging. Indeed, most older people feel satisfied with their lives.

Nevertheless, a significant number and proportion of older adults do experience mental health difficulties. The most common disorders, in order of prevalence, are anxiety problems (e.g., phobias and obsessive-compulsive disorder) and mood disorders, such as clinical depression, which in North America affects one to four per cent of the population age 65 and older (though the prevalence for the institutionalized elderly has been found to be as high as 12-15 per cent.9

Of these, clinical depression is probably the most serious and has the gravest implications for health and well-being. For example, mental disorders can negatively affect the ability of older people to recover from other health problems. Heart attacks are five times more likely to be fatal for a person who is depressed. Untreated depression can interfere with the patient’s ability to follow the necessary treatment regimen or to participate in a rehabilitation program.

For older people, physical illness and disability is also a major risk factor for the onset of depression. Post-stroke depression, for example, is quite common, and older patients often have mini-strokes that start a cascade of mood problems. Depression is also associated with Parkinson’s disease, thyroid problems and cancer-related malignancies in the stomach, colon, lungs and brain. Viral illnesses, too, such as shingles, can be closely associated with a depressive disorder.

Most people think of depression only as sadness and low mood, but clinical depression is far more than the ordinary down moods everyone experiences now and then. Depression is a whole body disorder.

Depression is also more than a feeling of grief after losing someone you love; following such a loss, a depressed mood is generally a very normal reaction to grief.

When a depressed mood continues for some time, whether following a particular event or for no apparent reason, the person may be suffering from clinical depression. Clinical depression is a whole body disorder. It can affect the way you think and the way you feel, both physically and emotionally.

Knowing what to look for in terms of signs and symptoms of depression in older people is important, both because of the potential risks to the person if ignored, and because the condition is highly treatable.

The following Depression Symptom Checklist is useful for adults of all ages. If the person has experienced four or more of the symptoms within the past two weeks, a physical and psychological evaluation by a physician and/or mental health specialist should be sought.

Be aware, however, that the symptoms of depression experienced by older adults may differ from those experienced by younger people. This can make accurate diagnosis and treatment difficult. For example, an older person who is depressed may be more likely to report physical symptoms such as insomnia or aches and pains rather than feelings of sadness or worthlessness.

Depression Symptom

Checklist

  • A persistent sad, anxious or empty mood.
  • Loss of interest or pleasure in ordinary activities, including sex.
  • Decreased energy, fatigue, feeling ―slowed down.
  • Sleep problems (insomnia, oversleeping, early-morning waking).
  • Eating problems (loss of appetite or weight, weight gain).
  • Difficulty concentrating, remembering, or making decisions.
  • Feelings of hopelessness or pessimism.
  • Feelings of guilt, worthlessness, or helplessness.
  • Thoughts of death or suicide; a suicide attempt.
  • Irritability.
  • Excessive crying.
  • Recurring aches and pains that don't respond to treatment.

You also need to be aware that some symptoms of depression also occur in other medical conditions common in older people. For example, weight loss, sleep disturbance, and low energy also occur in diabetes and heart disease; apathy, poor concentration, and memory loss are also found in Parkinson’s and Alzheimer’s diseases; and achiness or fatigue may be present in many other conditions. In addition, fatigue, high or low mood, sedation, and difficulty with memory or concentration can be depressive symptoms but can also occur as side effects of medication. To determine the proper diagnosis, a physician must conduct a thorough evaluation, taking into consideration all current prescriptions and over- the-counter drugs.

Mental health problems in late life usually occur in the context of medical illness, disability and psychosocial impoverishment11. Older people are especially vulnerable to mental health problems at critical transitions (e.g., widowhood, disablement, institutionalization, caring for a spouse with a dementia) and/or when they are socially or emotionally isolated (which can result from critical transitions).

Unfortunately, while effective treatments exist for many common mental disorders, there are still barriers to identifying and treating mental health problems in older adults - indeed, it has been found that, at present, only about 10 per cent of elderly depressed people are thought to seek or receive psychiatric help. Barriers to seeking treatment include the mistaken belief that mental disorders like depression or dementia are normal

in older people and that no effective treatments are available. Moreover, some older people themselves believe that mental health problems and their treatment are shameful, represent a personal failure, or will lead to a loss of autonomy. They may thus deny having mental health problems or refuse treatment from mental health care providers.

The good news about depression, for adults of all ages, is that nearly 80 per cent of people with clinical depression can be treated successfully with medications, psychotherapy, or a combination of both. Even the most serious depressions usually respond rapidly to the right treatment. But first, depression has to be recognized.

8. This sub-section has been adapted from: www.nimh.nih.gov/publicat/over65cfm and Older Adults and Mental Health, www.aoa.gov/may2001/factsheets/Older-Adults- and-Mental-Health.html.
9 and 10. Source: Jamer, Roderick. Living with depression. Canadian Association for Retired Persons‖ website http:/www.50plus.com/
11 ―Psychosocial Approaches to Mental Health Challenges of Late Life, www.seniorsmentalhealth.ca