What are the symptoms of depression in older adulthood?
The Canadian Psychological Association’s fact sheet on Depression lists the symptoms of depression. These symptoms also identify depression in older adults. Symptoms typically manifested by older adults suffering from depression include loss of energy, decreased interest and pleasure in usual activities, pain and somatic complaints, and complaints of memory problems.
Who is affected?
Depression should not be seen as the unavoidable fate of older age. Still a number of seniors experience depression. On the one hand, the rate of major depression in older adults is relatively low, touching 3-5% of older adults aged 65 and over living in the community. On the other hand, the prevalence of symptoms of depression in this population is significantly higher, with about 15% of older persons in the community reporting significant levels of depressive symptoms
Some subgroups of older adults present a higher risk for depression, in particular individuals afflicted by chronic disease, older adults living in long-term care and nursing homes, and those providing care for a family member (e.g., to a partner suffering from dementia).
What are the other problems associated with depression?
Depression increases the risk of death in older adults by 2 to 3 times. Depression constitutes the most important factor associated with risk of suicide in old age.
Depression amplifies the functional disabilities produced by physical illness, interferes with treatment and rehabilitation, and further contributes to decline in physical and cognitive functioning.
Why is depression often missed and/or under-treated among seniors?
Depression can be hard to detect in older adults for several reasons. Older adults are often reluctant to admit to psychological symptoms or difficulties and are more likely to communicate their psychological distress by complaining of physical symptoms. Several symptoms of depression (e.g. sleep problems, feeling fatigued, and lack of energy) also naturally occur in older adulthood; as such, in some cases these symptoms may be mis-attributed to normal aging rather than depression. Also, the myth that it is normal for older adults to feel some amount of depression may result in true cases of clinical depression being overlooked.
What are the causes of depression in later life?
A history of depression in earlier adult life is a risk factor for depression in later adulthood. Chronic health problems and the loss of spouse, especially for men, can be associated with depression. Major depression may also occur after experiencing a cerebrovascular accident (stroke).
Factors such as loss of control and independence as the result of illness and/or disability, loneliness, and lack of social support can also lead to depression in older age.
What psychological approaches are useful to treat depression among seniors?
Several psychological treatments for depression used with young and middle-aged adults are also effective with older adults. In particular, cognitive behaviour therapy, interpersonal therapy, problem- solving therapy and reminiscence therapy are treatments whose efficacy is supported by empirical research.
Cognitive-behaviour therapy helps individuals with depression become aware of how thoughts influence mood and behaviour and learn to correct negative ways of thinking in order to alleviate depression.
Interpersonal therapy helps the depressed person cope with current stresses and challenges in interpersonal relationships – in particular in the context of conflicts, grief and bereavement, changes in roles, and social support.
Problem-solving therapy helps individuals with depression develop effective problem-solving skills to cope with current difficulties, such as managing a health condition or adjusting to living in a nursing home.
Reminiscence therapy helps individuals with depression re-evaluate personal memories in order to rediscover a sense of worth and life coherence and meaning.
These psychological treatments are safe and effective alternatives to medications, with combined drug and psychological treatment often used for complex cases.
Psychological treatments can be particular useful for people who are unable to, or unwilling, to take antidepressant medications.
Where do I go for more information?
More information on depression in older adults, including more detailed descriptions of psychological treatments and other supports, can be found in the National Guidelines for Seniors’ Mental Health: The Assessment and Treatment of Depression, Canadian Coalition for Seniors’ Mental Health (2006).
You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/PTassociations/.
This fact sheet has been prepared for the Canadian Psychological Association by Dr. Philippe Cappeliez, Emeritus Professor, School of Psychology, University of Ottawa.
Revised: March 2020
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