An in-depth exploration of depression in older adults: part 1

In the first article of a two-part series, distinguished consultant psychiatrist Professor Farooq Khan explores depression in older adults, including the typical signs and symptoms, and how it differs from depression in younger individuals and treatment options.

What are the typical signs and symptoms of depression in older adults?

Depression in older adults can manifest differently compared to younger individuals, often with less obvious signs. Recognising these signs is crucial for timely intervention and treatment. The presentation can differ in individuals but the main components of mood, cognition and thought process will remain similar.

Mood changes

Individuals suffering from depression can describe a persistent sadness that incorporates prolonged feelings of sadness, hopelessness, or emptiness. They might be irritable or angry, and their family may describe them as being ‘short-tempered’. It is possible that older adults will not ‘describe’ the sadness more openly.

Physical symptoms

Body aches and pains may appear without a clear medical cause, often accompanied by fatigue and low energy. Appetite usually decreases, causing weight loss, though some may gain weight due to binge eating. Sleep disturbances are common, affecting both falling and staying asleep, while some experience excessive sleepiness.

Cognitive changes

Depression presents with memory problems including difficulty concentrating, remembering details, or making decisions. This can be sometimes misinterpreted as ‘dementia’ presentation, but it is depression which causes deficits in cognition. Body movements and overall activity become slower, and speech becomes low in volume and tone.

Behavioural changes

People with depression can have problems with social interactions. They prefer being aloof, avoiding mingling, which negatively impacts on hobbies, or activities that they used to enjoy. They may neglect responsibilities, resulting in poor personal care, disrupted household chores and negligence of financial responsibilities.

Emotional and psychological symptoms

People with depression often experience feelings of worthlessness or guilt, self-blame, or feelings of being a burden to others. They may lose interest in daily activities or find little to no pleasure in activities they once enjoyed. Additionally, they may experience heightened anxiety or worry, which can lead to agitation or restlessness.

Thoughts of death or suicide

Suicidal thoughts and preoccupation with death, dying or suicide often arise in severe depression. Increased intensity may lead to planning or attempting suicide. Monitoring for signs like giving away possessions or organising affairs is crucial, as these actions indicate a higher risk of a suicide attempt.

Changes in routine or behaviour

Some people with depression appear withdrawn from social activities, hobbies, or previously enjoyed activities. Decision-making becomes problematic and there could be a noticeable hesitation in making decision.

Somatic complaints

Some individuals experience worsening of chronic medical conditions without clear medical reasons. This happens more commonly in older adults and may result in increased frequency of medical visits without significant findings.

Recognising and addressing depression in older adults

Open Communication: Encourage open conversations about feelings and emotions. Older adults may be reluctant to discuss their mental health due to stigma or generational attitudes.

Regular Check-ups: Routine medical and mental health check-ups can help identify depression early.

Professional Help: Consult healthcare professionals, including primary care physicians, psychiatrists, and psychologists, who can diagnose and treat depression.

Support Networks: Engage family members, friends, and community resources to provide emotional and practical support.

Treatment Options: Consider therapy (such as cognitive-behavioural therapy or interpersonal therapy), medications (antidepressants), and lifestyle changes (exercise, diet, social activities).

Depression in older adults is a significant concern that requires attention and appropriate intervention. By recognising the signs and encouraging open communication and professional help, it is possible to improve the quality of life for older adults suffering from depression.

How does depression in older adults differ from depression in younger individuals?

Depression in older adults can present differently than in younger individuals due to various factors such as physical health, life stage, and social circumstances.

Presentation of symptoms

Older adults:

Physical symptoms: Older adults often report more physical symptoms such as unexplained aches and pains, fatigue, and changes in appetite or weight, and may experience more sleep disturbances.

Cognitive symptoms: Symptoms like memory problems, confusion, and slower cognitive processing can be more prominent.

Less obvious sadness: They may not express feelings of sadness or hopelessness as openly. Instead, they might appear more irritable or withdrawn.

Anxiety: Increased anxiety or agitation can be more noticeable.

Younger Individuals:

Emotional symptoms: Younger individuals are more likely to report feeling sad, hopeless, or experiencing a sense of emptiness. They are much more vocal and descriptive about how they feel.

Behavioural changes: They may show changes in eating and sleeping patterns, significant weight changes, and a noticeable drop in energy levels.

Social withdrawal: Avoidance of social interactions, hobbies, and previously enjoyed activities is common.

Causes and triggers

Older adults:

Health issues: With advancing age comes a number of other physical health issues including chronic illnesses, pain, and disability which can contribute significantly to depression.

Losses: There are increased chances that with age people will more frequently experience bereavement and loss of friends and family members.

Isolation:  The purpose of life might be impacted, and individuals' roles within the family, community, and society can change with retirement and reduced social interaction. Declining physical health can lead to decreased mobility, contributing to feelings of isolation and loneliness.

Cognitive decline: Cognitive decline and dementia can also be contributing factors. One of the issues will be not being able to communicate feelings and emotions due to impact on cognition.

Younger Individuals:

Life stressors: Factors like academic pressures, career stress, relationship issues, and identity crises are common triggers.

Social media: Media plays an important role in the lives of younger individuals compared to older adults. Exposure to social media and online interactions can play a significant role in affecting mental health.

Substance use/misuse: Higher rates of substance use and abuse can be both a cause and a result of depression in younger people.

Diagnostic issues

Older adults:

Ageing: Symptoms of depression may be mistakenly attributed to ageing or medical conditions, leading to underdiagnosis.

Stigma: There might be a greater reluctance to seek help due to generational stigma around mental health.

Communication barriers: Older adults may have difficulty articulating their emotional distress, making their depression less likely to be recognised.

Younger individuals:

Overlapping conditions: Depression may coexist with other mental health conditions like anxiety, ADHD, or eating disorders, which can complicate diagnosis.

Behavioural misinterpretation: Symptoms of depression in younger individuals may be misinterpreted as normal teenage or young adult behaviour.

Treatment

Older adults:

Medication sensitivity: Older adults may be more sensitive to medications and their side effects, requiring careful management and monitoring.

Comorbid conditions: Treatment plans must account for coexisting medical conditions and the potential for drug interactions.

Therapeutic approaches: Emphasis on supportive therapies, cognitive-behavioural therapy (CBT), and interventions that address social isolation and physical health.

Younger Individuals:

Therapy: Greater use of talk therapies such as CBT, interpersonal therapy (IPT), and psychodynamic therapy.

Lifestyle interventions: Focus on lifestyle changes including diet, exercise, and structured daily routines.

Technology: Use of digital tools, apps, and online therapy platforms to engage younger individuals.

If you are suffering from depression and would like to book a consultation with Dr Khan, do not hesitate to do so by visiting his Top Doctors profile today.