Last updated: Apr 14, 2008
By the time people are over 65, illness and personal loss have likely started to intrude in their lives. Sadness and grief are normal reactions to these situations, but sadness and grief do not equal depression.
"Older adults are fairly resilient considering the stress many of them are under," says Joel E. Streim, MD, a geriatric psychiatry specialist at the University of Pennsylvania. "Many older adults are losing companions and spouses, coping with physical disability and dependence, or moving to senior housing. And we know that relocation is one of the most stressful events in anyone's life. So when depression does occur, it is an illness that must be treated."
Depression is persistent and interferes with a person's ability to function in daily life. It robs people of their peace of mind and their enjoyment of simple pleasures; makes them feel worthless, unlovable, and irritable; and can contribute to early death.
Depression hits the elderly hardest
Suicide is the most feared complication, and it hits older adults harder than any other age group. In 2004, people aged 65 years and older accounted for 16% of all suicide deaths in the United States even though they comprised only 12% of the population.
That same year, 14.3 in 100,000 people age 65 and older died of suicide. The rate in the general population was 11 per 100,000. The older people get, the worse it gets. For every 100,000 white men age 85 years and older, 49.8 committed suicide. Depression is to blame for many of those deaths.
Why depression gets missed
"Depression gets missed in geriatric populations for several reasons," says Kenneth Robbins, MD, a psychiatrist who runs a geriatric inpatient unit in Stoughton, Wis. "The assumption is that because people are older and they've had a lot of losses, 'How could they not feel depressed?' And so, they don't treat a major depression that would be easily treatable."
While it's true that depression is not a normal reaction to aging, the risk of depression increases as people age and become more debilitated. The rate of depression in older people living in their own homes, who get around pretty well and are in decent health, is in the range of 1% to 5%. The rate goes up to about 13% in people who need home health care.
Aging can worsen existing depression
There's another side of depression in the elderly. Sometimes it's a continuation of a problem that existed when a person was younger. Aging doesn't cure depression, and time definitely doesn't heal all wounds.
"I've been in and out of therapy throughout my adult life, and I'm still in therapy," says Evelyn, 90, who lives outside Boston. Evelyn has struggled with eating problems since her kids were born, and several therapists have confirmed that her difficult relationship with food is a manifestation of her depression.
Lots of medical problems get more complicated as you age, and depression is no exception. It can be harder for doctors to diagnose, and treatment is sometimes trickier. But effective treatment is available. You need to find a doctor who will be diligent in getting to the source of your symptoms and persistent in finding the best possible treatment for you.