Last updated: Aug 01, 2008
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Older depression patients tend to be tight-lipped about their emotions, so the signs of suicide may be harder to catch.
(CORBIS)
While the elderly make up just 12% of the population, this age group accounted for 16% of suicides in 2004, according to the National Institute of Mental Health. Family members, caregivers, and primary care physicians may mistake the signs of depression in the elderly as part of the normal aging process, but a failure to detect a greater problem can have dire consequences.


Depression is not a normal part of aging, and the best thing you can do for your elderly loved one is not to dismiss any sudden change in mood or function. One of the biggest misconceptions about depression in elderly people is that it is a natural response to circumstances, according to Kathleen Buckwalter, PhD, RN, professor of gerontological nursing research at the University of Iowa.

Increased medical burden, the loss of loved ones, and a decline in vision or other senses can all bring on bouts of depression among the elderly, even if a patient has no previous history of mental illness. According to a 2003 article in Clinical Geriatrics, a 2001 study found that up to 75% of depressed elders who committed suicide had seen a physician within the previous month. "Nobody really asks them how they're doing or if there is been a change in how they're doing," says Bruce G. Pollock, MD, PhD, the president of the American Association for Geriatric Psychiatry. "Physicians seeing them for other medical problems seldom ask them directly, 'Have you thought your life isn't worth living?'"


A loss of independence and mobility may also bring on depression which, left untreated, can turn to thoughts of suicide. "People who are becoming more dependent on others or more limited in the things they can do can't always adjust to that," says Martha L. Bruce, PhD, professor of sociology in psychiatry at the Weill Medical College of Cornell University and chair of the Geriatric Mental Health Foundation. "If someones life has changed significantly, look for a notable change in that person's approach to life."

But it can be tough to catch the signs of depression before it is too late. While younger patients are more apt to talk about their unhappiness, older depressed people tend to be tight-lipped. "With older people, its more subtle," says Dr. Pollock. "Its sometimes hard to distinguish [their depression] from their medical burden."

Part of the problem could be cultural. "Older males won't talk about it. They think it shows weak character, and they aren't given license to talk about their feelings," explains Dr. Pollock. "With the World War II generation there is almost a masked depression. They may tell everyone, 'Things are OK,' and they've already made up their minds to kill themselves."

Since the signs of suicidal thinking can be difficult to discern, it is important for caregivers concerned about an older person to monitor the means of suicide at his or her disposal. For instance, a University of Rochester study found that firearms are the most common method of suicide among older adults. The presence of a firearm in the home makes for an increased risk, so consider talking to your loved one about removing any guns from the house.

Even if the clues are subtle, you can help catch and treat elderly depression before your loved one becomes suicidal:


Look for a change in usual activity. "The biggest warning sign is when there is a change in function and somebody isn't doing the activities they used to enjoy doing," says Dr. Pollock. "You can see this either in a pretty short time frame or in a general decline."

Don't normalize your elder's depression. "It's easy for a caregiver to empathize with those feelings and to normalize them," says Bruce. "Sure, we can understand why someone gets depressed, but just like we treat a broken leg or open wound, because we understand something doesn't mean we don't go ahead and treat it."

Start a dialogue. "You don't have to ask, 'Are you going to kill yourself?'" says Buckwalter. "You can ask, 'Do you ever lose hope?'" You should also ask if they have ever thought about how to harm themselves.

Share your concerns with your loved one's primary care doctor. "Don't expect that the physician is going to pick up on it," says Bruce. "As a caregiver, you can go in with the patient and help articulate the issues you want to talk about, so walk in prepared."

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