Depression in old age

Health risks increase steadily with age. Just as with physical well-being, older age is a risk factor for mental health. From a certain age onwards, many people experience changes in their lives that can lead to strong emotional reactions. Examples include retirement, the loss of a spouse, loneliness or physical limitations.

Mood swings or depressive moods are often overlooked, underestimated or overshadowed by physical symptoms. Depression is not a definitive consequence of ageing, but depressive symptoms are widespread among the elderly and increase with age. A study on age-related depression involving 2,850 people aged 75 and over found that 31.1 % of participants had depressive symptoms. This figure is significantly higher than in younger samples (aged 60–75).

In other words, out of 100 people over the age of 75, 31 are likely to suffer from depressive symptoms. By comparison, in 2017, 3.4 % of the world’s population suffered from depression, which means that the prevalence of depression among older people is potentially much higher than in other age groups of the population.

Recognising depression in old age

Depressive symptoms can be difficult to detect in older people. Even with regular visits to the doctor, it is common for symptoms of depression to go unrecognised. Feelings of weakness, lethargy, difficulty concentrating, sleep disturbances and sadness can all be dismissed as simply a normal part of ageing. Those affected often underestimate the potential severity of such changes. Meanwhile, depression can remain undetected and thus become a serious health risk for older people.

Physical predictors of depression

• Poor physical health: While depression can be an emotional response to the mere fact of having a chronic illness, it can also be a symptom of a condition such as cancer, thyroid problems, vitamin deficiency or infection.
• Limited mobility and independence: Some physical illnesses lead to permanent impairments that require help from family members. This can subsequently lead to feelings of being a burden.
• Prescription medication: Medication can have side effects that can trigger depression (e.g. steroids, painkillers, high blood pressure medication, etc.).
• Cognitive impairment: A 2004 study concluded that depression and cognitive impairment are correlated and often occur together in old age. Therefore, if an older person begins to experience cognitive decline, they are more likely to become depressed.

In summary, it is advisable for all older people to pay close attention to their mental state. A possible change in mental disposition can be a sign of a physical problem and vice versa.

Depression caused by loneliness

Loneliness and social isolation play a major role in depression – social ties are often reduced in old age. Depending on the region, some older people have difficulty getting around, live in remote areas or have simply lost most of their friends. Various factors can lead to isolation, which is not conducive to mental health.

If possible, it is advisable for older people to find a way to be part of a community. Whether it’s a hobby, informal get-togethers with friends or even getting a pet, all of these things will have a positive effect on their general mental state.

Personal losses in life are difficult regardless of age. However, in older age, these losses tend to occur more frequently in shorter periods of time. This accumulation can be traumatic. The loss of a spouse after decades of marriage, the loss of old friends, the loss of a pet – none of these things are easy to cope with. In addition, a loss can also be symbolic in nature: a certain lifestyle, physical strength and health, cognitive abilities, etc. All these forms of loss can contribute to the development of depression.

Measures against depression in old age

In recent years, brain research has clearly shown that the ageing process and stress reduce neuroplasticity in the brain, while physical activity, a varied environment and learning promote it. That is why physical training is one of the few methods that can improve neuroplasticity quickly, easily and effectively. Sport and exercise have an influence on the growth, differentiation, survival and repair processes of brain cells.

“Exercising” often sounds overwhelming and quite daunting, especially for someone over 60. However, it is highly recommended to keep the cardiovascular system active and healthy through physical activity. The following activities are already extremely effective:

• a walk in the neighbourhood or nearby woods,
• swimming at the local pool,
• light and relaxing yoga,
• walking the dog,
• dancing,
• and much more.

Consider joining a local group such as a club, sports group or similar – socialising only enhances the benefits of the activity itself.

Another part of physical health is controlling your body weight and eating a healthy diet. Body weight and diet are directly related to hormone regulation, physical health and mood. It is advisable to stick to whole foods, healthy fats and plenty of vegetables and to avoid fried foods, fast food and any kind of packaged “snacks”.

Limiting alcohol consumption and not smoking are also important factors for good mental health and physical well-being.

Another important aspect of a healthy lifestyle is exercising the brain. As mentioned above, cognitive impairment is closely linked to depression, so it is crucial to “train” the brain regularly. Just like the muscles in the body, the principle of ‘use it or lose it’ applies here. This principle is especially true for older people who suffer from (or are at risk of) dementia or Alzheimer’s disease. Here are some ways to train your brain:

• Talking – having a mindful conversation stimulates the brain
• Read a book
• Play an instrument
• Gardening or a craft hobby
• Puzzles and crossword puzzles

Depression in old age: recognising the symptoms

However, simply feeling sad or stressed does not automatically mean that you are depressed. The following list of symptoms should help you assess your situation.

• Depressed mood – recognisable through self-perception or observation by others
• Loss of interest in activities that were previously enjoyable
• Excessive tiredness/loss of energy/exhaustion
• Feelings of worthlessness/excessive or inappropriate feelings of guilt
• Recurring thoughts of death, suicidal thoughts or actual suicide attempts
• Reduced thinking ability, declining concentration or indecisiveness
• Psychomotor agitation or slowing
• Insomnia or increased need for sleep/daytime sleepiness
• Significantly increased or decreased appetite and subsequent weight gain or weight loss

Age-related depression: What can be done?

The lifestyle changes mentioned above are not classified as clinical interventions, but they are just as important and effective when it comes to mental health. The two most important treatment options for depression are: psychotherapy and medication.

Antidepressants: These types of medications work at a biochemical level by improving the production and conversion of certain chemicals in the brain. Antidepressants take time to work (approximately 4–6 weeks) – during this time, factors such as sleep quality, appetite or concentration may gradually improve before the depressive mood lifts completely. Sometimes people start to feel better and decide to stop taking their medication or reduce the dose without consulting their doctor. This is not recommended, as it can lead to withdrawal symptoms or a return of depression.

A 2005 study on the use of antidepressants in older people concluded that four weeks of antidepressant treatment is likely to show initial positive effects. To prevent relapse and recurrence of depression, medication should be continued for up to six months after a good response.

Psychotherapy: Psychotherapy can usually be used either as a stand-alone treatment or in combination with medication. There are different types of psychotherapy, which can be divided into the following groups:

• Evidence-based therapies: These include CBT (cognitive behavioural therapy), which focuses on changing unhealthy thought patterns.
• Psychodynamic therapies: These deal with a person’s experiences and relationships, as well as their emotional reactions to them.

Regardless of the type of therapy, you should find a trained and certified professional who can help you or your loved one cope with depression. Digital psychotherapy can also be a suitable method for overcoming depressive symptoms – even for older people who are less tech-savvy. Feel free to find out more on our website.