Senior Depression: Overlooked, Different and Not Normal
So what do we mean by all that? Depression in seniors is not a normal part of aging. But it affects over 6 million Americans 65 and older. It often occurs with other illnesses and lasts longer than depression in younger people. And depression in seniors is often overlooked by doctors, loved ones and even the depressed.
As a loved one and/or caregiver, it’s important to understand how and why these aspects of senior depression work. And as a senior experiencing depression, you should know that ignoring it won’t help and can lead to other health issues. Let’s unpack each of these in more detail.
What is Depression?
Feeling “down” or lethargic is normal for anyone, especially after traumatic events like the loss of a loved one. Persistent feelings of sadness and loss of self-worth especially when these feelings affect normal daily routine may indicate depression.
Depression is not a normal part of getting old. It’s not a normal part of any age. Yes, you’ll get down sometimes. You’ll experience a range of emotions after life-changing events such as retirement, death of a spouse or major illness. Feelings from these events can seem overwhelming. But you eventually bounce back.
It’s when these feelings persist, affecting daily life, that depression moves in. And though it’s not normal, it’s also not uncommon, affecting over one-fifth of the senior population.
Most seniors deal with declining physical health whether it’s a general slowing down or a chronic illness such as diabetes, heart disease or cancer. They also deal with some dulling of their mental edge. This is normal. So the popular perception is that “it must stink getting old with all these health problems.” And this is the problem.
If we think this way then we, as loved ones or caregivers, are missing a potentially big problem. Here are some chilling statistics: Those 65 and older have a higher rate of suicide than the general population. The suicide rate of people between 80 and 84 is twice the general population.
Doctors miss this too. According to some studies, about 75% of seniors who die by suicide had visited a physician within a month of their death. This is not blaming doctors for missing it. Elderly patients can mask their symptoms with drugs and alcohol. Also, the normal aches of old age occupy the doctor’s attention. And the symptoms of depression can be confused with dementia, heart disease, strokes and the effects of medication.
Some elderly people are simply not comfortable talking about their feelings. Maybe it’s a generational thing. Others just don’t want to burden others with their problems. After all, they may already have physical issues. Why throw another problem on the table?
As stated above, seniors eventually run into a physical illness and/or cognitive decline of some kind. These declines often result in depression. And for many, these physical and cognitive setbacks become part of their life. For example, someone dealing with the chronic pain of arthritis may become depressed. The arthritis isn’t going away and neither will the depression if not recognized and treated.
Here’s another difference: vascular depression. When blood vessels harden over time, they reduce the flow of blood to the brain, leading to vascular depression. This condition usually affects those 60 and older.
Finally, seniors are already at greater risk for things like cardiac disease. Depression can actually double this risk. On top of that, depression reduces a person’s ability to recover from events such as a heart attack or stroke.
Recognizing Depression in Seniors
Everyone is different so these lists won’t cover every person. But they’ll give you an idea of some of the more commons signs, symptoms and risk factors.
Factors that Increase Depression Risk
- Being female
- Widow(ers), single, divorced, unmarried
- Minimal or no social support network
- Social isolation
- Loss of a loved one
- Children have moved out
- Major life event such as retirement or moving to a nursing home
- Physical conditions like cancer, dementia, diabetes, stroke and chronic pain
- Previous history of depression
- Family history of major depression
- Fear of death
- Certain medications (or combinations of)
- Alcohol or substance abuse
Signs of Depression
- Changes in appetite and resulting weight loss or gain
- Feeling lethargic, decreased energy levels
- Difficulty concentrating
- Difficulty making decisions
- Change in sleeping patterns
- Change in communications: e.g. they used to call or email frequently, now they do it less and less
- More preoccupied with their physical health
- Thought of suicide
- Changes in daily life: Do they have an unkempt appearance where before they were always groomed? Is their house messy where before it was always clean?
Retirement and Depression
Nearly 76 million boomers are heading toward senior living over the next few decades. If you’re one nearing the big “R” have you thought about what you’ll do? What to do with your time becomes a problem for many retirees. Why?
You create a void when you retire. You work your whole life. You make sacrifices. Get stressed. Work long hours, occasionally to the detriment of your family. All for the ultimate goal of retiring. And for some that goal comes with, “I’m not working. Now what?”
For those 45 or 50 years, 40+ hours a week, you were occupied. You didn’t have to wonder where you would be come Monday morning.
This void can be stressful for some seniors, depressing for others. Some self-identify with their careers. For others, their jobs were simply a means to an end. But to suddenly lose that takes adjustment for almost everyone.
So how do you avoid the retiree blues?
Recognizing that Your Feelings Are Normal
With any big life-changers, there will be feelings of uncertainty, stress and even depression. This is normal. It helps to realize this and to know that most retirees experience some levels of these emotions.
But like any event in life, what matters is how you react to that event. With retiring, that translates to having a road map. There’s still time to do what you always wanted to do. So let's look at your map.
Embracing Your Dreams
There is only one success – to be able to spend your life in your own way—Christopher Morley
Even if you didn’t spend your working life quite the way you wanted, now is the time. Live your dreams. Retirement is a great time to make this happen.
Learn Something New. Strengthen Your Brain.
Can you avoid the retiree blues by playing the blues? Maybe you always wanted to play guitar in a rock band. Take lessons. Practice every day. Enjoy learning something new.
There are bands out there with retirees playing Jimi Hendrix and Cream covers. When you’re good enough, find one. Better yet, form your own band. Even if you never get good enough you’ve learned something new. The experience may open doors to something else that may change your life. It happens.
Plus, studies show that learning new things—especially learning to play an instrument—will help strengthen your brain even as you age.
We said it. Maybe you need a second shot, particularly if you’re career was unfulfilling. Work at a homeless shelter. Become a barista philosopher (i.e. work in a coffee shop). Invent something. Start your own business. Many seniors find second careers doing this. With your experience, you are years ahead of most of the working population. Find work in an industry you are interested in.
Short on Dreams?
Your dreams don’t have to be big achievements. What did you always want to do but never seemed to have the time for? Don’t limit your time-frame. Dig back as far as you can. Think about what really excited you before you had a career. Make a list.
Did you change college majors from art history to something more practical like business? Start studying art history again. Take college enrichment classes. Plan a trip to the Louvre in Paris or the Uffizi Gallery in Florence. Volunteer as a guide in a local museum. Become the expert you always wanted to be.
Holiday Depression in the Elderly
Rather than looking at Holidays as times one was happy in the past, we need to look at holidays as long-lasting, always present memories and experiences,
as we do with every day of every year. The meaning we give to holidays is in
our heads and hearts, and therefore we are in control of how we perceive and
deal with the emotional highs and lows that are symbolically connected with
them. If we are alone now in the present for whatever reason, and choose not
to be alone, we can make plans to do things with people we enjoy being with,
in spite of the fact that they are not necessarily our first choice to spend
the holidays with. If on the other hand we enjoy spending time alone, then we
should make plans to do something alone that we enjoy. Not planning meaningful
activity, during times we know we will feel alone and depressed is
self-defeating, and necessarily creates the stage for depression.
I am not suggesting that activity be planned just to fill time. It needs to
be meaningful, or else whatever is planned will itself contribute to the wave
of depression and lethargy that we ourselves invite. While seniors make it a
point, often beyond what is asked for by family members, NOT to INTRUDE in the
lives of their children and friends during the holidays, we need to be careful
that we don’t deprive and rob them of our presence, and of the significant
contribution we make to the entire family. Regardless of the extent of either
good or strained feelings among members of the entire family, our presence and
participation adds history, meaning and life to any and all family gatherings.
While autonomy and independence are a legitimate and desirable goal of all
people, they are at the same time a hindrance in promoting interdependence,
happiness and fulfillment for us and all members of our family.
Now for the tough part: mending and healing relationships that may seem as
if they are on the brink of disarray, strained or troubled. The very first
thing we have to realize is that whenever we speak or think in terms of
“blame” we defeat ourselves. Relationships, in particular family
relationships, are very complex, and because of this fact, it is important to
think in terms of processes, circumstances and situations rather than blame.
We, who have lived a little while, have come to learn that we, and of course
everyone else in the world, do not know whether a decision that is made or
activated today, will reap benefit or havoc until it has the opportunity to
play itself out. If we knew the result of any decision or action in advance,
there would be no need to strive for, risk, or hope for the many aspects of
our life that we now do, and that, in fact, help to create pleasure and
meaning for our life. There also would not be any opportunity for growth,
happiness and fulfillment of ourselves or of all those with whom we are in
relationship. If we truly understand this we will delete the word and meaning
attached to “blame” from our vocabulary, and from our life. Instead
of “Blame” we need first to look at ourselves, our intentions,
actions, hopes, fears, and disappointments and then take all that we have
experienced and learned throughout this process of self understanding to
include the joy and the pain, and transfer our new-found understanding of our
own processes to that of understanding members of our own family.
There is a reason for everything that we do. You may respond by saying,
“Oh you mean that there is an excuse for everything”. No, excuse
denotes blame. Rather than excuse, we need to think in terms of understanding,
and if understanding is not possible, then we need to come to terms with
“it”, whatever “it” may be, at least for the present, as
something that we cannot make sense of. Each of us has problems and complaints
with others, as others have with us. There is no getting away from the fact
that whatever process of understanding or misunderstanding applies to the way
we are towards others, in turn applies to the way in which all people think,
react, and interact with others. That is why the key to understanding,
interacting well with others, and the ability to enjoy the company and gifts
of others is knowing and understanding ourselves, first, foremost and always.
How is this accomplished? The most important way in which this occurs is
learning to live for the moment, appreciating what we have, and what others
have to share with us, now; at this time in their and our lives; rather than
wasting time pondering, yearning for, or seething over what happened in the
past. It is only by living in the present that we can truly be with and for
others, and in turn allow others to be with and for us. It’s both as simple
and as difficult as this.
Living and experiencing ourselves, others and life in the present dictates
that we come to terms with the hurts, and unfilled expectations that are
caused by our family. As much as we hurt, are disappointed, and believe that
we did not receive what was our “due”, be it from family members or
others, we need to realize that we, in turn, are perceived by family and
others as the source of their pain, disappointment and unfulfilled
expectations of us. It’s quite a dilemma, isn’t it? Not really, not if we
remember what was discussed earlier in this article, that we need to think in
terms of processes, situations, and circumstances rather than
“blame”, and that there is never any guarantee that a decision I
make right now will be one that is beneficial or harmful. I won’t know that
until I see the unfolding of such a decision. Being kind, understanding, and
patient to oneself is the surest way that we can extend those gifts to others.
Acceptance of ourselves, as we are, as we understand and know ourselves to be
at this particular moment in time, enables us to accept others in this
fashion. For it is this process of accepting ourselves and others that
enhances our ability to enjoy holidays, – no more, no less – than every other
day of our life.
We all feel “blue” every now and then. Depression, however, is feeling consistently sad, discouraged and lacking self-worth for a prolonged period. Some people experience depression for the first time (called late onset) in their senior years, while others have struggled with it for years.
Depression, though, is not a normal part of aging even though it may feel like it. Your body doesn’t work like it used to. You may have a chronic illness. Maybe your spouse has died. These things are inevitable for many seniors.
Pushing through depression and keeping it away takes work. We’ll look at two ways depression can spawn. And three ways—regular exercise, church and volunteering—you can fight depression.
The Creep or The Big Punch?
Depression can creep in slowly or lay you out like an Ali roundhouse. Either way it’s a fight. The depression that punches hard and fast results from a life-changing event such as death of a spouse, major health problem or significant change in environment such as moving to an assisted living facility.
These events can and should make you feel sad for a while. But if they persist and affect your ability to lead a normal life, there’s a problem.
Slow depression builds for months or even years without you realizing it. Seemingly innocuous events or changes pile on top of you, blocking your once sunnier world. These events can be small health issues, change in routine, and decreased independence among others.
Neither scenario is easy to fight. The life-changing event is just easier to recognize. Either way, there are many ways to back your depression against the ropes and keep it there.
Regular Exercise: Getting Started
There’s a reason exercise is always at the top of lists promoting better lives—it works. Exercise has numerous health benefits. It improves the quality of life for those with chronic illness. And studies show that seniors who exercise are less depressed than those who do not exercise. It’s like a cheap drug with a better high.
But exercise and the relationship to depression gets a little tricky. The more depressed you are, the harder it is to exercise.
So if you’re depressed, how do you get motivated to exercise? Here are some suggestions:
- Make a pros/cons list of exercising. For example, if you don’t exercise, you’ll continue to be 1) depressed 2) unable to keep up with your grandkids 3) unable to fit into your clothes 4) increase your risk for nasty health issues such as hypertension.
- Tell friends, family and neighbors about your new exercise routine. “I’m starting to walk 30 minutes every day.” Announcing your plans gives you commitment to keep it going. And your loved ones will probably ask you from time to time about your progress.
- Find an exercise buddy. Knowing a friend is waiting for you every morning at 7 to walk around the neighborhood is an extra motivator.
- Reward yourself. If you complete a week of daily exercise, buy yourself a new book, a new outfit, or treat yourself to a dinner out.
Go to Church
Maybe you stopped going to church years ago. Maybe you’ve never stepped foot in one. That’s okay. Church isn’t for everyone. But even if you’ve never been “religious”, a church is a great way to get out of the house and socialize. You don’t have to be a believer to attend. Just go to socialize. If you’re not terribly social, go just for the music.
Pick a church that makes you feel alive and one where you feel comfortable. Some churches are as much about socializing and having fun as they are about spirituality. Many have lively house bands that provide entertainment during services. Others stage elaborate pageants and plays. Most have activities outside of the normal Sunday service such as field trips, picnics, and volunteer opportunities.
If you just need to reconnect with your spirituality, a church can be healing. Many studies have shown the positive benefits of religion and spirituality for seniors whether it’s coping with illness or fighting depression.
A study in the journal Counseling, Psychotherapy and Health, concluded that, “For some, religion can provide a means of coping with the challenges that accompany aging, such as chronic pain, isolation, dependence, and disability.
Helping others gets you out into the community, meeting new people and feeling good about yourself. On top of all that, numerous studies show that senior volunteers have lower rates of depression and live longer and healthier lives.
One study showed that health benefits were gained reaching a volunteer threshold of about 100 hours a year or just two hours a week. Not a bad trade-off for feeling better about your life.
The kinds of volunteer opportunities are nearly unlimited whether you want to work with children, animals, your hands or your mind. Volunteering gives you the chance to do something you are passionate about. Do you love animals? Your local SPCA probably needs volunteers to walk dogs and play with cats. Looking for something a little wilder? There may be a wildlife rescue center in your area.
The largest senior volunteer network is RSVP (Retired and Senior Volunteer Program) with over 500,000 volunteers across the country. On Seniorcoprs.gov, you can plug in your zip code and area of interest and see what’s available near you.
The bottom line with depression in seniors: Seniors aren’t likely to let you know how they’re feeling. But you can look for some of the signs and potential risk factors. Also know that depression, if not treated, can lead to other health issues.