Depression may present differently in older adults

Research shows that loneliness and social isolation are associated with higher rates of depression and death wishes. — Photos: Filepic

Depression should not be perceived to be a normal part of ageing.

In fact, many older adults feel satisfied with their lives, despite having more illnesses or physical problems than younger people.

However, it can be difficult to detect the symptoms of depression in senior citizens.

This is as older people may have different presentations, compared to younger people.

For some older adults with depression, sadness is not their main symptom.

They may actually express their mental health condition through physical symptoms like pain or body aches.

One of the earliest manifestations would be a loss of interest in pleasurable activities.

For an older person, these activities could be something ordinary like reading the newspapers first thing in the morning or watching the 8pm news on television.

The feeling of numbness, leading to sudden disinterest in such routine activities, is cause for concern.

Older adults may also display decreased energy or fatigue by moving or talking more slowly and having difficulty concentrating, remembering or making decisions, which can mask underlying depression.

Often, social factors can underlie depression in older people, especially the loss of a spouse, social isolation, boredom and financial problems.

Retirement, which is perhaps one of the most significant of life events, can result in depression.

It brings on a new role in life, which is often difficult to accept, as retirees are often treated lightly and made to feel unwanted or worthless.

This condition is often referred to as the “post-retirement blues”.

Sometimes, depression in older adults may also be related to chronic use of alcohol or pain medication.

Frequently, they may experience depression after other major life events, like a medical diagnosis of a heart condition or the death of a loved one.

Those who have had depression at a younger age are more likely to have a recurrence as an older adult.

Medical conditions like stroke or cancer have an unusually high propensity to lead to depression.

Yet, others may become depressed for no clear reason.

This used to be referred to as endogenous depression and may emerge in old age for the first time.

In such cases, there may be a genetic predisposition to depression.

Social isolation

Even though depression is a mental health condition, it can sometimes be expressed through physical symptoms likes aches and pains.Even though depression is a mental health condition, it can sometimes be expressed through physical symptoms likes aches and pains.Everyone needs social connections to survive and thrive.

But as people age, they often find themselves spending more time alone.

Social isolation is not necessarily bad.

At times, people crave solitude. Being alone can be relaxing, meditative and rejuvenating.

However, social isolation typically refers to solitude that is unwanted and unhealthy.

Older adults may avoid social interactions, including those that were once enjoyable, or cancel plans frequently and feel relieved when plans are cancelled.

They may also experience anxiety or panic when thinking about social interactions.

Social isolation can involve emotional isolation, which is an unwillingness or inability to share one’s feelings with others.

When socially-isolated individuals lack emotional interaction and support, they can become emotionally numb.

Studies show that loneliness and social isolation are associated with higher rates of depression and death wishes.

In Japan, the problem was noted to be so serious that in 2021, Tetsushi Sakamoto was appointed the country’s first Minister for Loneliness to implement measures to prevent the problem of loneliness and social isolation.

A similar post exists in the United Kingdom.

There is hope

Depression is a medical condition that requires treatment from a mental health professional.

While family and friends can help by offering support in finding treatment, they cannot treat a person’s depression.

Often, the older family member would have regular follow-up with a doctor, possibly for a chronic condition like heart disease, diabetes or hypertension (high blood pressure).

If that relative is suspected of having symptoms of depression, it is best to get this regular doctor to make a referral to a psychiatrist.

This may involve a detailed discussion on observations of the family member, as symptoms of depressions are not always detected by non-mental health medical practitioners.

Elderly people too often mask their symptoms or are in denial of their distress.

It is important to seek treatment as soon as symptoms are noticed.

Even severe depression can be treated.

Medications for depression include those intended to balance hormones that affect mood, such as serotonin.

Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are commonly prescribed to older adults.

A psychiatrist can prescribe and help monitor medications and potential side effects.

There is also a need to examine the risk of drugs interacting with one another, as the older adult is likely to be on other medications as well.

The psychiatrist will also rule out other medical conditions like hyperthyroidism and anaemia, which can mimic the symptoms of depression.

Psychotherapy, which can help a person identify and change troubling emotions, thoughts and behaviour, is usually done with a clinical psychologist.

An example of such a therapy specific to the treatment of depression is cognitive behavioural therapy (CBT).

One of the signs of depression is when the person no longer takes an interest in the activities they once found pleasurable, like gardening or playing golf.One of the signs of depression is when the person no longer takes an interest in the activities they once found pleasurable, like gardening or playing golf.

Depression and dementia

Dementia is a syndrome involving deterioration in memory, thinking, behaviour and the ability to perform everyday activities.

This is not a normal phase of ageing, although as we progress into old age, it is not uncommon to experience more frequent episodes of forgetfulness.

Depression is common in people with Alzheimer’s disease and related dementias.

Dementia can cause some of the same symptoms as depression, while depression can also be an early warning sign of possible dementia.

However, depression must not be confused with dementia, as depression is highly treatable, while dementia is a progressively worsening condition.

Medications for dementia may only be useful in slowing down further deterioration of memory and thinking skills, but not to cure the condition.

A misdiagnosis does a great disservice to those exhibiting symptoms of depression, as quick and accurate diagnosis, followed by appropriate intervention, can result in the patient bouncing back to normalcy in no time.

Sensitivity in care

Caring for older adults with depression requires sensitivity and interpersonal skills to help the older person achieve the highest possible level of functioning and well-being.

At times, family members themselves are challenged with the complexities of caregiving.

They in turn battle guilt and emotional stress in themselves.

On the other hand, when the ageing population is neglected, it does not reflect well on our collective values and priorities.

It also means that we forget that everyone gets old someday.

What is more frightening is that while as a society, we take great comfort in the increasing lifespan of each subsequent generation, it also means that older people with undetected and untreated depression only have their suffering prolonged.

The take-home message here is that while depression is serious, for most people, it gets better with timely and appropriate treatment.

Datuk Dr Andrew Mohanraj is a consultant psychiatrist, the Malaysian Mental Health Association president and an adjunct professor of psychiatry at Taylor’s University. For more information, email The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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