How to Spot the Signs of Depression in Older Adults

I was a teenager when I first experienced depression. It was hard to fall asleep and I did not want to wake up for school. Everything lacked meaning because I felt worthless. I did not want to see friends and when I did, it didn’t go beyond the pleasantries. Even doing the most basic activity like showering was painful. It was a challenging part of my life but it allowed me to develop a certain awareness of not only my own mental wellbeing but others’ as well.

Depression is a common mental health condition; the WHO estimates that 5% of adults experience depression; however, adults older than 60 years have a greater prevalence at 5.7%.

Here are some signs and symptoms to be mindful of as our older loved ones go through their golden years that might be evidence of depression.

Physical Signs

Although depression is a disorder of mood, there are many physical manifestations of the disorder. The first signs you may notice could be physical ones. Are they sleeping and eating properly? How is their body looking? Do they seem more tired than usual?

Liz Hughes, an LPCC in San Diego and owner of Mind Body Therapy PLLC shares that the following may be reflective of depression in older adults:

• Unexpected weight changes (gain or loss)
• Appetite changes (eating more or less than normal)
• Abnormally low energy levels
• Drastic sleep changes such as oversleeping or insomnia

Rebecca Bouchard, the Brand President of ComForCare with over 20 years of experience in home-based care, adds that someone with depression may complain of physical aches and pains without a clear medical cause as an expression of their depressed mood.

Cognitive Signs

Hughes explains that depression symptoms in older adults can sometimes present as cognitive issues. The new onset of diminished ability to think, concentrate or indecisiveness may be reflective of depression. Bouchard clarifies that the cognitive symptoms of depression may mimic the memory issues of dementia, and are sometimes referred to as "pseudodementia", however they tend to improve when the depression is adequately treated.

It’s crucial to note that not everyone experiences depression in a similar way and the diagnosis can be more complicated with older adults.

Behavioral Signs

There can be behavioral manifestations of depression. Hughes suggests noticing how the person is taking care of themselves. For instance, does their living space look significantly more messy than usual? Are they struggling with hygiene like showering or brushing their teeth? These behavioral changes can sometime be signs of depression in older adults. In cases of depression, speech and movements can also be impacted. Are they speaking and moving much slower than normal?

Bouchard shares that irritability or unexplained restlessness may be evident. It could potentially be a sign of depression if they have trouble sitting still or are constantly fidgeting.

Emotional Signs

Hughes shares that a core emotional symptoms of depression is a loss of interest in activities that they used to enjoy. Socially isolating themselves and not engaging with their friends and family meaningfully may also indicate depression.

“[A sign to watch for is] a sense of sadness or hopelessness that is pervasive. Having a few bad days can be a common experience but to meet the criteria for a symptom of depression, a low or depressed mood must be present more days than not over a period of at least two weeks…so a few bad days wouldn’t mean the person has depression,” says Hughes.

“If these signs are observed, it’s important to encourage the individual to seek professional help, as depression is treatable at any age, and early intervention can significantly improve their quality of life,” advises Bouchard.

Common Causes of Depression Among Older Adults

There isn’t a single cause of depression. However, there are risk factors that can increase its likelihood. Genetics play a role; people who have family members with depression are more likely to experience it. Having a medical condition such as cancer can negatively impact mental well-being.

Lifestyle factors such as lack of physical activity, unbalanced diet, poor sleep and increased stress can play a role. Physical limitations increase with age and impair the ability to perform pleasurable activities. Lastly, aging adults generally spend less time with other people as work and parenting duties diminish. A lack of social connections can lead to feelings of loneliness and depression.

Differences With Younger Populations

Bouchard states that depression in older adults can look different than in younger people. For instance, depression in older adults may manifest more often with physical symptoms like pain, fatigue, and cognitive difficulties, which can be mistaken for aging or other health conditions.

In addition, it is important to recognize that older adults are more likely to be experiencing the loss of loved ones or declining health, which are risk factors for depression. There is evidence that the risk of suicide is increased in older men.

“Older adults may withdraw socially and be less likely to discuss their feelings due to the generational stigma around mental health…In contrast, younger people often express their emotional distress more directly and may be more open about mental health challenges,” says Bouchard.

Cultural Factors

People from different cultures express their thoughts and feelings related to depression differently. Some cultures believe it’s taboo to speak about mental health or emotional issues and associate it with losing face or shame. In this context, depression may be more likely to manifest or be expressed as physical symptoms such as pain or digestive issues.

How To Support an Older Adult With Depression

Hughes shares that the first step in supporting someone who is depressed is having a candid, non-judgmental conversation with the person you are worried about. In a supportive way, you can mention some of the above signs and ask if they’ve noticed these behaviors. More often than not people experiencing depression will have noticed but sometimes the onset of depression is gradual and harder to accept.

“Oftentimes we worry addressing the depression symptoms will make the person feel worse when sometimes it is actually helpful to the person who is struggling because they may feel seen and supported. Ask them how you can help during this time, maybe it’s making them a meal or an extra phone call a week,” advises Hughes.

Bouchard recommends family members support their loved one by connecting them with mental health professionals, being good listeners, and staying regularly connected. They can also encourage healthy lifestyle choices like exercise, good nutrition, and regular sleep, assisting them with daily tasks.

“It’s important to remain patient and understanding throughout the process, as recovery takes time. Family members should watch for worsening symptoms, including suicidal thoughts, and seek professional help when needed. Loving support and connection can greatly help the older adult in managing and overcoming depression,” says Bouchard.