Understanding Late Life Depression
Learn about late life depression
Depression is one of the most common causes of suffering in older adults and significantly affects their quality of life. In the U.S. depression affects the lives of 15% of all seniors over the age of 65. Those in nursing homes and hospitals are hit particularly hard by this condition, experiencing significant distress as a result of depression and the multitude of ways that it affects their well-being. It is far more than feeling sad or unhappy. Depression has serious consequences in every area of their life. Many people assume that negative mood states in late life are a natural response to commonly experienced situations such as the loss of friends and relatives, retirement from a long-held job, or the need to alter one’s lifestyle to cope with medical conditions more frequently experienced in this stage of life. However, depression goes beyond reactions to commonly experienced situations. This disorder results in significant distress and disruptions in the individual’s overall functioning, endures over time, and represents a notable contrast to the individual’s previous status. Depression is not a normal part of aging. It is a treatable illness that can be overcome with the right intervention.
Depression in late life can reflect a relapse of a prior episode or be an indication of a long term disorder. However, it is not unusual for individuals to experience depression for the first time at an older age. Often when this occurs, the depression is brought on by a medical illness. The presence of a medical condition can make depression more difficult for even medical professionals to recognize and harder for the individual to cope with. This is likely one of the main reasons that less than 10% of those suffering from late life depression receive treatment. Another reason is that the symptoms of depression in older individuals differ from what is seen in younger age groups.
Late life depression statistics
It has been estimated that more than 6 million people in the U.S. over the age of 64 suffer from late life depression. While research shows that depression occurs in about 5-8 out of every 100 Americans, the rate in individuals age 65 and older rises to 15 in 1000. Considering that so few individuals suffering from this form of the disorder seek treatment, this is considered to be a significant underestimate of the problem. While women experience late life depression at twice the rate of men, suicide rates are considerably higher for men with late life depression when compared to same age women and younger individuals of both genders.
Late life depression and co-occurring disorders
Disorders found to co-occur with late life depression include:
- Panic Disorder
- Generalized Anxiety Disorder
- Obsessive-Compulsive Personality Disorder
- Dependent Personality Disorder
- Avoidant Personality Disorder
- Alcohol Abuse
Causes and Risk Factors
Causes and risk factors of late life depression
Changes in the Brain – Age related changes in the brain have been shown to be related to the development of late life depression. This is one explanation for the strong association between depression and neurodegenerative disorders such as Alzheimer’s disease.
Nutritional Deficiencies- The diets of older adults are often lacking in key nutrients. Chronic deficiencies in specific nutrients, including folic acid and vitamin B-12, have been linked to the development of late life depression even after such deficiencies have been corrected.
Loss of Sensory Capabilities – Hearing and vision loss are common problems seen in older adults. In addition to the fear that they may lose all of their vision or hearing, even a moderate degree of loss in these faculties can lead to loss of independence (e.g. inability to drive or navigate within their environment safely) and the inability to engage in a number of activities that contributed to their quality of life (e.g. playing cards with friends, reading, watching movies).
Vascular Risk – There is some evidence that some cases of late-onset depression might be the result of injury to areas of the brain associated with mood, due to a series of small strokes which deprive those areas of sufficient oxygen. The greater the risk of such vascular events, the greater the likelihood late life depression will develop, since with increasing damage to the brain, it become less able to regulate negative mood states in response to stressful situations.
Insomnia – While most people consider insomnia to be a consequence of depression, newer research suggests that it may lead to the onset and re-occurrence of late life depression.
Signs and Symptoms
Signs and symptoms of late life depressive disorders
The symptoms of depression can significantly alter your quality of life and your capacity to function normally in everyday activities. Despite the fact that the symptoms of late life depression vary among older individuals, they differ far more extensively from symptoms seen in younger populations. Symptoms include:
- Unremitting sadness (lasting two weeks or more)
- The sense that one is moving through water or that moving at all is an effort
- The sense that everything and everyone around the individual is slowed down
- Extreme and exaggerated concern over one’s financial situation
- Disproportionate worry about health problems
- Loss of interest in pleasurable activities- In later life many individuals already have a restricted range of interests and depression results in loss of pleasure in almost all life activities.
- Frequent crying with or without specific reasons
- The sense that one has no worth or value that they can contribute anywhere in their life
- Feeling helpless to control anything within themselves or their environment
- Physical symptoms such as pain or gastrointestinal problems.
- Social withdrawal- In late life due to the loss of friends and relatives and limited ability to get around, social interaction is limited
- Chronic, ambiguous physical complaints with no discernible medical cause
- Excessive help seeking behavior and dependency on others to make decisions
- Demanding and angry outbursts with no detectable cause
- Confusion and disorientation
- Weight fluctuations – In late life depression, loss of appetite and weight loss is more frequent than increased appetite and weight gain
- Agitated pacing, inability to sit still, and fidgeting- limited mobility can make this a bigger problem, increasing the individuals discomfort
- Difficulty sleeping – In late life depression, early morning awakening is a frequent problem and too much sleep is rarely seen
- Trouble paying attention, concentrating, remembering, and making decisions – These symptoms often cause the individual to conclude they have dementia, leading to increased depression and severe anxiety symptoms
Effects of late life depressive disorders
Effects of Late Life Depression vary depending on the individual, any illnesses that exist, in addition to the depression and their life circumstances. Some of the more common effects include:
- Increasing inability to tolerate physical pain
- Hyper-vigilance related to bodily functions and interpreting normal aches and pains as an indication of a catastrophic illness.
- Impaired cognitive functioning (e.g. planning, memory, decision making, problem solving)
- Debilitating effects on general ability to function normally in daily activities
- Increased use of medical health services/Decreased use of behavioral health services
- Increased risk of morbidity and mortality due to complications of other illnesses and risk of suicide