Depression affects people of all ages, but adults over 65 can be especially vulnerable due to  multiple potential risk factors. Depression also tends to go unrecognized or misdiagnosed in seniors, especially when they are managing other physical or mental health challenges. Even though being apart from family can be its own risk factor, living in a senior living community offers potential for greater support when someone becomes depressed.

While not uncommon, geriatric depression, according to the CDC, should not be dismissed as “normal,” and treatment is possible. Here we look at the complicated signs of depression in older adults, especially as they may appear in a senior living situation, and what to do when you witness them.

Possible Causes of Depression in Seniors

Dealing with Change

Depression may come and go over a lifetime but recurrences often surface during times of change or a break in routine. Moving to a senior living community, or even changing apartments or levels of care within that community, can bring up feelings of instability until a person becomes more settled. A senior may experience other life changes as well, such as the death of a close friend or relative, or the loss of mobility, which likewise shakes up their routine and sense of stability.

Feelings of Isolation

One of the benefits of senior living is that residents become part of a community. Typically, moving to an independent or assisted living community stands to relieve feelings of isolation that older people often experience when living alone, especially if their ability to go places, socialize, or care for themselves has been limited. In a senior community, they have neighbors and activities right at their doorstep. Even this lifestyle can get interrupted by events like COVID-19 or other situations that may call for social distancing. 

Dependence on Others 

According to the National Association of Mental Health (NAMI), “Depression in older persons is closely associated with dependency and disability.” Senior living offers a full life for people with a full range of needs. Residents of independent living may need only minimal help with chores or errands, while those who require assisted living or memory care rely on more complex forms of expert support. All across that spectrum, however, the feeling of dependence on others is uncomfortable for some.

How to Recognize Depression

Even with the best care and a supportive community, depression can rear its head. A study in the Industrial Psychiatry Journal discussed some of the known causes of depression, adding, “These difficulties often emerge in older adulthood, increasing the likelihood of depression; yet depression is not a normal consequence of these problems.” In other words, we need not accept depression in the elderly as an inevitable condition.

Symptoms of Depression

Depression may stem from a clear cause like those listed above, or it may develop gradually. The CDC recommends watching for these signs, in yourself or others:

• Sadness that lasts for weeks
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies 
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps, or digestive problems that do not get better, even with treatment

Clearly, some of these symptoms may have other causes, including physical illness or side-effects from medication. Sometimes people have a bad day. However, when you notice several of these symptoms on an ongoing basis, and other causes have been ruled out, it’s a good idea to seek a medical opinion.

Depression May Look Different in Older Adults

There are a few ways in which depression and its symptoms differ in seniors compared with the wider population. 

• Some seniors with depression report no sense of sadness at all. Instead, their symptoms are mainly physical.
• Loneliness is a risk factor, but not everyone dislikes being alone. It’s important to recognize that some older adults enjoy quiet time to themselves.
• When a senior lives alone, it can take longer for a loved one to notice small signs and symptoms.
• Signs of depression and dementia can look similar, so it’s best to seek a diagnosis from a medical professional.

How to Support a Loved One with Geriatric Depression

If you notice that an older adult you love is exhibiting signs of depression, start by talking to them. Encourage them to share what they’re feeling and ask whether they believe they need help. Simply having someone to talk to can start them on the path to better mental health, and it can also help you both better assess what’s going on. 

If your loved one lives in a senior community, explore the healthcare resources available there, and make sure their condition is known to the staff or skilled nursing providers. If a senior has a trusted friend or neighbor, you might bring that person into the conversation as well. 

What Should You Do If You Feel Depressed?

If you are a senior experiencing signs of depression, speak to your doctor or a mental healthcare provider. You can also practice good self care by doing the following:

• Get some form of physical exercise regularly
• Continue to learn new skills; you’re never “too old”
• Stay in touch with friends and family, whether it’s in person, through letters, or over the internet
• Keep up with hobbies
• If possible, spend a little time outside each day
• Eat a healthy diet and follow your doctor’s advice on nutrition and medications
• Know that it’s always okay to ask for help 

Depression is a serious and complex mental health condition, further complicated by the challenges of aging, but it can be recognized and treated, leading to a better quality of life and better overall health.
Remember, if you are or someone you know is experiencing a mental health crisis, please get help right away by calling SAMHSA's National Helpline at 1-800-662-HELP (4357).