Depression affects about 1 of every 6 older adults. Some older adults have had depression earlier in their life. Others develop it for the first time during old age.

Causes of Depression in Older Adults

Some causes of depression may be more common among older adults. For example, older adults may be more likely to experience emotionally distressing events that involve a loss, such as the death of a loved one or a loss of familiar surroundings, as when moving away from a familiar neighborhood. Other sources of stress, such as reduced income, a worsening chronic illness, a gradual loss of independence, or social isolation, may also contribute.

Disorders that can lead to depression are common among older adults. Such disorders include cancer, heart attack, heart failure, thyroid disorders, stroke, dementia, and Parkinson disease.

Depression Versus Dementia

In older adults, depression can cause symptoms that resemble those of dementia: slower thinking, decreased concentration, confusion, and difficulty remembering, rather than the sadness people tend to associate with depression. However, doctors can distinguish depression from dementia because when depression is treated, people with depression regain their mental function. People with dementia do not. Also, people with depression may complain bitterly about their memory loss and rarely forget important current events or personal matters. In contrast, people with dementia often deny memory loss.

Diagnosis of Depression in Older Adults

Depression is often difficult to diagnose in older adults for several reasons:

• The symptoms may be less noticeable because older adults may not work or may have less social interaction.

• Some people believe that depression is a weakness and are reluctant to tell anyone that they are experiencing sadness or other symptoms.

• The absence of emotion may be interpreted as indifference rather than depression.

• Family members and friends may regard the symptoms of a person with depression simply as something that is expected as people get older.

• The symptoms may be attributed to another disorder, such as dementia.

Because depression may be difficult to identify, many doctors routinely ask older adults questions about their mood. Family members should be alert for subtle changes in personality, especially lack of enthusiasm and spontaneity, loss of sense of humor, and new forgetfulness.

Treatment of Depression in Older Adults