Depression
Responding to Older Adults with Substance Use, Mental Health and Gambling Challenges
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Depression is caused by a chemical imbalance in the brain. It affects thoughts, feelings, behaviour and physical health. It
causes great suffering for people who are depressed and for the people who care about them.
People may be depressed when they have a sad, despairing mood that lasts for more than two weeks. Depression is not the same
as sadness, though it can be triggered by sadness caused by loss, stress or major life change. Depression may also develop
for no obvious reason. People who are depressed cannot just "get over it."
Depression in older adults
People can have episodes of depression throughout their lives, or they may have their first episode late in life. Depression
can affect anyone at any age. However, depression in older adults is often unrecognized because some signs of depression can
be mistaken for signs of aging. Older people who are depressed rarely ask for help on their own. When left untreated, depression
may continue for weeks, months or even years. Untreated depression is the main cause of suicide in older adults.
Depression may be related to:
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medical conditions, such as chronic pain or illness, thyroid problems, stroke or Alzheimer disease
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physical, emotional, financial or sexual abuse, or neglect
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side-effects of certain medications
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alcohol use, which when used to relieve depression can create other problems or worsen depression
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the death of a spouse or other family members or friends
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loss of intimacy and touch, isolation, loneliness
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transition, as when moving from the family home
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loss of independence
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feeling less safe.
Fortunately, antidepressant medications and counselling can help to lift depression.
How common is depression in older adults?
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As many as 20 per cent of older adults experience depression (Seeking Solutions, 2003).
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Depression is more common among older people living in institutions than among those living in the community.
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Suicide is five times more likely in people over 60 than in younger age groups (Mood Disorders Association of Ontario, n.d.).
Signs of depression
People often think that depression in older adults is a normal response to aging (for example, "It's no wonder he's depressed,
he's 82," or "If I had arthritis, I'd probably be depressed too.") However, depression is not a normal part of aging.
An older adult may be severely depressed if he or she:
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does not get dressed or does not answer the phone or the door
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loses interest in activities he or she used to enjoy, or spends more time alone than usual
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feels hopeless, worthless and sad
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has unusual outbursts of crying, agitation or anger, or shows little emotion
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talks less than usual or answers questions with as few words as possible
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calls, complains or demands frequently
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does not sleep well or sleeps too much
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eats more or less than usual
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lacks energy
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seems confused or has trouble remembering things
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has trouble making decisions or following through with plans
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talks about suicide.
How to talk with an older adult who is depressed
Older adults may not want to say they are depressed. They may think depression is a part of growing older. They may think
they should just "snap out of it." They may worry that others will think they are weak or lazy. They may worry they will lose
their independence because others will think they cannot cope on their own.
It takes time for you to build trust with the older adult, and it takes courage for the older person to express his or her
feelings. When you are alone and can spare some time to talk:
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Encourage the person to share his or her feelings by asking questions (e.g., "How have you been feeling?" "Is something on
your mind?"). Give the person time to answer, and take time to listen. Don't give examples of others you know with similar
or more difficult problems.
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Show that you understand that times are hard, and that it can be hard to talk about it. Be positive but truthful (e.g., "It
can't be easy with everything that has happened lately.") Don't try to make the person's problems seem less serious than they
are.
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Try to give hope by pointing out the person's strengths or even the smallest improvements in his or her situation (e.g., "I
see you're up and dressed, and so early in the morning."). Notice what has changed since your last visit; has the person smiled
or called you by name?
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If an older adult talks with you about feelings of hopelessness, worthlessness and sadness, gently encourage him or her to
seek help (e.g., "It's worthwhile seeing a doctor about these feelings; there is help.").
When to get help
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If you think an older person in your care may be depressed, report this to your supervisor. Your supervisor can find professional,
qualified care for the person.
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Take it seriously if older adults talk of planning suicide, even if they say it often. If a person talks of suicide, listen
and talk quietly and calmly. You could ask, "How do you think you would commit suicide? Do you have a plan?" Talking with
the person about his or her plans will not make it more likely he or she will commit suicide. Report what you are told to
your supervisor.
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Talking with someone about suicide may make you feel emotional and upset. If this happens, share your feelings with your supervisor
rather than with family and friends. You must always protect the privacy and confidentiality of the older people you work
with.
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If you are interested in feeling more prepared to discuss this issue with older adults, you may wish to take the workshop
asist: Applied Suicide Intervention Skills Training. Check with the Canadian Mental Health Association to see if this workshop
is available in your community. (See the
Extra Resources section for contact information.)
In Responding to Older Adults :
1 The Nature of Aging
2 Substance Use, Mental Health and Gambling Challenges in Older Adults
3 Communication Tools and Techniques
Centre for Addiction
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