Depression in older people

Although depression is the most common mental disorder in older people, along with dementia, it often tends to go unnoticed or be confused with other conditions.

On the one hand, it is common to attribute symptoms to the aging process itself that may not be related, blaming the loss of interest and enthusiasm for things on age, instead of on depression.

"It's just a sign of getting older" is a phrase we've all heard, but it can be inaccurate, as it's not true that the aging process itself implies depression.

Adding to this difficulty is the fact that depression in older adults is much more likely to present atypically. While we generally associate depression with sadness and low mood, in older people irritability, restlessness, or even physical symptoms are common, and they often co-occur with other illnesses.

On the other hand, depression and dementia can present in very similar ways. While dementia is also characterized by the previously mentioned loss of interest and enthusiasm, it can also include irritability and restlessness. Furthermore, both conditions can be marked by changes in personality, memory lapses, and alterations in sleep and appetite.

For a correct diagnosis and treatment, it is essential to consult a doctor.

Although additional tests can be performed to help (especially to rule out a physical illness as the cause of the symptoms), the primary diagnostic method is an interview with the individual and their family. This interview provides information about their medical history, current health status, and allows us to assess their mental state.

Important antecedents in depression in older adults:

• The presence of other illnesses, including past substance and alcohol abuse.
• The history of similar previous episodes.
• Family history.
• The user's previous personality.
• The social, family or work environment, as well as a possible decline.
• The psychosocial situation. Today we know that, along with biological predisposition, it is included among the causes of depression.

In addition to the symptoms previously described for depression, suicidal thoughts are common. Although this is typical in depression at any age, the risk of suicide is four times higher in older adults than in the general population, with age itself considered a risk factor for suicide in people with depression.

Ageing and suicide

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Other risk factors for suicide include: being male, having little social support/isolation, alcohol (and/or other toxic) use, living in a rural area, access to lethal means, having pain or poor health, having made previous attempts, a family history of suicide, feelings of guilt and hopelessness, and some personality traits, such as impulsivity or a tendency toward violence.

Therefore, it is essential to ask openly about suicidal thoughts. It is not true that talking about it fuels the idea; this is a widespread myth. The only way to detect the risk and prevent it is by asking.

Finally, it's important to emphasize the need for treatment if depression is diagnosed. In mild cases, psychological treatment may be an option. However, in most cases of depression in this age group, it will be essential to start pharmacological treatment as soon as possible.

Although an antidepressant will be the cornerstone of treatment, other medications are often necessary depending on the clinical presentation, and may include anxiolytics, antipsychotics, hypnotics, or others. Treatment must be individualized, taking into account the person's age and symptoms, any co-occurring medical conditions and potential interactions with medications they are taking for those conditions, the patient's preferences, and the ease of taking and accessing the medication.

In conclusion, although depression in older adults is very common, it is sometimes mistaken for dementia or the natural aging process. It is important to pay attention to what these individuals express and ask about what they are not saying. Despite the usual reluctance to seek treatment, especially medication, its implementation is essential for a positive outcome.