About 43 million people in the United States — around 14 percent of the population — are 65 or older, and that number is projected to increase 20 percent by 2030, according to data from the Substance Abuse and Mental Health Services Administration (SAMHSA).

While there’s many benefits to enjoy during your golden years, including time spent with loved ones after retirement, the American Psychological Association (APA) says that aging “also comes with unique challenges: the loss of close friends and family members; complex and debilitating medical issues, such as sight and hearing loss; and increased financial pressure.” Identifying these challenges is becoming more important: Although recent research published in the Journal of Clinical Psychology found that people tend to be happier as they age, it is estimated that 20 percent of the 65 and older population meets the criteria for some type of mental health disorder.

“While seniors are less likely to be depressed than younger people,” Suzanne Allard Levingston writes in an article for The Washington Post, “the size of the baby boom population will demand new strategies to care for them. 

The most common mental health disorders for aging Americans are depression and anxiety, which are also leading risk factors for suicide. Nursing@Georgetown created the following infographic to help illustrate some of the common signs and risk factors of depression among aging Americans.

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  Understanding Depression Among Aging Americans

  As the population of the United States ages, there is a growing need to focus on the mental health challenges faced by older adults, particularly depression. According to the Healthy Aging Program at the CDC, “Because mental health is essential to overall health, it should be treated in all Americans, including older adults, with the same urgency as physical health.”

  • 46 Million1 people age 65 or older live in the U.S.
  • 20%2 of people age 55 or older have some type of mental health disorder.
  • 7 Million3 people age 65 or older suffer from depression.

  What Factors Complicate Diagnosis?

  • According to the CDC, the majority of older adults are not depressed. However, those who do experience depression or other mental health issues are often misdiagnosed or undertreated.4
  • Mental and physical health are linked. Depression can exacerbate existing physical or chronic conditions, and vice versa.5
  • 80% of older Americans have at least one chronic condition.6
  • 50% have two or more.7
  • Many older adults don’t seek treatment due to factors such as:8
    • Inadequate insurance coverage
    • Lack of coordination among primary care, mental health and aging service providers
    • Stigma surrounding mental health and its treatment
    • Access barriers such as transportation
  • 60% of older adults do not receive the treatment they need for depression.9

  Why is Depression Dangerous for Older Adults?

  Depression is a leading risk factor for suicide. Studies show that depression and other mental health challenges can lead to suicide in older adults at alarming rates. Over the past two decades, rates of suicide among older adults in the U.S. have steadily increased.

  • 8,255 Americans age 85 or older died by suicide in 2014.
  • 44% The increase in suicide rates for women ages 65-74 between 1999 and 2014.
  • 7.5% The increase in suicide rates for men in ages 65-74 between 1999 and 2014.

  Awareness and Prevention Can Make a Difference

  Although depression can be difficult to recognize among older people, caregivers and primary care practitioners should understand that it is not a normal part of growing older, nor is it incurable.

  80% of older Americans who suffer from depression could be successfully treated if they saw a physician or were properly diagnosed.10

  How to Recognize and Respond

  1. Watch for warning signs:
     • Feelings of hopelessness and pessimism
     • Feelings of guilt, worthlessness and helplessness
     • Irritability, restlessness
     • Loss of interest in activities or hobbies once pleasurable
     • Fatigue and decreased energy
     • Difficulty concentrating, remembering details and making decisions
     • Insomnia, early morning wakefulness, 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 treatment11
  2. Take mentions and thoughts of suicide seriously.
     • Seek immediate medical attention from a primary care practitioner. For confidential advice, call the National Suicide Prevention Lifeline: 800-273-8255.12
  3. Consult health care professionals. They can:
     • Determine whether an underlying condition whose symptoms can mimic depression, such as anemia or pneumonia, could be the cause.
     • Evaluate medication regimens. Certain combinations of drugs for behavioral and physical conditions can cause or exacerbate depression.
     • Suggest common treatments for depression such as psychotherapy, antidepressant medications, or electroconvulsive.13

  Please note that this graphic is for information purposes only. Individuals should consult their healthcare professionals before following any of the information provided. Nursing@Georgetown does not endorse any organizations or websites contained in this graphic.

  Sources

  ¹http://www.aoa.acl.gov/aging_statistics/profile/2015/docs/2015-Profile.pdf
  ²https://www.cdc.gov/aging/pdf/cib_mental_health.pdf
  ³https://www.cdc.gov/aging/pdf/cib_mental_health.pdf
  ⁴http://www.cdc.gov/aging/mentalhealth/depression.htm
  ⁵http://www.aarp.org/relationships/caregiving/info-03-2012/depression-symptoms-senior-citizens.html
  ⁶http://www.cdc.gov/aging/mentalhealth/depression.htm
  ⁷http://www.cdc.gov/aging/mentalhealth/depression.htm
  ⁸http://www.apa.org/about/gr/issues/aging/mental-health.aspx
  ⁹https://www.ncoa.org/news/resources-for-reporters/get-the-facts/healthy-aging-facts/
  ¹⁰http://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts
  ¹¹http://www.cdc.gov/aging/mentalhealth/depression.htm
  ¹²http://www.aarp.org/relationships/caregiving/info-03-2012/depression-symptoms-senior-citizens.html
  ¹³http://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml

Symptoms of depression include persistent sadness, withdrawal from previously enjoyed activities, difficulty sleeping, physical discomfort, self-medication via substance misuse, and feeling lethargic, according to the CDC. They go on to note that depression is not considered a normal part of growing older, and while it is normal to experience sadness, grief, loss, and mood swings, depression that impacts a person’s ability to function requires treatment and support.

Anxiety often goes hand in hand with depression, according to a publication from the CDC and the National Association of Chronic Disease Directors (NACDD). The report goes on to highlight how almost half of older adults who are diagnosed with depression also meet the criteria for anxiety. The effects of anxiety include persistent worry along with physical symptoms that can include muscle tightness, restlessness, difficulty sleeping, stomach problems, and nausea all lasting for an extended period of time.

The APA outlines how serious the physical consequences of depression and anxiety can be: “The feelings of hopelessness and isolation that often spur thoughts of suicide are more prevalent among older adults, especially those with disabilities or confined to nursing homes.”

The rate of suicide among both men and women ages 65 to 74 has steadily increased over the past two decades. In 2014, the highest suicide rate in the country was among people 85 years or older.

There are several reasons why treating depression in the elderly poses a unique challenge. Common among patient’ concerns are: “inadequate insurance coverage, stigma around mental health… denial…and lack of transportation,” according to the APA. Systemic reasons include things like a shortage of trained geriatric mental health providers and miscommunication between health care providers.

In addition, when older adults visit their primary care providers, they tend to focus on physical symptoms rather than talk about how they’re feeling or what they’re experiencing mentally and emotionally, according to a fact sheet from the Illinois Department of Public Health. This can lead to mental health issues that go unrecognized, untreated, or undertreated. For example, the AARP points out that depression is sometimes misdiagnosed as dementia.

The good news is that there are effective treatments for depression, and adults with depression can improve from treatment if they receive it. Primary care providers such as Family Nurse Practitioners play an important role by identifying at-risk older adults and taking necessary follow-up actions by implementing routine mental health screenings and treating symptoms that negatively impact quality of life. 

Please note that this blog post is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided. Nursing@Georgetown does not endorse any organizations or websites contained in this blog post.