15.2 Depression in Later Life

Depression is one of the most common mental health problems of older adults. The features of depression are the same for elderly people as for younger people, including feelings of profound sadness and emptiness; low self-esteem, guilt, and pessimism; and loss of appetite and sleep disturbances. Depression is particularly common among those who have recently undergone a trauma, such as the loss of a spouse or close friend or the development of a serious physical illness (Draper, 2014).

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Bereavement and Gender

11.4 million Number of widows in the United States
2.8 million Number of widowers

(U.S. Census Bureau, 2010, 2005; Etaugh, 2008)

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[Oscar] was an 83-year-old married man with an episode of major depressive disorder. . . . He said that about one and one-half years prior to beginning treatment, his brother had died. In the following months, two friends whom he had known since childhood died. Following these losses, he became increasingly anxious [and] grew more and more pessimistic. Reluctantly, he acknowledged, “I even thought about ending my life.”. . .

During . . . treatment, [Oscar] discussed his relationship with his brother. He discussed how distraught he was to watch his brother’s physical deterioration from an extended illness. He described the scene at his brother’s deathbed and the moment “when he took his final breath.” He experienced guilt over the failure to carry out his brother’s funeral services in a manner he felt his brother would have wanted. While initially characterizing his relationship with his brother as loving and amiable, he later acknowledged that he disapproved of many ways in which his brother acted. Later in therapy, he also reviewed different facets of his past relationships with his two deceased friends. He expressed sadness that the long years had ended. . . . [Oscar’s] life had been organized around visits to his brother’s home and outings with his friends. . . . [While] his wife had encouraged him to visit with other friends and family, it became harder and harder to do so as he became more depressed.

(Hinrichsen, 1999, p. 433)

Overall, as many as 20 percent of people become depressed at some point during old age (APA, 2014; Mathys & Belgeri, 2010). The rate is highest in older women. This rate among the elderly is about the same as that among younger adults—even lower, according to some studies (Dubovsky & Dubovsky, 2011). However, it climbs much higher (as high as 32 percent) among aged people who live in nursing homes, as opposed to those in the community (CDC, 2014; Mathys & Belgeri, 2010).

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Making a difference To help prevent feelings of unimportance and low self-esteem, some older people now offer their expertise to young people who are trying to master new skills, undertake business projects, and the like (Murayama et al., 2014). This elderly man, who volunteers regularly at an elementary school, is teaching math to a first-grader.

Is it more likely that positive thinking leads to good health or that good health produces positive thinking?

Several studies suggest that depression raises an elderly person’s chances of developing significant medical problems (Taylor, 2014; Coffey & Coffey, 2011). For example, older depressed people with high blood pressure are almost three times as likely to suffer a stroke as older nondepressed people with the same condition. Similarly, elderly people who are depressed recover more slowly and less completely from heart attacks, hip fractures, pneumonia, and other infections and illnesses. Small wonder that among the elderly, increases in clinical depression are tied to increases in the death rate (Aziz & Steffens, 2013).

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The power of music The look on the face of this nursing home resident as she listens to music on her iPod underscores the repeated research finding that music helps improve the physical and emotional functioning of many elderly people.

As you read in Chapter 7, elderly people are also more likely to commit suicide than young people, and often their suicides are related to depression (Draper, 2014). The overall rate of suicide in the United States is 12.1 per 100,000 people; among the elderly it is more than 16 per 100,000.

Like younger adults, older people who are depressed may be helped by cognitive-behavioral therapy, interpersonal therapy, antidepressant medications, or a combination of these approaches (Cleare et al., 2015; Dines et al., 2014). Both individual and group therapy formats have been used. More than half of elderly patients with depression improve with these various treatments. It is, however, sometimes difficult for older people to use antidepressant drugs effectively and safely because the body breaks the drugs down differently in later life (Dubovsky & Dubovsky, 2011). Moreover, among elderly people, antidepressant drugs have a higher risk of causing some cognitive impairment. Electroconvulsive therapy, applied with certain modifications, has been used for elderly people who are severely depressed and unhelped by other approaches (Coffey & Kellner, 2011).