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Depression in Older Adults Often Undiagnosed

Depression and aging do not necessarily go hand in hand. A survey of Californians ages 50 to 95 found that factors such as chronic illness, physical disabilities, and social isolation—which often coincide with increasing age—were stronger predictors of depression than age itself.

That said, the incidence of depression is clearly higher in older adults. An estimated 6.5 million of the nation’s 35 million people age 65 and older suffer from major depression.

Unfortunately, the disease is often undiagnosed, misdiagnosed, or left untreated in the elderly and can increase the risk of early death and repeated hospitalization. There is also reason to believe that late-life depression can be more serious than depression in younger people.

One reason depression may go undiagnosed is because of life circumstances that are common as we age, such as the loss of a spouse, family members or friends (due to death or geographic relocation); retirement, which may be accompanied by a loss of status and self- identity; financial concerns; fears of death or loss of independence; social isolation; and medical problems.

Any of these factors may trigger symptoms of depression that are mistakenly attributed to life stresses and are not recognized as a true depressive illness.

Many older people who live alone do not have adequate support networks. Some don’t know where to find help or are overwhelmed by the many resources providing medical care, social services, and financial assistance.

Stigma of psychiatric illness

Older adults tend to be embarrassed or reluctant to seek professional help for emotional problems, partly because the stigma of psychiatric illness is especially strong among people in this age group, and/or because they remember the days when treatments were less effective. In addition, friends and family often fail to perceive signs of distress.

Older depressed people are more likely to tell their primary care physician about physical complaints than about subjective feelings of depressed mood. For example, they may report loss of appetite, insomnia, or lack of energy but not a loss of interest or enjoyment in daily activities. Unfortunately, doctors and patients alike often consider these symptoms a normal part of aging.

Diagnosis may be difficult

Because older people often have other medical illnesses and take more prescription drugs, it can take some medical sleuthing to accurately pin down a diagnosis of depression. Depression might be the primary disorder, a reaction to a prescription drug, or the result of an underlying condition such as cancer or a stroke.

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It also might be a psychological reaction to a diagnosis of a serious illness or debilitating chronic pain or impairment. Finally, it could be a direct or indirect biological effect of an illness on the brain.

The possibility of dementia adds further difficulties. Symptoms of major depression can mimic those of a dementia-causing condition such as Alzheimer’s disease (disorientation, distractibility, and memory loss, for example).

Doctors need to evaluate an individual’s mental status, medical history, and current physical health status carefully to find the primary cause of the psychological symptoms.

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