Betty Davis said it best – "Getting old ain't for sissies."  If you live long enough, here is what will most likely happen.  You'll experience at least one serious illness if not multiple chronic ones.  You will see friends and loved ones get sick and die.  You will be forced to redefine your sense of purpose in life, perhaps more than once.  You will grieve over both physical and personal losses.  If you are lucky, normal feelings of grief and sadness will be temporary but this may not always be the case.  Sometimes, those negative feelings may deepen into a persistent state and interfere with your ability to function.  In fact, stressful life experiences are one of the most common triggers for a serious medical condition called clinical depression.

Depression is one of the most common mental disorders experienced by elders.  Of the 35 million Americans age 65 or older, about 2 million suffer from full-blown depression and another 5 million suffer from less severe forms of the illness.¹  Of most concern, while people 65 and older account for 12 percent of the population, they represent 16 percent to 25 percent of suicides. ²   

Medical professionals are adamant that depression is not a normal or a necessary part of aging.  They also stress that it is very treatable, no matter what your age. 

The snag is that depression is often harder to recognize in the elderly than in their younger counterparts:

• Doctors and patients may both subscribe to a policy of "Don't ask.  Don't tell."  Older patients may mistakenly believe that depression is a sign of personal weakness or that they can will it away.   If their insurance plan doesn't cover mental illnesses to the same extent that it covers other illnesses, they may avoid the discussion because of cost.  For their part, doctors may be so focused on solving the patient's long list of physical ailments that they miss depression.  
      
• Despite evidence to the contrary, patients, caregivers and even health professionals may assume that persistent depression is an acceptable response to the challenges of aging with its illnesses and social and financial hardships.  Quite simply, their functional expectations may be set too low.³  
   
• Cognitive deterioration from other causes may mask the signs of depression.   For instance, research has shown that dementia and depression often co-exist but dementia patients can not describe how they feel.  Other common medical conditions that can cause cognitive impairment include endocrine disorders, obstructive sleep apnea, and vitamin B₁₂ deficiency.⁴
   
• Symptoms in older adults may be atypical.  While they may exhibit classic symptoms like sadness, hopelessness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss, they're just as likely to become irritable and agitated.  They may become confused, have memory problems, or develop exaggerated fears and fixations with physical ailments.
   
• Elderly adults who live alone may have little social interation with people who know them well enough to notice changes in their personalities.

If left untreated, depression can last months or even years.  Not only does this consign the individual to unnecessary psychic misery, but it makes all other medical problems more difficult to treat.  Depression doubles their risk of developing cardiac disease, reduces their ability to rehabilitate, and increases their risk of death from illness. Studies of nursing home patients with physical illnesses have confirmed that the presence of depression substantially increased the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack.⁵

Researchers are still investigating the whys of depression.  What they all agree on is there is no single cause.  It can be related to one or a combination of factors: 

• A neurochemical disorder, which can be mild or severe, is often responsible for most severe cases of depression, usually marked by major changes in personality and detachment from reality.  Neurochemical imbalance might be especially suspect when the person's circumstances do not seem to warrant sadness or anxiety.
  
  
• Depression often co-exists with other illnesses.  Such illnesses may precede the depression, cause it, and/or be a consequence of it.⁶
• Some medical conditions, like Parkinson's disease, endocrine disorders and vascular disease, can directly affect the body's chemical systems and parts of the brain that govern mood. 
• Being diagnosed with a life-threatening disease or living with the limitations of a chronic condition or chronic pain can put you at increased risk for serious depression.
• People with anxiety disorders (such as post-traumatic stress disorder, obsessive-compulsive disorder and panic disorder) and cognitive disorders (such as dementia) are more likely to experience depression. 
• Certain medical procedures (such as bypass surgery) may trigger depression.
• Certain medications can trigger or intensify depression.
  
  
• Some types of depression tend to run in families. However, depression can occur in people without family histories of depression as well.⁷  Genetics research indicates that risk for depression results from the influence of multiple genes acting together with environmental or other factors.⁸
   
• Events such as the death of a loved one, divorce, financial strains, history of trauma, moving to a new location or significant loss can contribute to the onset of clinical depression.
  
  
• Stressful life experiences are a common trigger.  These include:
• A recent bereavement (including the loss of a pet)
• Leaving the workforce
• Moving out of a family home
• Living alone
• A dwindling social life
• Conflicts with family or friends
• Financial problem
   
• Excess use of alcohol may contribute to depression or be a symptom of it.
   
• Low self-esteem, feeling out of control and fear of death or dying predispose people to depression.   

¹ National Institutes of Health.
² Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
³ Meyers BS. Geriatric Psychotic Depression, Clin Ger 1997;5:16-20.  
⁴ Guy G. Potter, PhD and David C. Steffens, MD, MHS, Depression and Cognitive Impairment in Older Adults, Psychiatric Times, November 1, 2007.
⁵ Depression in the Elderly.  The Cleveland Clinic
⁶ National Institute of Mental Health
⁷ Tsuang MT, Faraone SV. The genetics of mood disorders. Baltimore, MD: Johns Hopkins University Press, 1990.
⁸ Tsuang MT, Bar JL, Stone WS, Faraone SV. Gene-environment interactions in mental disorders. World Psychiatry, 2004 June; 3(2): 73-83.

Learn more about Depression in Later Life:

Key Point 1: When a person is not thinking clearly, it can be caused by many different issues.  Depression is one of them.

Key Point 2:  Finding the appropriate treatment for depression often takes time and trial.  Proper treatment can result in dramatic improvement in mental and physical health, so it is important to take the time necessary to find the treatment that works best for you.