My mother is 80 and being cared for by my father, age 84. I suspect they are both depressed. My sister says “Who wouldn’t be depressed at their age?” She thinks depression is normal at their age and that treatment would not help. Am I wrong to be concerned?

Unfortunately, depression often goes unrecognized in older people. It frequently is misdiagnosed or considered a natural part of aging. Sometimes people expect that to be old is to be depressed. However, depression is not inevitable, nor is it normal in late life.

Some medical conditions can cause depression; for example, thyroid disease, brain tumor, pernicious anemia, Parkinson’s disease, kidney disease and some cancers. Depression often is a reaction to illness, especially if it produces chronic pain, disability, or dependence on others. Medical conditions associated with changes in body image ( strokes, amputations, and problems in walking that require assistive devices) are particularly threatening. Medical conditions that provoke anticipation of greater disability or of death (such as cancer, Alzheimer’s disease, or cardiovascular disease) can bring on depression. Depression can be a side effect of many medications. Loss of sight and hearing, which become more common in later life, can also trigger depression. These changes not only may affect one’s ability to function in the physical environment, but they also can isolate people and make them more dependent.

The rate of depression is also high among those who are family caregivers. Depression among dementia caregivers is three times higher than depression in the general population; for non-dementia caregivers, the rate is two times higher. Poor caregiver health is associated with higher levels of depressive symptoms.

Thus, when depression is suspected in an older person or family caregiver, it needs to be addressed. Depression is disabling. Severe depression can be life threatening. Depressed people appear to be more susceptible to infection and other illnesses, and they take longer to recover from illness than nondepressed people. Most people who commit suicide are depressed, and suicide is disturbingly common in the older population.

Depression in older adults is highly treatable. More than 80 percent of depressed people can be treated effectively and their symptoms will go away within weeks. However, many older people who are depressed never receive proper treatment, and under-treatment is a common problem. The earlier treatment is received, the better. Generally, the longer depression exists, the more difficult it is to treat.

When depression is suspected, the first step is to encourage the person to get a medical evaluation to uncover any physical conditions or medications that may be contributing to the symptoms. However, expect to take an active role in making the appointment and taking the person to the doctor. The nature of depression—low energy, lack of motivation, and feelings of helplessness—makes it difficult for a depressed person to take steps to help himself. Also, some older people view depression and seeking help as a sign of weakness or personal failure, and therefore may deny being depressed or resist help. If this is the case, talk with the person about physical symptoms you observe and are concerned about, and do not use the word depression. It is helpful to let the doctor know beforehand the changes that have been observed in the person. Consider putting your observations in writing for the doctor. If physical illness and medications are ruled out as a cause for depression, ask for referral to a mental health professional for evaluation and treatment.

For more information, download the publication, Depression in Later Life: Recognition and Treatment at extension.oregonstate.edu/catalog/pdf/pnw/pnw347.pdf. It addresses several aspects of depression in later life including: how depression differs from grief, types of depressive illness, signs of depression, treatments, and how to help the person who is depressed. It also discusses handling some special problems: What to do when the person denies being depressed, helping from a distance, and identifying and responding to a person who is suicidal.

For additional information, visit this eXtension Learning Lesson: Recognizing Depression in an Older Adult.