Depression in older people, especially older people with dementia, is common, under-recognized, and is definitely not a part of normal aging. Figuring out whether an elderly person is depressed is understandably difficult. Many elderly people have no psychological problems other than feeling isolated, depending on others, being in pain and dealing with the death of friends and loved ones. Of course, these things make for unhappiness, but we may decide that a depressed elderly person is just having a "normal" reaction to a life full of difficulty.
The presence of dementia makes a depression diagnosis even more difficult. Sometimes these patients can't express their distress, have forgotten particularly unhappy events, or appear sad and morose as a feature of their dementia— not of depression.
Unlike with younger people, in the elderly, the boundaries for identifying depression become blurred. For example, if a younger person has problems sleeping, it will prompt professionals to look for the other characteristics of a depressive illness. But normal sleep for elderly people is often interrupted in the absence of depression.
Things to consider
If you have an older friend or relative whom you suspect may be depressed, possible questions to ask include:
- Has there been a recent change? Such as low energy, poor sleep, more irritability or fewer activities?
- Is the person talking about being worthless, helpless or wishing to die?
- Do they want help and are they willing to try to get better?
- In people with dementia, are there troubling features beyond their forgetfulness, such as weight loss, excess irritability, poor sleep and severe fatigue or lack of energy?