Talking about anxiety and depression with older loved ones can be hard. Here's how to start.

Amanda Pérez Pintado, USA TODAY
·5 min read

The arrival of COVID-19 brought a rise in mental health concerns and most Americans say the country faces a crisis. Older adults haven't been exempt from the mental toll of the pandemic, which has left them with increased rates of depression.

The stigma surrounding mental illness has contributed to the perception that depression is a normal part of aging and makes it harder for older adults to seek professional help, said Marcia Ory, a regents and distinguished professor at the Texas A&M School of Public Health.

"Depression is common in old age, but aging is not in itself a factor in who's going to be depressed or not," Ory said.

Estimates put the rate of depression among older adults at or below 5%, according to the Centers for Disease Control and Prevention. That rate, however, rises among older adults who are hospitalized – 11.5% – or need home healthcare – 13.5%.

Older adults are at a higher risk of depression, in part, due to the relationship between the mental illness and other conditions. The CDC estimates about 80% of older adults deal with at least one chronic health condition.

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Factors like other medical conditions, loneliness and social isolation, lack of physical activity, sleep problems and functional limitations can be related to depression, but do not necessarily cause depression, according to the National Institute on Aging.

"When there's new onset of depression for older adults, it's brought on by the many changes that they're going through, as they get older," said Kathleen Cameron, Senior Director of the National Council on Aging's Center for Healthy Aging.

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What are signs of depression?

Common symptoms of depression include feelings of sadness or anxiety that last for weeks at a time, according to the CDC.

Some other signs of depression are changes in appetite or sleep, irritability, fatigue, feelings of hopelessness, and loss of interest in once pleasurable activities.

"Depression often manifests itself differently in older people, where they don't say they're sad and blue, but they lose interest or they don't sleep as well or they're not eating as well," Ory said. "The symptomatology is unique for every single person."

Suicidal thoughts may be symptoms of depression. Adults ages 75 and up account for fewer than 10% of all suicides, but have the highest rate, according to the CDC. Older men have the highest suicide rate compared to other groups.

"Older men, particularly, they tend to be more stoic and have kind of succumb to the stigma associated with mental health and don't seek help," Cameron said.

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When to talk to a doctor

Older adults who recognize signs of depression that last for more than two or three weeks should consult with their primary care doctor to rule out whether the symptoms may be caused by other factors, such as medication or medical conditions, said María P. Aranda, a professor of social work and gerontology at the University of Southern California.

"It could be something else that's occurring that may be precipitating the the anxiety or the insomnia," Aranda said. "It'd be important that they consult with their physician to identify how it started, the severity of the symptoms, what type of evaluation or assessment would they need to rule out any other things."

Aranda said older adults experiencing depression shouldn't lose hope, as there are effective treatments for the condition, such as medication and psychotherapy.

In cases of suicidal ideation, it's important to seek help as soon as possible, Ory said.

"Immediately somebody starts expressing suicidal ideation, you want to get them help right away, which usually the first thing would be calling a suicide hotline and then making an appointment with their healthcare provider," Ory said.

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What family and friends can do

Family members, Ory said, can sometimes pick up first on whether a person's mood has changed over time and there are things they can do to help an older adult in their lives experiencing depression.

"They're not clinicians, so they can't treat depression, particularly the more serious and long lasting depression, but they can offer support," Ory said.

If an older loved one is showing signs of depression, here's what you can do:

  • Start the conversation. Show empathetic concern about the changes you have noticed in them, experts suggested. Ory recommended avoiding using the word "depressed" outright and instead talking about the signs they have noted. Aranda suggested family and friends communicate they want to be supportive and "they're in their corner."

  • Help set up a medical appointment and accompany them. Family members and friends can encourage loved ones to seek medical treatment. "But it's not just saying, 'Oh, I think you should talk to your doctor,'" Ory said. "(It's) 'Let me make an appointment and go with you.'"

  • Participate in activities the person enjoys. "Going out on outings with their grandchildren, getting together with friends," Cameron said. "Better understanding what the older person wants to achieve in their life will help to seek out some solutions and help the person get to the place where they're back to doing those things that they truly enjoy."

  • Keep in mind that it might take more than one try for them to open up. "It might take multiple times to have that conversation," Cameron said. "You don't want to alienate the person that you tried to have the conversation with if you're pushing too much, so don't give up. Keep going back but sometimes you have to do it in a kind of in a gentle manner."

If you or someone you know is struggling with suicidal thoughts, you can call the National Suicide Prevention Lifeline at 800-273-TALK (8255) or chat online any day or time.

If your or someone you know is struggling with substance use disorders, you can call the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357.

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This article originally appeared on USA TODAY: Depression and anxiety in elderly Americans: Signs, symptoms and tips