Geriatric Depression Not a Normal Part of Aging

November 5, 2020

Depression can present differently in older adults and can often go unrecognized and untreated, said Dr. John Burkhardt, associate professor of psychiatry and behavioral medicine at The University of Alabama College of Community Health Sciences.

“It’s a myth that depression is a normal part of aging. It’s not,” said Burkhardt, a clinical psychologist who also practices at University Medical Center, which CCHS operates.

Burkhardt provided a presentation about geriatric depression October 13 as part of this semester’s Mini Medical School program. Mini Medical School is a joint program of UA’s OLLI program and CCHS and provides an opportunity for OLLI and community members to receive updates and learn about trends in medicine and health.

Depression is a leading cause of poor health and disability in the U.S., and more than 17 million adults had at least one major depressive episode last year, according to the National Alliance on Mental Illness. The organization said approximately 13 million American adults are diagnosed with depression, but that between 30% and 50% of adults go undiagnosed.

Stigma is a barrier, and can be more pronounced with older adults, Burkhardt said, adding that between 25% and 30% of adults don’t follow through with mental health referrals. “Stigma is a barrier for older adults to seek mental health care,” he said.

Signs of depression include sadness, feelings of guilt, worthlessness and hopelessness, difficulty concentrating, poor sleep and decreased appetite – “a negative view of themselves, others, the world and no hope for the future,” Burkhardt said. “The depression we’re talking about is the kind that impacts you’re daily living.”

He said for older adults, depression can present as cognitive symptoms, including diminished memory and executive function, loss of interest in activities and symptoms without a clear-cut medical cause, such as fatigue, joint pain, poor sleep and weight gain or loss. But he also said that “late-in-life depression can occur with cognitive impairments, especially attention and executive function, and can result in more morbidity and mortality and greater disability.”

In addition, depression can worsen chronic conditions, such as asthma and diabetes, and can co-occur with stroke, cardiovascular disease, Alzheimer’s disease, chronic pain and cancer.

The financial costs associated with geriatric depression are high. For Medicare beneficiaries, health-care costs associated with depression can be upward of $22,000 annually; for older adults who are not depressed, costs are half as much.

COVID-19 has also added to geriatric depression, Burkhardt said. The pandemic has resulted in stress, fear, health concerns, isolation and loneliness. “It’s separated us from our families and friends and has limited our activities,” he said.

To help, Burkhardt recommends staying connected with others via technology, being physically active, maintaining good nutrition, hydration and sleep, limiting social media and news intake to an hour a day, getting a pet and considering therapy. “Gratitude and acts of kindness can also be very beneficial,” he said.