Increased depression as we age is common, but it’s not a normal and inevitable part of getting older. Most depression in older adults is related to factors that can be addressed, which is good news – there’s support, treatment, and hope for older adults facing depression.
Increased depression as we age is common, but it’s not normal and inevitable.
Studies suggest depression in older adults is related mainly to loss, regret, and change in relationships.
Facing sadness as we age requires holistic living and help from loved ones, friends, and caregivers.
“Getting old ain’t for sissies, is it?” I’d often say with empathy and kindness to my hospitalized elderly patients to lighten their mood. As a registered nurse, sometimes caring for patients twice my age, I saw the sadness in their eyes. The comment made them feel I understood their mental anguish as their bodies aged.
Statistics from the Centers for Disease Control and Prevention show increased depression rates among older adults when hospitalized or needing home healthcare. General estimates of major depression in older people range from 1% to 5%. However, those rates rise to 11.5% when hospitalized and 13.5% when their health requires in-home care.
According to the CDC, 80% of older adults face at least one chronic health condition (like heart or kidney disease), while 50% face two or more. So it’s no surprise that aging increases your risk of depression. It can be devastating to watch your youth slip away. Getting old isn’t for sissies.
Still, while most adults aren’t clinically depressed, nearly everyone may face some situational depression as they age. They may also experience subsyndromal depression—meaning they have depression symptoms, but not enough to meet enough official criteria for major depressive disorder.
Studies say that getting older isn’t a direct cause of depression, but it is a risk factor. Why does aging increase our risk for depression, and what can we do about it?
Causes of depression as we age
Studies suggest depression in older adults is related mainly to loss, regret, and change in relationships. These challenges often occur during middle age, but increase each decade, making them increasingly harder to face.
Working in a hospital during my 40s, I cared for patients who struggled to adjust to changes like decreased physical stability and mental strength. I learned that I, too, need to be prepared for these three common changes and losses as I get older.
Various types of loss
Loss arrives in various forms the older we get.
Loss of physical ability creeps in slowly at first. Joints start aching, stamina reduces, and fitness slips away faster when you miss a workout. When you can no longer walk without a cane or drive on your own, sadness inevitably knocks at the door.
Increased mental sluggishness is another loss. It’s one thing to be less sharp than you used to be, but loss hits deeper when your kids ask you to stop driving.
Polypharmacy is also associated with depression in adults over 65 years old. Typically defined as taking five or more prescribed drugs, polypharmacy is a sign of declining health. While studies show it doesn’t directly cause depression, it’s connected to one’s risk of growing sadness.
When your health and physical ability decline to the point of losing your license, having an in-home caregiver, or moving to a nursing home, losing independence and usefulness can make a person feel trapped and powerless. It’s easy to slip into depression when someone has to rely on others, some of whom they don’t trust.
A change in beauty and looks is another form of loss weighing heavily on some aging adults. In 2021, Americans spent $14.6 billion on surgical and non-surgical cosmetic procedures. Women accounted for 94% of the patients, and only a small percentage of all procedures were for breast reconstruction surgeries after cancer treatment. It’s hard to overcome the loss of youthful beauty and accept the different glow of aging.
Many aging adults lose loved ones and face stressful changes with other friends, family, and caregivers. Loneliness is a massive problem for older people. Older adults who are socially isolated or lonely have a 50% increased risk of developing dementia, a 30% increased risk of coronary artery disease or stroke, and a 26% increased risk of all-cause mortality.
Regret and disappointment
Everyone faces various regrets and disappointments as we age. In her book titled The Top Five Regrets of the Dying, Bonnie Ware lists five regrets she heard from palliative care patients:
- I wish I’d had the courage to live a life true to myself, not the life others expected of me;
- I wish I hadn’t worked so hard;
- I wish I’d had the courage to express my feelings;
- I wish I had stayed in touch with my friends;
- I wish I had let myself be happier.
Regrets breed disappointment. These five regrets underlay the grief of unfulfilled dreams, distant friends and children, unmet needs, and misplaced values.
If we’re not careful, ruminating on sad disappointments can create a negative mental loop, triggering serious depression.
Changes in relationships
A 2019 study published in the journal Health & Social Care in the Community explored the impact of changing social networks on older adults. When social connections change, the support older adults rely on changes, too. This change affects their well-being, especially when accompanied by a health decline.
The study noted four themes of social network change that impact older people:
- Facing the illness or loss of a spouse;
- Experiencing changing relationships with children and grandchildren;
- Enduring the loss of people they’ve known for a long time;
- Feeling dependent and stressed when new helpers join their network.
Adults of any age relate to the stress and sadness caused by changing relationships. For older adults, this becomes a prime mental health challenge.
Fortunately, this study confirms what other studies also found: it is possible to successfully face the change in our social network by preparing oneself for these changes, setting new goals and expectations, and making adjustments.
How to face the sadness
Journeying through sadness as we age requires holistic living and help from others.
Holistic wellness encompasses the whole person's physical, mental, emotional, social, intellectual, and spiritual health. It's an essential concept for aging because when one area of wellness becomes challenging, like your physical health, you need the other areas to help you through the difficulty.
Furthermore, each area impacts the others. For example, facing mental and emotional challenges is harder if you're physically unhealthy. Likewise, exercising and eating well is tougher if you're mentally unwell. At the same time, belonging to a community – one aspect of social wellness – reduces physical and mental challenges.
As we age and journey through life’s challenges, tending holistically to each aspect of wellness is essential to face fears, losses, and regrets.
There are resources and treatments for depression, thankfully. If you need help, as we all do, reach out. Isolating yourself takes you deeper into depression. Summon the courage to talk to someone near you – a trusted loved one, friend, or care provider. You can also call 988 Suicide & Crisis Lifeline 24/7 for immediate help.
As you pursue a holistic lifestyle, consider seeking help and resources for each wellness category. Your insurance may cover nutritional counseling, physical therapy, and mental health therapy. Investing in your social and spiritual community — or bravely finding new ones — can improve your oxytocin and serotonin levels. Consider pursuing intellectual wellness by learning a new game, becoming a volunteer within your career field, or writing down your stories and wisdom to pass on to grandchildren.
Whatever you do, know that you’re not alone, that feeling better is possible, and that help is out there.
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