There is a common misconception that depression is a normal part of getting older, but there is no reason to accept depression when there are research-backed ways to keep depression at bay.
Isolation is a key predictor of suicide in older adults (1), and can create the conditions for depression to occur in adults who are not already depressed. Volunteering, attending church, or just having a regular get-together with friends or family can improve mood and provide a sense of purpose. Local senior centers can be a valuable resource for social events and activities.
The widespread shortage of geriatric psychiatrists put primary care providers on the front lines of mental health for older adults, which can provide challenges for PCPs who may not be comfortable prescribing aggressive treatment for mental health problems, but PCP’s have a unique opportunity to engage with their patient’s mental health because of the high level of trust patients have in their PCP. Older adults are often reluctant to talk about depression, due to stigma, so routine screening at regular intervals is key to prevention and treatment
The research literature is clear that exercise is important for both physical and mental health (2). Older adults risk becoming sedentary due to chronic pain and reduced mobility, but even short walks or gentle exercise, such as chair yoga or water exercise, can help prevent depression. Most gyms and local YMCAs have reduced-cost programs specifically designed for older people. Walking, even if just around the block, can be of benefit.
Common diseases of late-life, particularly cardiovascular disease (CVD), stroke, and diabetes, increase the risk of depression in older adults. This risk decreases when these conditions are well-treated and patients are compliant with their medication regimens. Complicating matters further is the fact that depression makes patients less likely to stick to their medication schedules and get appropriate treatment for their chronic conditions (ref). Obstructive Sleep Apnea (OSA) is a common disorder that decreases levels of oxygen in the brain, and accordingly can both cause depression and make it less likely that first-line treatments will be effective. Taking care of physical problems in a timely manner is an important tool in fighting depression.
Many older adults find it difficult to maintain a healthy sleep schedule. Observing proper sleep hygiene by going to bed at a set time each night, limiting electronics, alcohol and caffeine before bed, and getting sunlight during the day can help get sleep back on track. Click here for information about sleep hygiene from the National Sleep Foundation.
This downloadable and printable infographic may be a helpful reminder for you or your older patients at risk for depression:
- Wand APF, Zhong BL, Chiu HFK, Draper B, De Leo D. COVID-19: the implications for suicide in older adults [published online ahead of print, 2020 Apr 30]. Int Psychogeriatr. 2020;1-6. doi:10.1017/S1041610220000770
- Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;(9):CD004366. Published 2013 Sep 12. doi:10.1002/14651858.CD004366.pub6