Life is a rollercoaster. And as you approach the final loops and twists, it’s likely you’ll feel worse for wear. Depression can affect your parents greatly as they age. You need to be able to spot it and provide support.

Providing care for parents can be deeply frustrating and upsetting. They might have gone from having an active, flourishing social life to vegetating on the sofa, watching daytime TV from dawn until dusk. It might be you who’s making the effort to contact them and rarely the other way round. Even when you do, conversations won’t often top 10 minutes.

Even leaving the house for a simple walk around the neighborhood seems pointless to them. COVID certainly hasn’t helped older adults with depression. But from a caregiver’s perspective, it seems they have a near-professional level of commitment to sitting on the sofa and doing nothing.

What might seem unusual is that, according to a 2009 research article, depression actually gets less common as you age, affecting 1–5% of older adults. To put this in context, depression affects 13.1% of 18–25-year-olds, according to the latest data from the National Institutes of Mental Health.

Symptoms of depression in older adults – and why you might not spot them

One of the challenges of geriatric depression is that it’s easy to miss the symptoms or incorrectly assign them to other causes.

The symptoms might include:

• Prolonged sadness or despair
• Aches and pains that they can’t attribute to other medical problems
• A withdrawal from hobbies or social activities they used to enjoy
• Reduced appetite and weight loss
• Skipping meals, forgetting to take meds, and avoiding personal hygiene tasks
• A loss of hope
• Feelings of helplessness
• A complete drop in motivation and energy
• Expressions of worthlessness, such as concerns about becoming a burden or ‘hating who they’ve become’ in advanced age
• Increased alcohol or drug use
• Constant thoughts of death or expressions of suicidal thought
• Memory issues

You need to watch for these symptoms, because:

• They may not ask for help.
• They may feel that this is just a normal part of aging or that they have depression for a specific reason.
• They may be living alone, without someone to observe their signs and provide care.
• They may not attribute physical symptoms to depression.
• They’re from a generation that didn’t talk about depression, just kept calm and carried on. 

---

Depression is not a normal aspect of getting older. Your parents will need you to provide care for them during their mental struggles in the same way you would if you just found out that they had a fall and broke a leg.

This can also take its toll on you. Midlife increases the emotional burden on caregivers. You have to look in one direction and make sure your kids are okay, and the other to support your ailing parents. So you also need to remember to take the time to take care of yourself.

In this article, Team Vippi gives you the tools to help your parents if they have depression, including recognizing symptoms and how to connect them with medical assistance.

---

Separating depression from other mental health impairments in old age

When older adults develop depression, it often resembles other conditions.

Depression vs. Grief

Grief is a common theme of getting older. Your parents will have lost friends and most of their older family, and you may have lost a parent already, leaving the other experiencing feelings of bereavement.

It’s perfectly natural to feel grief after a loss – this is not the same as depression. While you should be there when your parent is suffering from either, you should be aware of the differences so that you can work out what kind of help they need.

Grief	Depression
Emotions are volatile. Your parents might even have moments of joy thinking back on better times with their lost loved one.	Your parents will feel flat and empty on a near constant basis.
Grief subsides after a while, even though everyone processes it at different speeds.	Depression only has an end date after treatment or management.
Grief subsides for brief moments of happiness – appreciating a hug or listening to a song they love, for example.	Depression saps the joy from happy moments and gestures.

However, while grief and depression are different, grief can be one of the triggers that sets off a period of depression.

Bear in mind that grief doesn’t just relate to a loss of people from your life. If your parent recently lost the use of their legs, for example, or their sight, they may be grieving their lost function all the same. However, when old age becomes one health issue after another, this can contribute to the hopelessness on which depression feeds.

Depression vs. Dementia

Dementia is a decline in mental acuity that affects over 6 million people in the U.S. While it’s different from depression, they can be hard to separate, because the mental fog that depression causes can be similarly disorienting.

Recognizing these differences means that you can help connect your parent with medical assistance for dementia early in its development. There’s no cure, but you can make their life manageable if you catch it soon enough.

Dementia	Depression
Mental function declines slowly.	Mental function gets rapidly worse.
Your parent may not know where they are even though they’re in a familiar place, not be aware what time or day it is, or misidentify you.	Your parent knows who you are, where they are, and the time and date.
Your parent struggles with short-term memory retention.	Your parent struggles to concentrate.
Your parent has impairments in movement, speech, or writing ability.	Movement, speech, and writing functions are slow but not impaired.
Your parent doesn’t seem to notice memory lapses.	Your parent expresses worry about memory issues or at least acknowledges them.

What to do if your adult is talking seriously about suicide

This is as much of a medical emergency as a heart attack or a stroke. The steps are:

1. Make sure they are not alone. If you can’t be there yourself, contact a family member urgently.
2. Ask them to hand over any weapons or sharp objects to you or the person keeping them company.
3. In the U.S., contact 911 or The National Suicide Prevention Lifeline on 1-800-273-TALK. (Outside of the U.S., contact emergency services or check the International Association for Suicide Prevention site for the best rapid-response port of call near you.)
4. Wait with them (or have someone wait with them) until help arrives.

Warning signs include:

• Someone actively talking about an urge to commit suicide.
• Someone making plans such as creating a will, offloading personal possessions, and saying goodbyes after a prolonged period of depression.
• Someone suddenly increases their level of dangerous or reckless behavior, such as deliberately dangerous driving or illicit drug use.
• Someone suddenly becomes extremely calm and blank after a prolonged period of emotional distress.

What to do vs. What not to do

To engage with a generation that may understand the feelings of depression without having the right labels to diagnose it or the tools to manage it, you need openness, honesty, compassion, and presence.

Parents can often be extremely stubborn – and rightly so. It’s understandable that someone with so many years of wisdom behind them might be reluctant to take advice. After all, they taught you everything you know, right? 

They can still be a pain in the ass regardless. But, right now, they need you.

Many people with depression feel unseen, but older adults with it can feel forgotten and left behind. They’ve watched their children grow up and develop responsibilities of their own. They may feel the only things they’re left with are their chronic health problems and the memories of the friends they’ve lost. It can be a very, very tough time.

However, there are gentle steps you can take to point them in the direction of treatment.

• Let them know you care. 
• Don’t be a fixer – just be there. Just being present can remind them that they’re still loved and relieve those feelings of being left behind.
• Help them with mundane tasks. This doesn’t just mean taking over and confirming their helplessness. But if your mom or dad is an avid gardener, for example, join in and pick the weeds with them. Feeling like they have a teammate might be the avenue they need to open up and seek help.
• Ask if they actually want to talk (they may not).
• Ask if they’ve mentioned their emotions to their doctor. Older generations might separate the physical, mental, and emotional aspects of depression more than is really the case. They may only mention physical symptoms to the doctor.
• Relate to them. Knowing that you understand how hard depression is can help them feel less isolated.
• Let them know it’s okay to feel depressed. It’s important to remove the stigma and shame that some older adults have around depression.
• If and when they decide to seek medical treatment, help them out with the internet side of it and take on tasks like talking to their insurer and helping them remember appointments.
• Provide healthy meals for them, whether you order in or prepare it yourself. Subscription boxes are a simple and effective way to make sure they’re eating healthy food. And it’s less time consuming for you.
• Invite them to activities. This depends on how mobile they are. If they can’t come to that picnic or show with you, take the grandkids over regularly and play board games with them. Perhaps think back through your childhood to reconnect them with activities they used to enjoy. If they always had an interest in aviation and warplanes, for example, take them round a military museum.
• If they open up to you, make it clear that depression is treatable in older adults, and that they’re not doomed to feel like this forever just because of their age.
• Make sure any regular nurses or carers are aware of their depression.

Things to avoid saying

They may dig their heels in when it comes to seeking treatment. But they’re hurting and need your support and empathy. So bite your tongue, swallow your frustration, and avoid saying things that suggest you don’t care, such as:

• “It’s just a natural part of getting older, you may just have to deal with it.”
• “Everything’s going to be okay.”
• “It might be time to snap out of it.”
• “Everybody has stuff going on, and we have to deal with it ourselves.”
• “Well, I had depression growing up, and you were never there for me.” (Maybe they have handled mental health conditions poorly in the past, but it’s not the time for guilt. It’s time to step up.)

When to connect your parent with a doctor

Making sure your depressed parent has access to medical intervention has effects beyond bringing the joy back to their life. 

Depression might also be happening as a side effect of medications they take for other health problems or due to an underlying medical condition. Their doctor might be able to adjust their medication or dosage. They may also be able to address health problems that could be triggering depression. 

Conditions and medications that can cause depression in older adults: 

Your parent’s depression might be due to chronic health problems, such as:

• Neurodegenerative conditions, like Parkinson’s, dementia, or Alzheimer’s
• Stroke
• Heart disease
• Diabetes
• Cancer
• Problems with the thyroid, such as Hashimoto’s thyroiditis
• B12 deficiency
• Lupus
• MS

Medications listing depression as a side effect include:

• Meds to control blood pressure
• Beta-blockers for heart problems
• Drugs to reduce cholesterol
• Tranquilizers and sleep aids
• Calcium-channel blockers
• Ulcer meds
• Heart medications that contain reserpine
• Steroids
• Pain medication for arthritis
• Estrogen supplements
• Anticholinergic drugs for gut issues

When your parent sees the doctor, make sure they’ve written down any known health problems and medications they take before they get there.

You can’t force them to seek treatment, and it doesn’t help their recovery process to do so. Their healing depends on a genuine desire to get better.

However, letting them know you see their pain, that you care, and that you’ll help with anything they need are ways to gently coax them in the direction of the professional care they need.

Next steps: Treatment for depression

Depression offers a tough road to recovery, but it’s a chance to heal nonetheless. Treatment options are available. You should try to convince your parent to seek out that opportunity for themselves, no matter how stubborn they are.

Talk therapy

In old age, this can take many forms, including:

• Counseling: They could talk to a mental health professional about their feelings. The healthcare professional would help them try to understand and work through their problems.
• Cognitive Behavioral Therapy (CBT): This is a type of therapy that helps people link their harmful thought processes to specific behaviors and triggers. They then support people in learning to manage those behaviors and adapt them into healthier thought patterns.
• Guided self-help: This may involve self-help groups, books, podcasts, or activities. 
• Interpersonal therapy: This type of therapy helps people connect and communicate with others better and strengthens relationships.

Self-help groups and activities

Self-help groups can help people feel connected and less isolated in older age. Rethink is a nonprofit organization that may help your parent link with self-help groups in their area.

Speaking to a religious leader may also help if your parent is affiliated with a religion – the leader may be able to talk to them or suggest options within their community.

Audio guides can be useful too if your parents are housebound due to illness or don’t feel like socializing.

Medication

Your parent’s physician might prescribe antidepressant medications to help them manage the low mood. One of the ways you can support your parent’s depression is by sitting in on this consultation so that you know all the details of the proposed treatment and enforce the regimen.

Before accepting the prescription, make sure the doctor knows which medications your parents take for other conditions. Antidepressant medication may have serious interactions with other drugs.

Make sure their physician tells you:

• The length of the proposed course of treatment
• Possible side effects
• When to take the medication, and how often
• Any possible interactions with other medications they take

If your parent wants to come off antidepressants, they shouldn’t simply stop taking them. Some medications for depression can cause withdrawal symptoms unless you taper off with a smaller dose.

A physician will often prescribe a combination of medication, talk therapy, and self help for older adults.

Lifestyle measures

Helping your parent reconnect with the joyful elements of their life can help them get some way of easing out of their depression (alongside formal treatment).

• Keep them connected. Get them out of the house (where possible), invite them with you to help others and volunteer in your community, convince them to get a pet, enrol them for an online class, and find any opportunity you can to laugh together. Anything that connects your parent to the outside world will be a huge boost.
• Stay in touch with them. Whether it’s a full family get together or a 10-minute call every few days, keeping in contact is one of the best ways to remind your depressed parent that they’re loved. The joy of a Facetime from their grandkids will help keep them afloat during these darker times. Sometimes, it really is the simple things that can help.
• Find purpose. Refocus your parents’ attention on the skills they have, not what they’ve lost. Maybe help them learn new skills like a language or musical instrument. Remind them not to stop dressing up every day (and also how good they look when they do).
• Where possible, travel. Book them a surprise cruise (many older cruises facilitate adults with reduced mobility) or even just on a walk or hike. A change of scenery can be a powerful reminder of the world outside of their living room.
• Rejig. If they have a garden, position the chairs to get as much sunlight as possible. It might be a good opportunity to help them declutter (no doubt in their piles of junk in storage they have old belongings that will help you take a trip down memory lane together). They might appreciate new furniture to brighten up their room or some help decorating to feel like their living space has a new lease of life.

Roundup

Depression is horrendous, and has some uniquely troubling effects in older adults. It’s easy to confuse old-age depression with the early stages of dementia or the grief that can come after the loss of loved ones. Knowing the difference and significance of each is critical for their betterment.

It can also be a challenge to convince your parent that they’d benefit from seeking treatment. Very often, older adults with depression have completely lost hope.

However, talk therapy, medications, self-help, or a combination are available to help them confront their depression and start strolling up the road to recovery.

As a caregiver, don’t forget that it’s vital to preserve your mental health. If you have other siblings to share the load, make sure they pitch in. Let your parent know that you need a day or two to yourself and that you still love and care for them, you’re just extremely tired.

You can do the right thing for your parents. It’ll take all your strength, but you’ve got more than you know.

Depression. (n.d.). https://www.independentage.org/get-advice/health/mental-health/depression?gclid=CjwKCAjwpKCDBhBPEiwAFgBzj7_0sF8DBHuDoHmJwuFJ1AKarBnphWdCJIOjncpeDqICgl8RjPVskxoCOT0QAvD_BwE 

Facts and figures. (n.d.). 

https://www.alz.org/alzheimers-dementia/facts-figures

Fiske, A., et al. (2010). Depression in older adults.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852580/

Hashimoto’s disease. (2017). https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease

Markowitz, J. (2004). Interpersonal psychotherapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414693/ 

National Health Service. (2019). Overview – cognitive behavioural therapy. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/ 

National Institute on Aging. (2017). Depression and older adults. 

https://www.nia.nih.gov/health/depression-and-older-adults

National Institute of Mental Health. Older adults and depression.

https://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml

National Instiute of Mental Health. (2019). Major depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml 

What to say to someone who is depressed, especially your mom or dad. (n.d.). https://elizz.com/wellness/what-to-say-to-someone-who-is-depressed/