When Your Golden Years Feel Blue: Recognizing and Battling Depression in the Elderly

According to the National Institute on Aging, depression in older adults can be brought on by a major life event or change — like retirement — or significant amounts of stress. Depression can also manifest for no clear reason at all.

Several common factors occur around retirement age that can potentially cause depression and anxiety in seniors, according to Steffens.

The National Institute on Aging has found that older people who had depression when they were younger can be more likely to develop those issues again later in life.

“One risk for depression and anxiety in older adults is prior history of that,” Steffens told RetireGuide. “Any kind of major life change or stress can bring that about.”

Though older people who are facing mental health issues again may have strategies or a support system in place, Steffens recommends that those at risk of depression and anxiety always seek help from a therapist or primary care physician.

According to the U.S. Census Bureau, one in every five Americans will be at retirement age by 2030, which would create a demographic shift where older people will outnumber children for the first time in American history.

Most retirees expect to stop working full-time to enjoy a slower pace of life, pursue new activities and reconnect with their families and communities.

But Daniel Jimenez, an associate professor of psychiatry and behavioral sciences at the University of Miami, has found that it’s not nearly that simple.

“Retirement plays a huge role in mental illness because when somebody asks you ‘tell me about yourself,’ what’s the first thing you say? You mention what you do. And when you retire, you’re no longer that. So, there’s a certain loss of identity,” Jimenez said.

Jimenez, an expert in cognitive behavioral therapy in older adults, told RetireGuide that jobs and careers for working professionals serve as more than a way to earn money — they provide structure to everyday life and a sense of purpose.

“When we’re left without that, we’re sort of drifting through life,” said Jimenez, who holds a doctorate in clinical psychology. “There’s a certain ‘what am I going to do now? I’m useless.’ There’s a lot of existential stuff that comes up.”

Another unfortunate reality of growing older is losing friends, family or a spouse as they age as well.

These challenging circumstances are difficult to navigate at any point in life but may be exacerbated to a greater extent with older people due to the changes that come with retirement.

“Not only having to deal with that, the loss of someone very close to you, but then also having to then reconcile with your own mortality because your time is coming soon,” Jimenez said. “We don’t know when but when you’re older, you’ve lived a lot more life than you have left.”

Depression, while treatable, is not a normal part of aging; however, older adults are more at risk for increasing health problems, which can make them more vulnerable to mental health issues.

According to a 2021 report by the National Institute of Mental Health (NIMH), a chronic illness like diabetes or cancer can make you more likely to have mental health issues.

Similar to the NIMH report, the CDC found that the number of older adults who experience depression jumps from one to five percent in a typical population to 13.5 percent in seniors who require home health care.

Along with chronic health issues, physical changes like declining eyesight and hearing can also have a negative impact on the mental health of older Americans.

“Every road leads either to or from mental illness,” Jimenez said. “Let’s say you’re having vision loss or you’re having hearing loss, which is common in older adulthood. That’s going to affect your mental health. You’re no longer able to see and our world is so dependent on vision and it’s a really big deal.”

According to the National Institute on Aging, many retirees are happy with their lives in spite of the many added challenges that come with age.

“Overall, older adults as a whole have a fair amount of resilience,” Steffens said. “They basically bring whatever toolkit that they have developed through life in terms of life stressors when they were younger, stressors within the family, stressors within work and all of that and are able to actually navigate that post-retirement period.”

But while most seniors are happy, many do struggle. Steffens said that it’s natural for older adults to have days when they don’t feel their best. But it’s important to note if bad days become a trend or if seniors experience a loss of interest in activities that they like doing. Other signs can include food not tasting as good as it used to, loss of concentration or trouble sleeping.

Eventually, this can culminate in seniors beginning to pull back and withdraw from others and parts of their life.

Depression may also manifest itself differently in older adults compared to younger generations, Steffens said.

Many older adults also experience anxiety, which is different from depression. According to the National Institute of Mental Health, anxiety involves anxious thoughts that don’t go away and worsen to the point that they interfere with your daily life.

Retirees are susceptible to anxiety due to the many added stressors that come with older age, from money issues to health.

“For anxiety, a lot of worrying,” Steffens said. “Thinking too much about things that you might have done, things that you might have said, things that you wish you would’ve done or said. The kind of thoughts you can’t get out of your mind.”

Steffens also advises family members or caregivers who suspect their loved one is struggling with mental health issues to be observant of sudden changes in behavior. Negative reactions could be a sign that something else is going on.

Dementia, a condition characterized by the impairment of brain functions, is more prevalent in older adults and can also lead to depression and anxiety.

The most common type of dementia is Alzheimer’s disease, according to the CDC.

“Usually, memory gets hit first. Everybody has the experience of going into a room and saying ‘why was I here, where did I put my keys,’ that kind of thing,” Steffens said. “But if it looks like somebody’s coming in and asking the same set of questions that they asked 10 or 15 minutes ago or an hour ago, and it really looks like the answer didn’t stick with them, that can be a sign of early memory problems.”

Unfortunately, dementia can be worsened by mental health issues — and vice versa. Older adults can experience intense stress from the symptoms of dementia as they come to terms with its effects.

Steffens also added that it is sometimes tough at first to determine if someone is dealing with depression or dementia. In these instances, doctors can provide depression treatment and then analyze how much the patient has improved.

Dementia can also lead to mental health issues in the patient’s spouse or caregiver. If your loved one has Alzheimer’s or a similar disease or condition, it’s important for you to remember to practice self-care and ask for help, if necessary.

“It’s an enormous, enormous stressor that affects the caregiver,” Jimenez said.

COVID-19 has had a profound impact on mental health that will be felt for years to come. According to the Kaiser Family Foundation, 40 percent of U.S. adults reported symptoms of anxiety or a depressive disorder during the pandemic.

In addition, anyone who decided to quarantine during the pandemic may have experienced more social isolation than normal — which was already a major issue for seniors and retirees even before COVID-19.

“The pandemic really exacerbated what was already happening there,” Jimenez said. “It gets harder and harder to interact with the outside world.”

While COVID-19 has negatively impacted mental health on a large scale, it has also increased public awareness of the social isolation and limited contact issues that some older adults regularly experience.

“If there’s a silver lining of the pandemic, it certainly is that people understand much more the impact of social isolation,” Allen said.

There are now more options and pathways available to avoid social isolation and loneliness, such as Zoom, remote work and other live-streaming services.

These tools can offer retirees the opportunity to stay involved with others to alleviate potential anxiety and depression triggers without leaving their homes. It’s a long-term gamechanger for older Americans who deal with chronic health issues and may not be mobile.

“One of the things that we’re finding in the pandemic is that older adults actually are pretty good at learning how to access groups, access the internet,” Steffens said. “A lot of times it can actually be very helpful.”

Everything from religious services to support groups are now often available online with relatively ease of participation. For seniors who aren’t very comfortable navigating the internet, Steffens suggests asking younger family members to help with the setup of these tools.

Steffens and Allen pointed out several societal shifts that may benefit seniors in the long term.

Mental health is as important as physical health, but there is still a stigma surrounding the topic of mental illness in many communities. If you think that you or a loved one is dealing with some form of mental illness, the most important thing to remember is that it’s OK to get help.

“We talk about everything else but mental illness,” Jimenez said. “We talk about hearing loss, and we talk about vision loss — and these are all things that are really important — but when we’re talking about mental illness, it affects one in five … which is astronomical.”

The steps you should take if you are struggling with your mental health depend on the resources available to you. According to Jimenez, the most ideal outcome would be for you to schedule appointments with a psychologist and psychiatrist at the same time.

You can also go talk to your primary care physician about your concerns; treat this like you would any medical issue.

“Most primary care doctors, they’ve had good training in the assessment and treatment of depression,” Steffens said.

If you are a family member or caregiver and you think your loved one has depression or another condition, it is critical that you help them to help themselves. Be ready to combat the stigma that still surrounds mental health in many older adults.

“The older generation, while they may see what’s happening with their grandchildren, they may not be willing or able to recognize what is going on within themselves and within their peers,” Jimenez said. “There still remains a very large stigma around that.”

Older adults who are struggling should try to prioritize mental health where they can.

If you have Original Medicare, there are many mental health services and treatments that are available to you.

Medicare Part A will help handle the costs of mental health services that you receive in a hospital, like treatment or therapy.

Part B covers wellness visits, depression screenings, a psychiatric evaluation and some therapies and counseling.

Part D prescription drug plans typically are required to cover all antidepressant medications.

There are also options available to you if you have Medicaid, which is the largest payer for mental health services in the United States, according to the U.S. Centers for Medicare & Medicaid Services.

As far as online resources, MentalHealth.gov includes lots of useful information on various mental health topics, including how to identify and get help for mental illness.

For the many retirees who deal with mental health issues, there are multitudes more who are enjoying life.

According to a survey by TransAmerica Centers for Retirement Studies, 91 percent of retirees consider themselves generally happy people. And 40 percent of respondents indicated that their enjoyment of life has increased in their retired lives more than earlier years.

But there are still areas of concern that could lead to mental health struggles. The same survey revealed that 28 percent of retirees find that everyday activities are becoming difficult, and 20 percent often feel anxious and depressed.

Yet retirement can become less difficult if retirees prioritize creating structure in their day-to-day lives and work at staying social.

Having structure to each day is an absolute must, especially in retirement when seniors have more time on their hands.

If you’re physically able, one option to consider is to find a part-time job or to do volunteer work.

According to U.S. News & World Report, finding a job in retirement can provide a better life balance, offer social interaction and give you more money for a better lifestyle. Is there an industry you always wanted to work in but never did? Find something that is meaningful to you and can provide a few hours to structure your week around.

“The one thing that people may want to think about in terms of structuring their time is opportunities to go back as what they call ‘retired re-hirees,’” Steffens said. “Doing part-time work so that there is still some structure built in and it’s not just day-in day-out where your time is on your own and you don’t know what to do with it.”

Workforce changes brought about by the pandemic have also created a variety of opportunities for the chronically ill or those who can’t easily find work.

There are few quicker routes to mental health issues than social isolation and loneliness. According to AARP, people who live in isolation end up living shorter and less happy lives.

Isolation is a problem that older adults have faced for years — making it critical for them to find ways to stay connected to family members and friends.

“We really encourage people to make a social connection plan as they age,” Allen said. “When we think about being kids, we’re in school, we’re making friends, we’re going in groups. But often, we may as older adults think about a financial plan or a housing plan or something like that, but we don’t always think about a social connection plan.”

Allen touched on some of the considerations that go into developing a sound social connection plan.

For older adults, it’s become easier to stay connected or make new friends with other retirees through online clubs and activities over social networking applications.

Or they can opt for in-person options, such as inviting friends over to their homes, picking up part-time jobs or volunteering their time.

Though it’s not an alternative to medical treatment, mindfulness has emerged as an increasingly popular way to calm the mind by tracing thoughts and emotions.

Eric Loucks, director of the Mindfulness Center at Brown University, explains mindfulness and how it can benefit older adults who live with depression.

It may sound almost too simple but it’s also true: So much of happiness and health in retirement is having a structure to your life and having friends to join you on your path. If you don’t have those things yet, there are many ways to get them. And above all, it’s important to ask for help.

“For a whole host of reasons — stigma, lack of understanding, a whole bunch of stuff — we don’t want to talk about [mental health],” Jimenez said. “But it’s something that needs to be dealt with.”