As the COVID-19 pandemic rages on and individuals continue living in isolation, we’re seeing alarmingly negative mental health trends. And belonging to an at-risk population tacks on an even greater risk of loneliness, depression, and anxiety. Older adults experiencing depression might not even realize it or know how to ask for help, but removing these barriers to treatment could help save lives.
The Survey
The survey polled nearly 1,500 adults aged 65 or older and gauged respondents’ understanding and experience of depression, as well as actions they’d take if they were concerned about their mental health. It also paid special attention to the effect of COVID-19 on respondents’ mental health and habits. At the outset of the survey, which was conducted in August 2020, about 24% of respondents expressed concern that they might have depression but had not been diagnosed. Participants responded to statements like “I know the signs of depression,” “I know what to do if I think I’m suffering from depression,” and “Depression is a normal part of aging” with a level of agreement or disagreement. Over 70% indicated they understood the signs, and 45% agreed that normal aging included depression. Of respondents that identified themselves as depressed, 62% indicated they knew what to do if they were suffering from depression. However, when this same group was asked if they’d seek treatment, 61% answered no.
Why Avoid Treatment?
The reasons provided against seeking treatment varied from “I don’t think my issues are that bad” at 61%, “I can manage it without a doctor’s help” at 39%, and “I don’t want to be on medication at all” at 35%. In fact, one in three respondents believed they could “snap out of it” on their own. “These individuals were raised in a time when anything that was considered a mental health problem was a personal shame and was to be denied at all costs,” says psychologist Patricia Farrell, PhD. “They saw mental health treatment as something that was for persons who were weak, unable to care for themselves, and inferior in some ways.” This kind of thinking around mental health issues is a major obstacle to helping older adults overcome depression. Scientific research has linked depression to genetics and brain chemistry, but historic misconceptions are not easy to erase. “There’s a stigma with older adults; they don’t want it to be depression or anxiety,” says psychologist Deborah Heiser, PhD. “Someone has said to me ‘I would rather have a brain tumor than have depression’, because the stigma is so high for people.” By considering depression a personal weakness or character flaw, these individuals fail to recognize their suffering as a product of their environment or potential biological reaction. A first step toward identifying and treating depression in any age group is continued work in shifting that perception. “We know that the illness model for alcoholism has been helpful, and the medical profession has encouraged the use of this perception of alcohol abuse as a potentially genetically promoted illness,” Farrell says. “Depression can be seen the same way, and we do know that families have a number of individuals who are, for a variety of reasons, prone to depression and anxiety.”
Know the Signs
The COVID-19 pandemic has increased the potential for rising levels of depression in general, but older individuals face greater risk. Identified as one of the populations most at risk from COVID-19, older adults are enduring extended periods alone, cut off from their social lives, family, and regular routines. “The loneliness that they experience may not be something new, but the protractedness of the loneliness is something they have never had to face before,” Farrell says. Observing changes in demeanor from afar is more important than ever. Is the person still reaching out to others? Are they joining Zoom calls with family or friends, and if so, are they engaging as they normally would? Do conversations veer toward pessimism? Considering these questions can help identify shifts in behavior. Dentists and ophthalmologists can also serve as first responders in this arena due to more frequent interaction with patients than, say, a primary care physician. These specialists are often able to notice changes more readily and recommend the patient speak with a mental health professional if appropriate. Some signs, however, aren’t as visible to an outsider. A misconception for decades was that the symptoms of depression are the same across the spectrum of life. In truth, depression presents differently in older adults and can even mislead the individual experiencing it. For many, sadness is not the main symptom of depression. The National Institute on Aging lists common symptoms in older adults as fatigue, having trouble sleeping, and feeling grumpy, irritable, or confused. Heiser, whose early research helped health professionals more accurately identify depression in people living in nursing homes, points out that somatic symptoms can also be red flags of a deeper issue. “We have to look at older adults without the expectation that they should be depressed or that they should have physical infirmities—that backache or headache are normal," Heiser says. “They’re not.”
How to Help
Barriers to treatment are common for older adults. Accessibility poses a problem when individuals can’t easily leave their homes to visit a mental health provider. And utilizing telemedicine can range from difficult to impossible depending on the level of the individual’s computer literacy—if they even own a computer. For more mental health resources, see our National Helpline Database. The systemic disparities in mental health care for older people can make it difficult to receive the treatment they need. So, what can be done? Experts aren’t certain depression can be prevented—factors like environment, biology, and certain illnesses are known stressors that can trigger its development. But there are lifestyle habits that have the potential to lessen the blow. People are more susceptible to depression when they feel they lack purpose in life. Heiser suggests volunteering, mentoring, or philanthropy as avenues for connection. “By adding those things in concrete ways, by giving back, they’re leaving a legacy and having a meaningful relationship,” Heiser says. Maintaining and nurturing important relationships, scheduling events to look forward to, spending time outdoors, and practicing meditation are other healthy ways of dealing with stress and leading a happy life. But above all else and if possible, professional counseling, as well as medication when appropriate, are perfectly normal and healthy options for treating depression—no matter your age. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
