Late-Life Depression: Triggered By Age…Or Ageism?

No one knows for certain what causes depression or what role it is meant to play in the evolution of humankind. Most current theories propose it is the result of the interaction of factors as varied as epigenetics, trauma, illness, stress, loss, guilt, regret, isolation, side effects from medications, and even hearing problems. We do know that many times depression is the result of external events, but just as often it is believed to be the result of internal factors such as negative self-talk or a generally pessimistic worldview.

It’s normal to feel sad when bad things happen. But when you can’t bounce back and the feelings of sadness, lethargy or anger begin to affect how you get along with friends and family, it becomes a real problem.

One tell-tale sign that you are depressed is that when time passes and the situation improves, you don’t feel better.

According to a 2015 study by the National Institute of Mental Health, 6.7 percent of American adults 18+ annually experience at least one episode of symptoms sufficient to warrant a diagnosis of Major Depressive Disorder. That figure is projected to be more than doubled for older adults. The founder of the Weill Cornell Institute of Geriatric Psychiatry, Dr. George Alexopoulos, predicts that 15 percent of the population over sixty-five will develop clinical depression and that more than two-thirds of those will remain undiagnosed and untreated. The thing to remember is that depression is one form of mental illness that can be fatal because it may lead to suicide, especially among seniors. According to the New York Times (8/7/13), elderly white men have the highest rate of suicide with 29 per 100,000 over all, and more than 47 per 100,000 among those over age 85. Dr. Martha Bruce, PhD, also of Weill Cornell, says this alarming figure is “partly a result of so much stigma about mental illness and partly a result of ageism.”

Ageism is only now being recognized as a significant contributing factor in late-life depression. One reason for this new awareness of age discrimination may be that the Baby Boomers who created our youth-obsessed culture are now entering their sixties and surprised to find traditional assumptions about old age at odds with their values and lifestyles.  Ageism remains the last socially accepted form of prejudice. Older adults continue to be portrayed as frail, inflexible, and a burden on society. These attitudes are instilled in us when we are young and are further reinforced by the media and society as we grow. What’s even worse is that we tend to internalize these socially constructed biases without questioning them.

Studies have shown a definite link between age discrimination and depression.  If you believe the stereotypes, the instant you turn 65 you are suddenly “old and in the way.” These unfounded characterizations have a corrosive effect on our self-esteem and tend to make us withdraw from activities that are not “age-appropriate.” If you add this sense of marginalization to the loss of identity, loss of youth, loss of career, loss of independence, and loss of friends or loved ones you experience as you age, you have a surefire recipe for depression. In fact, loneliness, and the depression it causes, have been cited in a recent study by the Alzheimer’s Association (2015) as a major factor in cognitive decline.

There are several reasons why depression in older adults often goes untreated. The state of the medical profession is one. There is a severe shortage of doctors trained in geriatric medicine, especially in psychiatry. General practitioners rarely take the time to screen for depression or anxiety during routine check-ups. If an older person complains of feeling down or not enjoying life, the doctor is likely to say something like, “Well at your age, what do you expect?”  If your doctors pass off your symptoms as a function of age, call them on it. Depression is not a normal part of aging. And hopefully in the near future ageism won’t be either.

This article originally appeared in the Charlottesville Daily Progress on September 14, 2017