Contrary to what many people believe, depression is not a normal part of aging.
Despite often having risk factors for depression — one of which is having a chronic disease — older adults have some of the lowest levels of mental illness relative to all other adults.
To learn more about how depression, loneliness and social isolation affect older adults, we talked with Dr. Samantha Farro, who directs the integrated behavioral health program at the UCHealth Seniors Clinic on the Anschutz Medical Campus and in Lone Tree.
Farro is also an assistant professor in geriatrics at the University of Colorado School of Medicine.
Mental health and older adults
While depression is rare among older people, loneliness and social isolation are a different story, and something that many older people experience. Unfortunately, loneliness and isolation are related to higher rates of morbidity and mortality.
“Loneliness and social isolation are important to screen for and be aware of,” Farro said, adding that they can fuel a decline in physical and emotional wellbeing.
Farro said older adults who experience social isolation are at a greater risk for other concerning health issues such as:
- Heart disease
- Anxiety
- Sadness
- High blood pressure
- Weakened immune system
- Cognitive decline
What can older people, caregivers and loved ones do to prevent depression, loneliness and social isolation among older adults?
“There are different ways to help prevent loneliness and isolation from worsening and turning into depression and anxiety,” Farro said.
Older adults can boost their happiness by deliberately fostering relationships with people and staying engaged in their communities. Any activities that foster joy will stave off loneliness and help boost mental health. Try performing in plays or concerts, visit art museums or join a recreational sports league. Physical activities from dancing to pickleball to golf can be modified to accommodate people with different physical abilities, Farro said.
Other ideas for avoiding loneliness and social isolation include:
- Volunteer at a nonprofit, community or church
- Join a book club
- Enroll in an online or in-person class
“Joining a club to learn to dance or listen to live music; these kinds of community activities can be important and fun ways to stay engaged, especially if you live alone,” Farro said.
More tips for staying connected include:
- Discover a new activity or hobby: “Now is the time to pursue an interest you’ve always had,” Farro said.
- Explore: Have fun and meet people with similar interests at community senior centers.
- Use technology to connect: FaceTime and Zoom can be used for communication to maintain and nurture relationships.
- Exercise: If you have a pet walk it; get outside and into nature, which can be restorative and have a healing effect, she said.
What are other preventive strategies for aging healthy?
- Structure daytime activities so nighttime sleep is consistent
- Engage in daily exercises and daytime socialization to help regulate sleep
- Maintain a healthy eating schedule and refrain from eating in the middle of the night when possible
- Create a schedule around your day if that is helpful, especially if you are newly retired.
“Consistency is really important,” she said. “Our bodies love that.”
How did the COVID-19 pandemic affect the mental health of older adults?
The COVID-19 pandemic was not good for mental health, in general. Social isolation and lockdowns were especially tough for young and old alike.
But again, many older adults were able to face the challenge with perspective and drew from other life experiences to adapt. Older people can have different reference points for how to cope with challenges. They know that life is full of both good and bad experiences, Farro said.
For instance, she saw a surge in older people who were able to use technology to stay connected with family and loved ones. Many seized opportunities during the pandemic to pursue new creative endeavors such as cooking, gardening, crafts and reading.
Is sadness a natural part of aging?
Sadness is a natural part of life, Farro said, and as we age and face the death of loved ones, being sad is a normal reaction.
“Grief is normal reaction to death loss and a part of our life experience. It’s when we can’t accept the death and heal that it may be beneficial to get professional help,” Farro said.
What’s is the difference between a serious mental health issue and sadness or ‘the blues?’
“Whenever I think about what differentiates feelings that are normal vs. feelings that might lead someone to seek professional help, it is good to consider if a person is impaired in their ability to function every day in normal life. Can they still have meaningful relationships and relate to the outside world or is this hindering them?” Farro said.
“Older adults are a diverse group with wide variety of health, family, and economic situations so there can be different needs for different people.”
That’s not to say that older people are not faced with a lot of unique challenges that differ from younger adults.
For example, more older people deal with chronic illnesses, and they experience death loss more often as they age, all of which can put them at risk for loneliness and social isolation.
“It’s a balance,” Farro said. “They have real and tangible challenges, but over the course of a lifetime through all of their experiences, they often have also developed really effective coping strategies and resilience.”
Be aware of the differences between “normal” worry or feeling overwhelmed vs. anxiety. Seek help when needed. If you’re not sure whether you just have the blues or you need treatment for something like depression or anxiety, check with your doctor.
White men over age 75 face especially high risks for mental health challenges, including suicide
Farro said she doesn’t want to downplay important mental health risks that some older people face. For example, white men over age 75 have one of the highest suicide rates compared to other demographic groups. Ready access to lethal means such as firearms in the home contributes to increased risk.
Warning signs of suicide include:
- Talking about wanting to die
- Feeling hopeless
- Feeling trapped
- Being a burden to others
- Looking for a way to end their lives, such as searching online
“Suicide risk is important to talk about. If someone you love is having thoughts of wanting to die, call the 988 mental health crisis hotline or go to your nearest ER to have an evaluation done.”
Is it true that older adults often are very resilient?
“Yes, older adults are very resilient,” Farro said. “Often, it’s because they can put things in perspective and take a big-picture view. They have a great deal of life experience to draw from.”
When researchers assess life satisfaction, older adults often report some of the highest levels, she said.
“There is a lot to look forward to in aging even though there are challenges,” she said.
One of those stress points includes a huge milestone for many people: retirement.
“It’s a huge change as people ponder that next chapter in life and, for some, it can be overwhelming as they attempt to figure it out. Loss of structure can be a difficult thing to deal with.”
Her advice is to have a game plan: What do you enjoy? What do you value? What gives your life purpose and meaning outside of work? Explore and discover that and create daily and weekly routines to ensure you get to do it regularly.
How can loved ones help older adults avoid mental health challenges?
“You can listen to them,” Farro said. “Be patient. And be kind to yourself. Don’t forget to take care of yourself, because if you are depleted, you won’t be able to take care of others.”
You can also lend a hand with mobility and transportation, as these can be barriers as older people often initially need help learning about arranging rides, carpools or navigating public transportation.
If you are seeing signs of mental health problems in someone you care about whether it’s depression or anxiety or isolation and loneliness, encourage them to seek treatment.
“These are often treatable conditions and it’s never too late for people to get help.”
Options include evidence-based psychological therapies, medications, and other promising treatments.
‘’It’s not normal to be depressed. And just like any other health condition, you can get help. Just as you would if you had a broken leg or diabetes. There is no shame. We all need to reduce the stigma around mental health.”
Some older people are afraid to ask for help with mental health challenges. How can we overcome stigma and shame around asking for help?
Farro is dedicated to eliminating the stigma around aging, which she said is sadly prevalent in American society. Having contributed economically and financially for decades through work and careers, many may question their worthiness when that ends.
“Agism can erode our ability to be healthy. It changes how we see ourselves and others and can harm our relationships. Agism can be rampant and undermines many things we know about older adults: Most are doing well, that they have so many strengths and resources and contribute so much good in our community and world.”
