Mental Health: What Older Adults Need to Know

A study out of the University of Michigan found that people between 65 and 80 years old living in their own homes had an easier time coping with anxiety and other mental health challenges than younger folks during the Covid pandemic.

In fact, those findings of the University of Michigan’s Healthy Aging Poll are pretty much the same in non-pandemic times: Older adults adapt better to crisis situations.

“It’s resilience, wisdom, the ability to put current stressors in the context of past things we’ve been able to get through,” says Lauren Gerlach, D.O., M.Sc., a geriatric psychiatrist and assistant professor at the University of Michigan. Gerlach was the author of a paper that interpreted the results of the poll.

Seniors are at Higher Risk

Yet, research shows that older adults have a higher risk of developing depression. Chronic illness, the loss of loved ones and reduced mobility are a few common causes. Depression also goes undiagnosed in older people, meaning that many of them are left to struggle on their own.

Gone untreated, depression can lead to drug and alcohol misuse and suicide, both of which have increased among older adults in the last decade.


Depression is defined as feelings of sadness, anxiety, and/or lack of interest in activities that last for at least two weeks and impact a person’s ability to function normally. Depression can alter the way a person thinks, acts and feels. While they struggle with many of the same stressors as younger people, older adults also face a host of unique depression risk factors such as:

  • Chronic conditions, including chronic pain (about 80% of older adults have at least one chronic health condition, according to the Centers for Disease Control and Prevention)
  • Decreased functional ability and reduced physical mobility
  • Loss of independence (e.g., they can no longer drive)
  • Financial issues related to retirement
  • Loss of loved ones
  • Elder abuse
  • Caregiver stress
  • Lack of physical activity
  • Loneliness
  • Cognitive impairment

Depression amplifies other problems, like physical illness, and it interferes with treatment and rehab after injury. Some of the risk factors for depression – social isolation, declining health and grief – can also lead to substance use disorders like excessive drinking and using opioids and marijuana.

Gerlach says about half of older adults will have their first episode of depression after the age of 65.
Some research has shown that older adults who have late-onset depression are likelier to have a history of cerebrovascular disease (e.g., stroke, brain aneurysms, blood clots). More research has shown a link between late-onset depression and cognitive problems, especially in our ability to organize, plan, make decisions, solve problems and control our behavior.

Major Depressive Disorder

When it comes to older adults with major depressive disorder, the numbers are far smaller. Major depressive disorder is characterized by a persistently low or depressed mood, the loss of interest in pleasurable activities that alters a person’s social and work habits, feelings of guilt or worthlessness, a lack of energy, poor concentration, appetite changes, agitation, sleep
disturbances, or suicidal thoughts.

According to the Centers for Disease Control and Prevention, the rate of major depression in older adults ranges between 1 percent and 13.5 percent. Those who are hospitalized or living in care facilities are likelier to have major depression than those who are living independently.

Older Adults and Suicide

It is estimated that about 60 percent of people who die by suicide have had a mood disorder (e.g., major depression, bipolar disorder, a persistent low mood). Young people who die by suicide often have a substance use disorder, in addition to being depressed.

For older adults who die by suicide, however, many do not have a previous mental health diagnosis or a history of psychological treatment. Suicide notes left by the victim tend to talk about pain, illness, and the fear of becoming a burden. “It highlights the impact of depression and how hopeless individuals can feel,” Gerlach says.

White males 65 years and older have the highest rate of death by suicide, which is four times higher than the nation’s overall suicide rate. One in four seniors die by suicide compared to 1 in 200 younger people.

If You Feel at Risk, Dial 988

If you feel at risk of dying by suicide or fear that someone you know is at risk, call 988, a 3-digit phone number that will route callers to the National Suicide Prevention Lifeline.


Depression looks different in older adults, one reason it can often be missed. A study published in the journal Neuropsychiatric
Disease and Treatment in 2022 found that depression in older adults is characterized by a lack of interest, less sleep, weight loss, fatigue, poor concentration, a lack of hope, a loss of appetite and thoughts of death rather than sadness.

Doctors may view these symptoms as age-related frailty rather than a mental health condition. To make a correct diagnosis, it is important to consider depression but also to rule out other reversible causes such as the use of prescription drugs like opioids, steroids and benzodiazepines (Xanax, Valium, etc.) that can cause symptoms that mimic depression, says Gerlach. Over-the-counter
drugs like Benadryl can affect memory. Untreated illnesses like thyroid disease and sleep apnea can impact a person’s mood and ability to think.

Depression in older adults is often accompanied by changes in memory or difficulty in concentrating, which can be difficult to distinguish from dementia. Treating a person for depression can often help to improve concentration and focus, says Gerlach.

Treatment of Depression

First-line treatment for depression often includes a combination of medications and therapy. Antidepressants work well for the treatment of depression in older adults, as long as they don’t interact with other medicines the patient is taking.
And it’s important to remember that it takes 4-6 weeks for the drug to start having an effect, Gerlach says.

Research shows that behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are highly effective but not used enough in older

“Establishing a daily routine, getting exercise, maintaining a regular sleep schedule, avoiding drugs and alcohol, and socializing can all be helpful, too,” says Gerlach. If you’ve been feeling down for a while, it’s important to talk to your doctor about symptoms you might be having. While some stigma remains surrounding mental health treatment, “The current generation of older
adults is more willing to engage in care — which can have a tremendous impact on improving quality of life and happiness.

Talking to your primary care physician is a great first step,” Gerlach says. “The pandemic has really shined a light on
prevalence of mental health concerns and the importance of recognizing mental health as an
integral part of physical health.”

Tips to Protect Your Mental Health

Get enough sleep: Lack of sleep can cause depressed feelings as well as irritability. Aim to get seven to nine hours each night.

Stay active: Exercise can help improve your mood and strengthen your heart and lungs. Activities like brisk walking, swimming, and light yard work are all great choices for older adults.

Be social: Make an effort to stay in touch with friends and family to keep those connections alive. Consider volunteering at a local animal shelter or food pantry to help you gain a greater sense of purpose while meeting new people.

Eat right: Eating a heart-healthy diet can help you have more energy and prevent medical conditions that may indirectly increase your risk for depression.

Limit the use of recreational drugs and alcohol: Marijuana and alcohol are depressants.

Discuss your concerns:
Talk to your primary care doctor if you feel sad or depressed. They are trained to help you.

Manage your illness: If you have an illness like diabetes, keep it under control by working with your doctors.

For More Information

For more information about depression and aging, read the CDC article, Depression is Not a Normal Part of Aging. Again, If you feel at risk of dying by suicide or fear that someone you know is at risk, call 988, a 3-digit phone number that will route callers to the National Suicide Prevention Lifeline.