Risk Factors for Developing Depression Among Older Adults

Key Points:

  • Depression may begin or worsen in older age.
  • Though more research is needed, stressors that come about in later life may lead to mental health problems, including depression.
  • Possible stressors that come about in later life include challenging transitions, such as those related to changes in health or mobility, changes in employment (e.g., retirement), loss of friends and family, changes in living situation, and stress associated with caregiving for a family member or friend.
  • If you have gone through some of these changes, have noticed that you are feeling sad, angry, or overwhelmed, and are having trouble managing these changes, talk with your doctor.

Problems with Brain Health

Dementia/Alzheimer’s Disease

  • Dementia is a general term for a decline in thinking skills or memory that is severe enough to interfere with daily life. Alzheimer’s disease is the most common type of dementia.
  • Dementia is often linked with depression in older adults. This includes vascular dementia, frontotemporal dementia, and Alzheimer’s disease.
  • About 1 in 3 people with dementia also have severe depression (Major Depressive Disorder). Many more people with dementia also experience milder forms of depression.
  • Alzheimer’s disease is the most commonly experienced type of dementia and many people who have Alzheimer’s also have depression (ranges from 15-40% across studies).
  • Some research has shown that depression in older age groups may put brain health at risk.
  • It can be hard to tell the difference between depression and dementia in older adults as they can look similar. For example, having less interest in activities, changing sleeping and eating patterns, feeling slowed down, and finding it hard to concentrate.

This table might help you tell the difference:

Symptom Category
Dementia
Depression
Mood
Mostly normal mood, unhappiness fluctuates. Mood can improve with stimulation and support. Mood can be flat or can look disengaged.At least two weeks of low or sad mood for a majority of the day, every day that does not improve with stimulation.
Interest
Can experience loss of interest but it is more gradual (over years rather than weeks) and is not accompanied by sadness. Many people still enjoy structured activities.Loss of interest or pleasure over a few weeks often accompanied by sadness.
Eating and Weight
Gradual weight loss is common in dementia. Weight gain may be secondary to less activity and/or medications.More noticeable changes in appetite leading to weight loss or gain.
Sleep
Gradual changes in sleeping patterns due to brain changes.More noticeable changes in sleeping patterns over a few weeks-sleeping too much or too little.
Feelings of Agitation
Gradual increase in agitation that is often worse in the later parts of the day or when in unfamiliar settings.Faster changes in agitation over a few weeks. Usually worse in the morning and persisting throughout the day. Can be accompanied by feelings of guilt and/or worthlessness.
Feeling Physically Slowed Down
Not common in mild to moderate dementia. Can occur over the course of a few weeks in severe cases of depression.
Guilt and Worthlessness
Uncommon. Worthlessness may present in times of stress when people become aware of their cognitive decline.Common in depression and is often accompanied with low mood and changes in appetite and sleep
Concentration and Thinking
Concentration stays normal in early stages of dementia but declines as the disease worsens. Thinking abilities slowly decline throughout the course of the disease. Loss of concentration and inability to maintain focus. People often have trouble making decisions and are concerned about making mistakes.
Suicidal Thoughts and Actions
Not common in dementia.Common in depression.
  • Psychological treatments such as cognitive-behavioural therapy, interpersonal therapy, and counselling can reduce symptoms of depression in older adults with dementia. If you notice your mood changing, talk with your family doctor.
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Physical Health Problems

Heart Problems and Cardiovascular Disease

  • Heart problems and cardiovascular disease can also be linked with depression in older adults. Not a lot is known about this link and work is being done to better understand it.
  • About 1 in 3 people who have had a heart problem, like a heart attack, will also get depressed within a year of the event. About 1 in 6 people get severe depression (Major Depressive Disorder).
  • Developing severe depression after heart failure can make it harder for your body to recover and can increase your risk of future heart problems or death. This is one of the reasons screening and getting treatment for depression after heart failure is so important.

  • Cardiovascular disease, which can lead to heart failure, may contribute to depression among older adults by changing parts of the brain involved with mood.
  • Psychotherapy, meditation and relaxation, including yoga, may relieve symptoms of depression caused by heart problems in older adults. These are safe options to consider.
  • It is uncertain whether antidepressant treatment is safe for patients with heart problems.
  • It is important to talk with your doctor if you have experienced any mood changes after a heart problem.
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Inflammation

  • Research has shown a link between inflammation in the body and depression among older adults.
  • When you are hurt or sick, inflammation in your body can help your immune system run more smoothly. Sometimes your body has trouble knowing the right amount of inflammation that’s needed and this can lead to having too much inflammation that lasts too long.
  • Older adults tend to have more inflammation than younger age groups due to health problems.

  • Too much inflammation in the body is linked with depression.
  • It is common for older adults with inflammatory diseases, such as multiple sclerosis and coronary artery disease, to get symptoms of depression.
  • Since we don’t know for sure how inflammation causes depression, it’s also hard to say what treatments might work the best.
  • More work needs to be done to know what will work, including testing if anti-inflammatory drugs might help older adults who have depression. If you notice your mood changing, talk with your family doctor.
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Problems with Nutritional Health

Vitamin B

  • Older adults are at risk of having nutritional problems, which may lead to depression or depressive symptoms.
  • Folate, a type of B Vitamin, might play a role in depression. Not only can low folate increase your risk of depression, it can also make antidepressants not work as well.

  • Although you may be eating a lot of vitamin B rich foods, supplements may be necessary to help your body absorb the right amount of nutrients.
  • Much more research needs to be done to understand the role of Vitamin B in depression in older age groups. Please talk with your family doctor when considering Vitamin B supplement for depression.
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Zinc

  • Zinc, a mineral needed for good health, might play a role in depression.
  • People with symptoms of depression or major depressive disorder may have lower levels of zinc in their blood. Inflammation is a possible cause of low zinc levels in the human body.
  • Low levels of zinc are more common in women than in men and in adults over the age of 65.
  • It is unknown whether increasing zinc levels might reduce symptoms of depression.
  • Much more research needs to be done to understand the role of zinc in late-life depression. Please talk with your family doctor when considering zinc supplements for depression.
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Disclaimer: Information on this website is offered ‘as is’ and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

References

Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. International Psychogeriatrics, 27(5), 727-737.

Chakrabarty, T., Sepehry, A. A., Jacova, C., & Hsiung, G. R. (2015). The prevalence of depressive symptoms in frontotemporal dementia: A meta-analysis. Dementia and Geriatric Cognitive Disorders, 39(5-6), 257-271.

Diniz, B. S., Butters, M. A., Albert, S. M., Dew, M. A., & Reynolds, C. F. (2013). The British Journal of Psychiatry: The Journal of Mental Science, 202(5), 329-335.

Fan, H., Yu, W., Zhang, Q., Cao, H., Li, J., Wang, J., . . . Hu, X. (2014). Depression after heart failure and risk of cardiovascular and all-cause mortality: A meta-analysis. Preventive Medicine, 63, 36-42.

Gleason, O. C., Pierce, A. M., Walker, A. E., & Warnock, J. K. (2013). The two-way relationship between medical illness and late-life depression. Psychiatric Clinics Of North America, 36(4), 533-544.

Martínez-Cengotitabengoa, M., Carrascón, L., O’Brien, J.,T., Díaz-Gutiérrez, M., Bermúdez-Ampudia, C., Sanada, K., . . . González-Pinto, A. (2016). Peripheral inflammatory parameters in late-life depression: A systematic review. International Journal of Molecular Sciences, 17(12).

Swardfager, W., Herrmann, N., Mazereeuw, G., Goldberger, K., Harimoto, T., & Lactot, K. L. (2013). Zinc in depression: A meta-analysis. Biological Psychiatry, 74(12), 872-878.

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Download: Fact Sheet: Risk Factors for Developing Depression Among Older Adults on our Fact Sheets web page.

Last Updated: September 2019