If you or someone you know is at risk of suicide, please call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text TALK to 741741 or go to SpeakingOfSuicide.com/resources for additional information.
Before her death, country music icon Naomi Judd had been open about her experiences with mental health issues, particularly depression and suicidal ideation.
Judd's daughters initially attributed her passing to "the disease of mental illness." And Ashley Judd later confirmed that her mother died by suicide. “When we’re talking about mental illness, it’s very important to be clear and to make the distinction between our loved one and the disease," she told ABC News. "It’s very real, and it lies, it’s savage.”
Judd's death is a somber reminder that mental health issues can affect anyone — and some elderly adults may face uniquely high risks for developing a mental illness like depression. But effective treatments are out there, and sometimes all it takes is an honest conversation to get people the help they need and deserve.
Mental health issues in older adults are common
Depression among older adults is generally rare, with prevalence rates at or below 5%, the Centers for Disease Control and Prevention estimates. But among those who are hospitalized or need home health care, the rate of depression is much higher (between 11.5% and 13.5%), the CDC says.
Part of that is due to the link between health conditions and depression; people who have chronic health concerns (like diabetes, heart disease or chronic pain) are more likely to also have certain mental health conditions. Older adults tend to have more health concerns, with 80% dealing with at least one chronic health condition, the CDC explains.
There are a variety of other risk factors that older adults may experience as they transition to this stage of life, Patrick J. Raue, professor in the department of psychiatry and behavioral sciences at the University of Washington, told TODAY. That can include the loss of loved ones, limited social contact and even retirement, Raue said.
As people get older they may also be less able to engage in the healthy coping mechanisms they used previously, such as exercise or socializing. "And COVID has made that even more pronounced," Raue said. "Social connections are important for all of us. But for an older adult who maybe is a bit isolated and has some issues with functioning or getting out of the house, that can hit those folks even harder."
Recent research found that around 20% to 30% of adults in the U.S. reported symptoms of depression and anxiety during the pandemic. And Raue said his research has found similar numbers for depression among older adults.
There's also a perception that many of these factors are simply a natural part of getting older, which leads people to overlook depression in older adults, Dr. Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, told TODAY. "But the truth is, it’s a treatable illness in the older years as well. And it can be a life-threatening illness if it’s not addressed,” she said.
Look for these signs of depression
There are two hallmark signs of depression to watch for in loved ones: persistent low mood and a loss of interest or pleasure in things that they once enjoyed doing, Dr. Sue Varma, board-certified psychiatrist and clinical assistant professor of psychiatry at the NYU Langone Medical Center, told TODAY's Hoda Kotb.
Other signs of depression may include changes in appetite or sleep, irritability, difficulty concentrating and physical symptoms (like aches and pains or digestive issues) that don't get better even with treatment, the CDC says.
Suicidal thoughts can be symptoms of depression, Raue said. But it’s important to remember that not everyone dealing with depression experiences those thoughts — and that there’s a spectrum of suicidal ideation. Some people may experience what’s known as passive suicidal ideation, leading to thoughts of wanting to die or not wake up the next morning without a specific plan to take their life. More active suicidal ideation may come with a plan to die by suicide within the next few days or weeks, Raue explained.
Any suicidal thoughts are concerning and worth bringing up to a provider or therapist, but active suicidal thoughts are rare, Raue said. And most people who have suicidal thoughts do not die by suicide.
"It doesn't get as much attention in the media, but the truth is that older adults have much higher rates of suicide compared with younger adults," Moutier said. In fact, adults aged 75 and up have some of the highest suicide rates in the U.S., according to AFSP estimates.
Sometimes, older adults who develop depression also had bouts of depression previously in their lives while other seniors may experience it for the first time later in life. But doctors may not use screening tools to look for depression or suicidal ideation in older adults, Moutier said. And these patients may be less willing to say that they're dealing with those thoughts unless specifically prompted by their doctor.
"They don't see it through the lens of a clinical and potentially treatable addressable health condition," Moutier said.
There are effective treatments out there
The mainstays of treatment for depression are evidence-based therapy techniques and, for some, medication. But research shows that some psychotherapy and counseling approaches on their own can be just as effective as medication, Raue said. "That's really great news because people have all sorts of preferences."
In particular, one form of cognitive-behavioral therapy called behavioral activation is helpful in older adults. This approach focuses on the connection between behaviors and feelings, as well as engaging in activities that are meaningful for each individual.
If formal counseling doesn't feel right, there are other options that can help build connections and reduce the stigma of talking about — and seeking help for — mental health issues among older adults. That might include peer support groups or emerging alternatives, like the Do More, Feel Better program Raue is developing based on a simplified version of behavioral activation. "It's helping depressed older adults gradually re-engage in activities that they find meaningful, important and rewarding," he explained.
How to start the conversation
There are many myths about depression out there, Raue said, many of which contribute to the stigma that makes it harder for people — especially older adults — to seek help. For instance, depression is not a normal part of getting older, and you are never too old to get mental health care.
Also, keep in mind that depression is not a character flaw or weakness. “You have to recognize this is a medical illness,” Varma said. “Nobody’s doing this to themselves. People do not choose to be unhappy.”
If an older adult in your life is showing signs that they may be depressed, you can reach out.
- Start by showing empathetic concern and willingness to hear what your loved one may be going through, Raue suggested. Varma recommended starting with an open-ended question (simply, "How are you really doing?") to get things going. Moutier also suggested asking smaller questions about what's going on in their life, like about how well they're sleeping or if they're still in touch with their old group of friends. "So many times we don't want to get involved. We're afraid of interfering or being too nosy," Varma said. "So we don't ask a person about their truth." But asking those questions and actively listening to the answers is the best thing you can do.
- Remind them that their doctor wants to hear about their changes in mental health and emotional well-being. "You might be used to just telling your doctor about physical issues, but it's OK to tell them about this," Raue said.
- Don't assume that someone is doing fine just because they have a full calendar of things to look forward to. It's important not to make assumptions about people's lives based on their circumstances, Moutier said. "You have to realize that when somebody is suffering with a mental health condition, it lives in their brain; it distorts your thinking and your brain lies to you," she explained. "So though you might have a caring family, success, wealth, fame, whatever — in the throes of a depression or a mental health condition, it doesn't sync up."
- Offer to go to the doctor's appointment with them as support and, if requested, to offer your observations and concerns, Moutier said. If your loved one is in therapy or taking medication, Varma suggested continuing to ask how it's going and if you can help.
- Know that your loved one may not open up the first time you try to have the conversation with them — and that's OK, Moutier said. "You can be patient and gracious and not push it unless there's a real urgent reason to," she explained. By letting them know you're always there to listen without judgment, they may come to you later when they're ready.
The most important thing to remember is that everyone has a role to play in supporting the mental health of the people in our lives," Moutier said. You don't need to go through special training, all you need to do is show up and show interest in others' lives, she said.