When Dr. Maxine Lewis visits patients in Hamilton, Ont., she pays close attention to their home’s cleanliness or the upkeep of their yard.
Stacks of dirty dishes or unkept lawns may be signs someone is struggling with depression.
“When you see someone in their own home, the person is less able to hide the signs that they’re not doing so well,” said Lewis, who is the city-wide chief of adult psychiatry for Hamilton. Geriatric psychiatrists, like her, are some of the only psychiatrists who make home visits.
Recognizing the signs of mental illness among seniors is important. A recent Statistics Canada report indicates a growing number of Canadian seniors have mood disorders, including depression and bipolar disorder. Mental health professionals point to increased physical ailments, but particularly increased social isolation, as causes.
Many people think it is normal for an older adult to feel sad, says Lewis, so they may not recognize a mood disorder.
“Just because you get older doesn’t mean that you should be depressed,” she said. “It’s not a normal part of aging.”
‘More susceptible’
In 2023, 8.5 per cent of adults over 65 reported a diagnosed mood disorder, according to the Statistics Canada report. That was up from six per cent in 2015.
Dr. Dallas Seitz, chief of geriatric psychiatry at the Centre for Addiction and Mental Health (CAMH), says other countries report similar rates of mood disorders among seniors. But Canadian data on the topic has been lacking.
“There’s not a lot of data out there about [the] epidemiology of mental health disorders in older adults,” he said.
While seniors are less likely to report mood disorders than younger generations, Seitz says their prevalence among seniors is still a concern.
“Older adults are more susceptible than younger adults to the negative impacts of mood disorders, including medical comorbidities, cognitive decline, higher suicide risk, and increased mortality,” the report says.
Physical decline
Chronic health conditions tend to increase as people age, and with that comes a greater likelihood of developing a mood disorder.
“We know that you have an increased risk of depression if you have medical comorbidities, and we also know that depression itself can be a risk factor for medical issues,” said Lewis.
Depression can increase a person’s risk of developing heart disease or diabetes, for example.
“Someone who’s depressed isn’t necessarily looking after themselves as well,” she said.
Michelle Stockwell, a certified nurse psychotherapist in Dundas, Ont., always has new psychotherapy patients see their family doctor and get bloodwork done before beginning psychotherapy. She wants to have a good understanding of patients’ physical health and how that might impact their mental health.
She also asks them about how they can improve their physical health, through things like regular exercise.
But sometimes another person’s health challenges can negatively impact a seniors’ mental health, she says.
Stockwell often sees people who are part of what she calls “the senior sandwich generation.” These seniors may be helping care for their spouse or another senior, or younger family members, like children and grandchildren. This can be a risk factor for developing a mood disorder, she says.
Many of Stockwell’s patients are couples, where one spouse has been diagnosed with a chronic condition, like dementia. The caregiving spouse often comes to her looking for support. “In order to help [their spouse], they’re trying to get some help and support themselves,” she said.
Geriatric psychiatrists do not just work with the senior who has mood disorder. They often also work with their relatives, says Seitz.
“If caregivers become physically or psychologically unwell, it really undermines their ability to support an older adult,” he said.
Prioritize socializing
Mental health professionals point to the loss of social connections as a key reason for seniors developing mood disorders.
“So many seniors find themselves living in isolation, and that isolation is very detrimental to your mental health,” said Ken Porter, national projects director with the Mood Disorders Society of Canada.
“We’re social beings, and we need to be interacting with other humans. When we spend too much time alone, it’s going to result in some type of mental health condition, most likely a mood disorder.”
According to the Statistics Canada report, seniors who lived alone were more likely to have mood disorders.
One of the difficulties of depression is that it makes people want to self-isolate, says Porter, who has lived with anxiety and depression for much of his life. “It’s a contradiction, where the thing that can help is the thing you don’t want to do.”
And seniors are more likely to be socially isolated, whether that’s because of leaving the workforce, living far from family or having limited mobility.
This is why many mental health professionals ask patients about their social connections.
When Lewis does assessments, she “takes a very thorough history of [patients’] social and demographic information, because we know how very important it is if people feel isolated, if they’re lonely.”
Stockwell agrees. She encourages her psychotherapy clients to prioritize social activities and for families to find shared activities, even if it is having a family subscription to a newspaper so they have something in common to discuss.
She also encourages them to find ways to grow stronger physically and emotionally, and to focus on what they have, not just what they have lost.
“I don’t think it’s necessarily a given that we’re going to have more anxiety and depression,” she said. “I think we haven’t been good at looking for it previously in the elderly, specifically with a lens in terms of what can be done about it.”
Re senior depression.
Many transactional systems used by seniors have moved to totally automated systems demanding passwords and rigid conformance to offer complex procedures with very
Limited access to live human dialogue Many seniors cannot cope with this change leaving them open to financial and legal problems and a sense of isolation/ despair and depression.
The requirement for service access via automated online systems requiring passwords and 2step verification effectively denies many seniors access to social, medical, and financial services that previously seniors could access via interpersonal telephone or in person contact.
The poverty and government neglect compounds the isolation.
I am reiterating previous comments as they are spot on and my own experience with my disabled senior brother trying to manage. I myself am a senior and live in shared accommodations, my oldest son struggling with diabetes and homelessness, Where to go and where to get real help is my constant search.
As a recently retired Family Doctor and a Senior, I concur that requirement for service access via automated online systems requiring passwords and 2step verification effectively denies many seniors access to social, medical, and financial services that previously seniors could access via interpersonal telephone or in person contact.
I notice this article carefully avoids mentioning poverty and government neglect as a cause of mood disorders among seniors. Low income seniors don’t even get enough money to afford to eat every day. Imagine having to worry every time you spend a dollar, or being forced to choose between housing expenses and groceries. Imagine worrying every day that you might end up on the streets homeless. Compound that with the fear of getting sick and being offered MAID instead of care. No wonder so many seniors are having mental health issues.