How Do I Recognize Depression and Anxiety in My Aging Parents?
What to Watch For — Before You Ever Get to What to Do About It
My wife and I have spent a lot of years paying close attention to our parents: watching how they move, what they eat, whether they're sleeping, and their health, among other signs. What took us both longer to learn was how to watch for what's happening in their minds. Depression and anxiety in older adults is rarely easy to spot. They hide behind phrases like "I'm just tired" or "I'm fine, just getting old," and it is entirely possible to be a devoted, attentive caregiver and still miss these signs for months.
In this article, I’m not going to talk about treatment. I am not a physician. Instead, I will share the narrower, harder-to-teach skill that has to come first: noticing.
Why Aging Makes This So Easy to Miss
As we get older, our life comes with a lot of loss, often stacked one on top of another. The loss of a spouse or a close friend, the loss of mobility or the ability to drive, or the sharpness of memory. The loss of a role we once played, whether that was a career, a house, or simply being the person other people leaned on. Any one of these losses can trigger grief or isolation on its own. Several of them landing in the same stretch of years can be enough to bring on real depression or anxiety, not just a “rough patch.” I’ve witnessed this firsthand with my relatives and my spouse. Honestly, at a certain age, you’re no longer experiencing a “rough patch” as much as a new normal.
Chronic illness adds another layer. When a parent is managing a condition that limits what they can do for themselves, it's common for that physical burden to manifest into feelings of helplessness, uselessness, or guilt about being "a burden" to the people who love them. None of this may be readily apparent. It may creep up in the easy-to-explain-away changes you are observing.
The Signs Worth Paying Attention To
Older adults are far more likely to describe what they're feeling in physical terms than emotional ones. A parent who is depressed rarely says "I think I'm depressed." They're more likely to say they're tired, that their stomach hasn't been right, that they don't have the energy they used to, or they just aren’t in the mood to do much. That's part of what makes this so easy to miss, and part of why it's worth learning to read between the lines.
You can start by watching whether they are pulling away from people and social activities that used to matter to them: skipping the card game, letting calls from friends go unanswered, losing interest in a hobby that used to fill their free time, having friends over. Watch for changes in appetite or sleep, in either direction, too much or too little of either. Watch for a general slowing down that doesn't seem to have a diagnosable physical cause. And watch for how they talk about themselves: expressions of hopelessness, of feeling like a burden, of wondering what the point of getting up is, of sadness or regrets. Watch for phrases like, “never mind, just forget about it.” Ordinary sadness tends to lift. These signs, left alone, tend not to.
Anxiety often accompanies depression in older adults, and it can look like a level of worry, restlessness, or fear about "what's coming next" that seems out of proportion to what's actually happening. Some of that worry is completely rational. Aging really does bring a string of unknowns: will I lose another friend, will I be able to take care of myself, will I become a burden? But when that worry starts to dominate every day, or shows up as physical tension, irritability, or trouble sleeping, it's worth paying attention to as its own thing, separate from whatever is causing it.
The Blind Spot Most Families Don't Know They Have
For any number of reasons, when it comes to adult children checking on their aging parents, many seem to assume that the parents’ doctors would know if something very serious was going on. Geriatricians (doctors who treat elderly people) include a few very short mental health questions in physicals of their older patients. These doctors know depression is extremely common in the geriatric population, but that most patients will not report symptoms of it unless asked. Even then, there is no guarantee the patient will answer honestly. One common way to screen for depression is with a two-question tool in which patients are asked if they have experienced a down or depressed mood and/or if they have lost interest in activities that they used to enjoy. A simple yes to either question prompts further discussion (or it should).
Unfortunately, researchers have found wide variations among the doctors who do see patients with serious chronic illnesses, but tend not to screen for depression in their older patients. As a caregiver, you should not assume that your parent’s doctor is automatically screening for depression. Even if your parent is seeing a doctor regularly as part of Medicare’s Annual Wellness Visit (AWV), it is still wise to ask the physician whether he or she has been screening for depression or for anxiety recently. You can even request such a screening.
Chronic illnesses can create a sense of burden and helplessness that can precipitate depression. Most profoundly, the diminishing ability to function independently can add to feelings of loneliness, uselessness, and anxiety... The loss of a spouse or close friend, a common occurrence in later life, can trigger grief and isolation, which can also lead to depression and anxiety. It is essential to recognize these risk factors and behaviors to implement appropriate interventions. — Chapter 3, Survival Guide to Caring for Aging Parents
A Final Word
I want to reiterate that I am not a medical professional and this is not intended to be used as a diagnostic tool. All I am suggesting is that you take a close look at your parent who says they are fine. Most of us know how to look for depression and anxiety in younger people, but few of us know how to recognize it in an older person (or even in ourselves). This article is not about what to do after you recognize that your parent may be suffering from depression or anxiety. It is only intended to help you recognize the signs and symptoms of depression and anxiety in your aging parent before they worsen.