The Medical Minute: Older Americans and mental health

May 28, 2003

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

Aging means adapting to many changes. Muscle strength and endurance is diminished, susceptibility to infection is greater. Our bodies' systems do not recover from illness and injury as quickly. Metabolism slows, sometimes leading to increased weight. Vision becomes less sharp and sometimes hearing is reduced.

However, the effects of aging are more than just physical. Memory often suffers with advanced age and as family and friends pass away many older Americans feel more alone. These feelings of depression and confusion are too often wrongly considered a normal part of the aging process. It's one reason why family and friends play a crucial role in helping to identify symptoms and get older loved ones the early help they may need.

Depression is present in 20 percent of older Americans. One in 10 people over 65 and as many as half of those over 85 have Alzheimer's disease and other forms of dementia. Suicide rates for people over 65 are one and one-half that of younger people and for men over 85, five times the national average. A significant number in these groups have subclinical depression.

Symptoms of depression include: sadness for more than two weeks, difficulty sleeping or concentrating, withdrawing from regular social activities, excessive worry, feelings of worthlessness, large weight changes and thoughts of suicide. Sometimes these symptoms have been present for so long, people don't seek help mistaking them for normal personality traits.

Dementia's early symptoms include: difficulty with new memories but preservation of older ones, confusion, trouble with common tasks and solving simple problems. In early dementia, a person may remember minute details about events from the past but be unable to remember what they have planned for next week. They may go to the store and forget how to get home.

Although many people recognize when these symptoms exist, too often they are reluctant to report them, fearing loss of independence or from a sense that mental illness is shameful. Unfortunately, even the federal government does not appear to take these problems as seriously as other ailments. Medicare normally pays 80 percent of the cost of treatment for physical problems, but pays only half the cost of diagnosis and treatment of mental disorders.

There are effective treatments for depression and dementia. Since some medical problems can cause symptoms common to depression and dementia, and because depression and dementia can overlap, the first step is to see a physician. A general physical and neurologic exam is usually done.

The doctor will examine memory, intellect and judgment through a series of questions. Current medications are reviewed to look for those that can cause depression or confusion as side effects, and to avoid drug interactions if treatment for depression or dementia has begun. Some blood tests for thyroid disease, anemia, vitamin B12 deficiency and infection are sometimes done. Occasionally a brain CT or MRI will be performed to evaluate for evidence of prior strokes which can increase the chance of depression and dementia.

Research into prevention of depression and dementia is ongoing. Family support and a strong social network plus general good health help reduce the risk of depression. There is also increasing evidence that the same things that prevent atherosclerosis can reduce the risk of dementia although there is not yet consensus on this among scientists and clinicians.

If depression is diagnosed, treatment can effectively regulate the problem. Current medications are safe and well tolerated. While dementia can not currently be cured, it is important to begin treatment as soon as possible since it can be slowed or arrested in many cases. It is important for families to recognize the possibility of depression or dementia and to intervene, since those with the problem may be reluctant to seek help themselves or may not be capable as a result of their illness.

For more information on depression, visit and on mental health in older Americans, visit

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Last Updated March 19, 2009