Living with Late-Life Depression: What You Need to Know and How to Help

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 Depression in older adults is a complex and often underestimated medical and social issue that significantly affects the quality of life for both patients and their loved ones. Recognizing it can be difficult due to its atypical symptoms and the frequent overlap with physical and cognitive conditions commonly associated with aging. Modern scientific literature emphasizes the need for a multidisciplinary and individualized approach to diagnosing, treating, and caring for those suffering from late-life depression.

In the expert insights and quotes below—supported by the research article "Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management" (Devita et al., 2022)—you’ll find key information and guidance useful for patients and their families. Each quote is accompanied by a question or a brief explanatory note to help guide your understanding of the topic.

Expert Insights

1. How does depression manifest in older adults, and why is it often overlooked?

“Late-life depression (LLD) is characterized by an atypical cluster of symptoms, i.e., somatic symptoms which are predominant compared to mood symptoms, so it is important to be aware of this particular clinical presentation in order to not underestimate LLD.”

“...the diagnosis of depression is challenging in elderly people, since it often presents with multifaceted and more somatic symptoms compared to adults, thus resembling a ‘real’ medical organic disease.”

Why this matters: Patients and their families need to know that depression in older adults doesn't always look like "sadness"—it often presents as vague aches, fatigue, and changes in sleep or appetite.

2. What are the risk and protective factors for late-life depression?

“The literature has shown that suffering from a chronic disorder or cognitive impairment, having a weak social, emotional and supportive network, living isolated, taking care of relatives with chronic disease, losing a partner, can facilitate the rising of depressive symptoms... On the other hand, having a high level of self-esteem, resilience and sense of control, keeping a healthy lifestyle and having a medium/high level of cognitive reserve represent protective factors for the rising of depression in elderly age.”

What to ask your doctor: “What factors in my or my loved one’s life might increase the risk? What can we do to reduce them?”

3. Why is depression often mistaken for dementia or other conditions?

“There is a substantial overlapping in the clinical presentation of late-life depression and early-stage dementia: a subjective perception of memory loss, as well as psychomotor retardation and a lack of motivation in answering at cognitive tests are typically observed in depressed older adults, and can be interpreted as signs of dementia.”

Practical question: “How does the doctor distinguish between depression and early-stage dementia?”

4. What are the most effective treatment approaches, and how is therapy chosen?

“The most effective approach is the biopsychosocial one, combining pharmacotherapy, psychotherapy and an array of lifestyle and social environment’s personalized modifications... The second-generation antidepressants, i.e., Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Norepinephrine Reuptake Inhibitors (SNRIs), are considered the first-line treatment options for depression in the elderly, because of their efficacy, tolerability and safety profile... As for younger adults, also for older people psychotherapeutic approaches are to be encouraged, even in the presence of cognitive decline.”

Helpful to ask: “What are the possible side effects, and what non-medication therapies are available for older adults?”

5. What role do family and multidisciplinary teams play in recognizing and treating depression?

“Moreover, caregivers and families can be helpful, since they may provide information about the patient’s mood, behavior and general functioning... a multidimensional assessment should always be provided, in order to take into account all the aspects discussed above, such as risk and protective factors, medical and psychological history, social context and recent life events. Moreover, when appropriate, specialists should choose a multidisciplinary approach, referring patients to other professionals that can have a role in the differential diagnosis or in identifying the most appropriate therapeutic option.”

Practical question: “How can our family help support diagnosis and treatment?”

Q&A

1. Can depression in older adults be cured, or is it an inevitable part of aging? 

Answer: Depression in older adults is not a normal or unavoidable part of aging. It is a common but treatable condition. The article emphasizes that depression often goes undiagnosed or untreated due to the mistaken belief that sadness and apathy are natural in old age. In fact, depression in older people causes suffering, reduces quality of life, and increases the risk of mortality and disability. Most cases can be effectively treated—especially if recognized early.

2. What are the most typical physical symptoms of depression in older adults, and how can I tell them apart from other illnesses?

Answer: In older adults, depression often shows up through physical (somatic) symptoms like loss of appetite and weight, insomnia, persistent fatigue, aches and pains, slowed movements, and low energy. These symptoms are often mistaken for common signs of aging or other health conditions (such as diabetes, heart disease, etc.). That’s why it’s important to tell your doctor about any changes in sleep, appetite, energy, or focus—especially if they are accompanied by a loss of interest in life or social withdrawal.

3. How is the best diagnostic method for depression determined in my case? 

Answer: The article stresses that there is no one-size-fits-all method for diagnosing depression. In older adults, a combination of tools is often used: self-report questionnaires, physician interviews, input from loved ones, and observation. If you have visual impairment, lower education levels, or memory issues, some tests can be done orally or with larger print. When cognitive impairment is suspected, cognitive tests and insights from close contacts are also helpful. The most effective method is the so-called multidimensional approach that combines multiple sources of information.

4. What should I expect during treatment—how long does it last, and how is progress monitored? 

Answer: Treating depression in older adults often takes longer and requires patience. It’s important to track progress over time—reassessments should be done when treatment begins and again after 6–9 months. If there is no improvement, the treatment plan or diagnosis may need to be reevaluated. This means the doctor should monitor not only mental but also physical health, watch for side effects of medications, and make changes if necessary. Regular follow-up is especially important if the person has other chronic illnesses or cognitive impairments.

5. What should I do if I notice worsening symptoms or no improvement despite treatment? 

Answer: If no improvement is seen after a certain period (for example, a few months) or symptoms worsen, it’s essential to inform the treating physician. The symptoms could be due to another illness or interactions between multiple medications (many older adults take several drugs at once). Sometimes depression may be a sign of early dementia or another medical condition. A reassessment may be needed, including lab tests, imaging, and consultations with specialists (psychiatrist, neurologist, geriatrician).

Conclusion 

Depression in older adults requires a careful, individualized, and multidisciplinary approach. It should not be seen as a natural part of aging but as a condition that can be effectively treated. Being informed about key topics—such as symptoms, diagnosis, and available help—is essential for timely recognition and effective management. The recommendations and facts presented in this article are entirely based on the scientific review by the team at the University of Padua and are intended to support patients and their families in their pursuit of better health, self-confidence, and quality of life.

Source Devita, M., De Salvo, R., Ravelli, A., De Rui, M., Coin, A., Sergi, G., & Mapelli, D. (2022). Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management. Neuropsychiatric Disease and Treatment, 18, 2867–2880. https://doi.org/10.2147/NDT.S347356