Depression Often Goes Undiagnosed Among Older People

By 2030, one in every five Americans will be over the age of 65. The National Institutes of Health says depression among that age group is widespread, but often goes undiagnosed. As the Baby Boomers hit their golden years, that problem likely will grow. As part of KPCC's special coverage of mental health issues, Susan Valot examines depression in seniors. Dr. Sam Elsanadi is a geriatric psychiatrist who deals with depression in the elderly. Many of his patients at the UCI Medical Center's Geriatric Inpatient Psychiatry ward suffer from depression, sometimes along with other illnesses.

Susan Valot: Sixty-six-year-old Linda lives on a quiet San Fernando Valley street. Her house is filled with pictures of her late husband.

Linda: There's one over there, is him with me. There he has a beard, here he doesn't.

Valot: Linda's husband, the man who's happy and smiling in all those pictures, was a musician. But nearly a decade ago, that career ended.

Linda: He didn't decide to retire. The music business decided he should retire. The music business is a very young business. And as he got older, the calls were coming fewer and farther between.

Valot: Basically, Linda's husband was forced to retire at 66; "aged out" of the work he loved. She says he quickly fell into a depression.

Linda: He was his work. And when there was no work, he felt he had been put out to pasture. And it was just intolerable for him.

Valot: Linda's husband was usually a happy-go-lucky guy when he was working. He'd whistle around the house. He loved to cook. But she says when the work stopped coming...

Linda: His whole role in life suddenly changed to making me happy. You know, what did I want for dinner, and where did I want to go, and what did I want to do. And it was like, ugh! Back off! You know, it was almost too much.

But that's really all he had. He had nothing else. And it was tragic to see. I mean, he was like wasting away. He would make these wonderful dinners and then he wouldn't eat it.

Valot: Linda says her husband went to a psychiatrist, but the medications didn't bring him out of his depression. One day, she came home and found he'd taken his own life.

Most of Linda's closest friends don't know about her husband's suicide. She's worried about how they'd feel about him, or about her. That's also why she didn't want her last name in this story. Dr. Eleni Hailemariam is a geriatric psychiatrist with the Orange County Health Care Agency.

Dr. Eleni Hailemariam: Even now, even with younger adults, mental illness, there's a lot of stigma with mental illness. And it's more... felt more with older adults. There is– it's considered a sign of weakness if somebody admits they have depression. And more often than not, they may not even realize they have depression.

Valot: Even skilled doctors have trouble spotting it. Dr. Sam Elsanadi heads up the in-patient geriatric psychiatry program at UC Irvine Medical Center. He says depression among older people isn't just a matter of feeling sad, or changing eating and sleeping habits.

Dr. Sam Elsanadi: They usually exhibit, manifest, their depression in a different way, like by visiting the doctor more frequently, by utilizing more medications, more hospital visits, ER visits. And this is their way of expressing their frustration about their sadness. It doesn't show in a psychological way. It's more in a physical way.

Valot: Geriatric psychiatrist Eleni Hailemariam says depression among older people is often triggered by a big life change, like what Linda's husband faced.

Hailemariam: If they have had a loss recently; it could be retirement. That can be a big loss. It could be a death of a loved one. It could be their physical health deteriorating. That's another loss. It could be things like not being able to drive.

Valot: Dr. Hailemariam says forgetfulness is another hallmark. And Hailemariam says when you're older, you often deal with so many health issues that it's hard to sort out which symptoms are physical and which are signs of depression.

Hailemariam: It's still confused when people have other medical problems, like cardiac problems, Parkinson's disease. There can be an overlap of symptoms. And usually it's labeled as part of those illnesses, and it's not identified as a separate illness. And it's– so it's not addressed.

Valot: With Linda's husband, the depression was addressed, but the treatment failed. Linda fell into a depression of her own after his death. As part of her treatment, her psychiatrist suggested a suicide bereavement group.

Now she helps others through the "emotional debris" by leading some of those groups at the Didi Hirsch Community Mental Health Center in the San Fernando Valley. Doctors Hailemariam and Elsanadi say they're seeing more and more geriatric psychiatry patients, many for depression. Elsanadi's even had to turn some away.

Dr. Hailemariam says Orange County's in the process of developing a more efficient system of mental health care for older adults. She says geriatric psychiatrists aren't overwhelmed yet, but it's coming.