Still Blue After All These Years: Chronic Depression in Older Adults

Welcome back, and thanks for joining us for part two of our series “Why So Blue? A Look at Depression as a Chronic Illness.” Our last post explained different types of depression and how primary care clinics can support patients with chronic depression. This part will address the often-overlooked issue of depression in older adults. The Centers for Disease Control and Prevention (CDC) reported, in 2021, 4% of adults aged 70 and over experienced depression. That number is likely higher now, and it means assisted living communities, nursing homes, and caregivers for older adults need to consider therapy appointments and self-management techniques, psychiatric medication and polypharmacy, and support for managing episodic and chronic depression. While many people expect older adults to be sad, Mia Croyle, MA, Behavioral Health Project Specialist in the Health Transformation department at MetaStar, emphasized that “depression should not be considered an inevitability with aging.” 

 From Golden Girls to Blues Brothers: Depression Risk Has Entered the Building 

Growing older can be considered one of life’s most challenging transitions, accompanied by loss, disability, and changes—both wanted and forced. Risk factors for depression at any age apply to older adults, but older adults also face unique experiences that make them more at risk of developing depression. Some of these factors are:

Loss 

Loss can manifest in various ways, such as leaving a cherished home, not being able to drive or do other activities that were previously possible, losing income, losing loved ones to death or illness, loss of purpose, or facing illness or disability. Social isolation is especially worrisome for older adults who may find it more challenging to leave their homes. 

Change  

Retirement, taking on the role of caregiver for a loved one, and relocating from a familiar home or community may be wanted or necessary shifts, but they can stir depression alongside excitement or acceptance. Facing declining income can be a dilemma for older adults, as retirement income is, on average, less than half of what a full-time worker earns in the United States (U.S. Bureau of Labor Statistics Q2 2025, Kiplinger, 2025). 

Health 

Older adults often encounter more health challenges, many of which involve physical changes and new limitations. Dealing with disability, loss of function, new medical diagnoses, and interacting with the United States healthcare system can be tough and, frankly, frightening. Some physical health diagnoses can also increase the chance of developing depression, while depression can increase the risk of getting certain other conditions. Additionally, older women are twice as likely to experience depression compared to older men due to declining estrogen levels.

Two other important factors that can contribute to depressive symptoms in older adults are discrimination and elder abuse. Older adults often experience ageism, such as being overlooked for a job or promotion or being spoken to in a condescending manner or as if they are not smart. These experiences can heighten feelings of loss and change, and they can inflame current depression symptoms or create new ones. Elder abuse can also cause older adults to feel worthless, hopeless, and helpless. As in many abuse situations, the victim can experience a host of behavioral health problems, including depression.

Code Blues: A Crash Course on Depression Symptoms in Older Adults 

Symptoms of depression in older adults are similar to those in younger adults, with a few specific differences.

What to watch for in older adults:

• Persistent aches or pains in any part of the body that have no apparent cause and do not improve even with treatment 
• New or increasing irritability, restlessness, frustration, or agitation 
• Difficulty concentrating, remembering, or making decisions 
• Decreased energy or increased fatigue   
• Eating more or less than usual or unintended weight gain or loss 
• Moving or talking more slowly than usual 
• Neglecting personal care  
• Difficulty sleeping, waking too early in the morning, or oversleeping 
• Increased use of alcohol or drugs, or engagement in high-risk activities 
• Obsession with death or suicide, or suicide attempts  

Tangled Up in Blues: A Good Treatment Can Be Hard to Find 

Depression in older adults often goes unnoticed and untreated for many reasons. The CDC cites logistical reasons such as cost, trouble with transportation, language differences, limited mental health care services, and lack of specialists in mental health care for aging adults. Many older adults are isolated, so it’s less likely someone will notice any concerning symptoms. 

The National Institute on Aging at the National Institutes of Health (NIH) and Croyle both add other reasons depression is overlooked in older adults: symptoms can overlap with other mental and physical health conditions and some symptoms, like fatigue and lack of energy, are dismissed as a part of getting older. Additionally, older adults raised in different cultures and different eras may express depression differently, often due to feeling stigmatized or being unaware they could benefit from treatment. However, “the best thing to do is to see a healthcare provider for an evaluation,” said Croyle. A healthcare provider can help untangle overlapping symptoms and provide treatments and resources for many conditions, including depression.

Teach Old Blues New Tricks: Become A Depression Self-Management Superhero 

There are plenty of ways for older adults to tackle depression and its risk factors. However, “activities may not look the same as they did before, or they might involve some creative solutions,” Croyle counseled. Medical providers, community organizations, and family and friends can help modify activities or find new ways to participate or help facilitate rides, technology, in-home help, and more, ensuring older adults don’t feel like they must do it all alone. 

Some ways to help self-manage depression, specifically for older adults with new or chronic depression are:

• Make and keep all doctor appointments. 
• Take all medications as prescribed and have a medical provider review any new medications or supplements. 
• Get a good night’s sleep—aim for seven to nine hours per night—and reach out for help with any sleep troubles.
• Engage in doctor-approved and pain-free movement. Even little movements can be beneficial. 
• Eat a variety of tasty, quality foods that fill you up and provide essential nutrients. 
• Practice breathing techniques, meditation, mindfulness, self-compassion, and gratitude, as these techniques have demonstrated a reduction in depression symptoms. 
• Stay in touch with family and friends. Consider other ways to connect when in-person visits aren’t possible. 
• Get outside, if you can, for fresh air and a change of scenery. 
• Continue to be social and participate in activities you enjoy. You may need some modifications or to participate differently. Family, friends, and caregivers can help brainstorm ideas. 
• Talk to a doctor or support person if you notice symptoms of depression. Asking for help is sometimes the bravest thing you can do. 

I’ve Got Friends in Blue Places: When They Just Want to Help 

For family, friends, and caregivers who are worried about a loved one showing new, worsening, or changing signs of depression, here are some ways you can help:

• Encourage them to seek help from a medical provider. 
• Offer to either set up an appointment for them or go with them to one.  
• Join them in activities they like doing. 
• Encourage them to join in on activities that involve being outdoors or a bit of movement. A change in scenery, a little movement, and some friendly interaction can make a big difference in the day for a person experiencing depression. 
• Listen for clues the person may be struggling. Refer to the symptom list above. 
• Don’t shy away from asking about suicide. As Croyle said, “some worry that asking about suicide may increase the risk, but there’s no proof of that.” Suicide rates for men 75 and older are ten times that of women in the same age group (CDC). “Asking about suicide can really help save lives,” Croyle added

Rhythm and Blues: The Soundtrack to an Improved Outlook 

Depression is an insidious condition that can make people feel despondent and worthless, often leading to hopelessness about the future. Croyle wants to counter that perspective: “No one—regardless of age—should suffer with symptoms of depression,” she stated. “Sometimes it takes effort to manage your depression, but your wellness is worth it.” 

The role of healthcare organizations in treating chronic behavioral health conditions like depression is constantly changing, aiming to deliver the best care at the lowest prices. MetaStar “has collaborated with several practices over the years, helping them improve their management of patients with chronic conditions,” Croyle explained.

Does your organization need help managing, monitoring, or treating chronic illnesses? If so, contact Emily Nelson, Vice President of Healthcare Transformation at MetaStar, today. From registries to quality reporting and all kinds of tools in between, MetaStar transforms those chronic illness questions into easy, affordable answers.

If you’re struggling, have thoughts of hurting yourself or others, or just need someone to talk to, please call or text 988 in the United States. Deaf/hard of hearing and chat options are available at https://988lifeline.org/. 

Starring… 

Mia has been with MetaStar for over seven years. She loves the variety her job gives her—there’s always something new to dig into. As part of MetaStar’s work with Superior Health Quality Alliance, Mia put on her superhero cape and helped fight stigma around substance use disorder through a series of podcasts.