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The Medical Minute: How can I help my aging parent with depression?

Maria R. says her mother has never had an easy life. “She’s dealt with depression for a long time,” says Maria, who asked not to use her real name.

But a few years ago, things began to escalate. The 81-year-old began pacing constantly. She lost nearly 25 pounds and stopped enjoying the opera she once loved. Panic attacks began waking her in the middle of the night.

Depression can intensify with age, especially after significant loss, medical illness or increasing isolation. “Depression is not a normal part of aging,” says Dr. Badr Ratnakaran, a geriatric psychiatrist at Penn State Health Psychiatry and Behavioral Health. “Sadness can happen. Grief can happen. But when it begins affecting sleep, appetite, concentration and daily functioning, that’s when we worry about clinical depression.”

Is it depression – or something else?

Older adults face unique stressors. Retirement, the death of a spouse, chronic illness and financial concerns can all contribute to declining elderly mental health. Social isolation among homebound seniors is a major risk factor. In fact, more than 40% of homebound older adults experience psychiatric disorders, most commonly depression.

But depression in seniors doesn’t always look like sadness.

“It can show up as physical complaints,” Ratnakaran explains. “Fatigue, body aches, stomach issues, sleep disturbances. Sometimes patients don’t describe feeling depressed at all.”

Maria’s mother underwent multiple gastrointestinal tests after complaining of unusual sensations in her body. Everything came back normal.

“It was this vicious cycle,” Maria says. “Was it irritable bowel syndrome? Was it anxiety? Was it early dementia?”

That confusion is common. Depression and dementia symptoms can overlap. Both may involve forgetfulness, slowed thinking or withdrawal. In some cases, depression may even be an early sign of cognitive decline.

“We treat the depression first,” Ratnakaran says. “If memory problems continue to worsen despite treatment, then we evaluate for dementia or cognitive impairment.”

Signs of depression

Sadness and grief typically ease over time. Depression lingers — often for months — and interferes with daily life. Warning signs include:

  • Loss of interest in activities once enjoyed
  • Significant weight loss or gain
  • Insomnia or sleeping too much
  • Restlessness or slowed movement
  • Persistent hopelessness or guilt
  • Withdrawal from friends and family
  • Expressions of wanting to die

“If there is talk of a specific plan for self‑harm, that’s an emergency,” Ratnakaran says. “Older adults have higher rates of death by suicide. We take that very seriously.”

 If you or someone you know needs support now, call or text the Suicide & Crisis Lifeline: 988.

How to start the conversation

Talking to a parent about mental health can feel awkward, especially if they come from a culture or generation that doesn’t openly discuss emotions. “Patience is everything,” Maria says. “You can’t just say, ‘Cheer up.’ Their reality is not yours.”

Ratnakaran agrees. Avoid blaming or dismissing language. Instead, lead with concern: I’ve noticed you don’t seem like yourself lately. I’m worried about you.

It also helps to normalize treatment. Depression isn’t a weakness – it’s a brain‑based medical condition. For resistant parents, it may take time to come around. “We revisit the idea of therapy or medication gently,” Ratnakaran says. “It may take multiple visits before someone feels ready.”

Therapy, medication – and purpose

If your elderly relative has depression symptoms, call their primary care doctor for guidance. For mild depression, therapy may be the first step. Medicare and many insurance plans cover counseling, including cognitive behavioral therapy. When medication is needed, special care is required, as many older adults already take multiple prescriptions.

“In geriatrics, we follow one rule: start low and go slow,” Ratnakaran says. “We carefully consider kidney and liver function and possible drug interactions.” In Maria’s mother’s case, a long‑term anxiety medication required gradual adjustment under his supervision. Stabilizing her sleep and restoring her weight were early priorities.

But treatment isn’t only clinical. “One of the biggest contributors to depression in older adults is isolation,” Ratnakaran says. Encouraging small, meaningful activities can help break the cycle and restore a sense of purpose.

Under Ratnakaran’s care, Maria has seen small victories with her mother. “She’s listening to opera again,” she says. “She’s gaining weight. She sleeps through the night sometimes. It’s progress.”

Find a Penn State Health psychiatrist near you.

Caring for yourself

Caregiver burnout is real. Maria balances a full‑time job, adult children and her own marriage. “There’s guilt,” she says. “If I’m relaxing, I think, ‘My poor mom is alone.’”

Ratnakaran reminds caregivers that they cannot pour from an empty cup. “Depression isn’t your parent’s fault,” he says. “But you must protect your own mental health.” That means setting boundaries, sharing responsibilities with siblings and accepting help. And remember that improvement may be gradual.

“Your parent may not be who they were five years ago,” Maria says. “Part of it is accepting where they are now.”

Elderly depression can feel overwhelming. But with the right support — medical care, social connection and patience — healing is possible. And sometimes, progress begins with a simple question: Are you OK?

Learn about Behavioral Health OnDemand.

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

 

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