There is a widespread assumption, held by families and by older adults themselves and sometimes by clinicians, that becoming low in later life is simply what happens. Losses accumulate, the body declines, friends die, and sadness is treated as the reasonable arithmetic of getting old.
Sadness in response to loss is indeed reasonable. Depression is a different thing, it is not a normal feature of aging, and it responds to treatment at any age.
Depression in older adults frequently does not look like depression in a thirty-year-old.
It often presents physically. Aches, fatigue, digestive complaints, poor sleep and appetite loss are common, and these get investigated as medical problems, sometimes for a long time, without anyone asking about mood.
Older adults are also less likely to report feeling sad, partly generational and partly because the experience itself is often less sadness than emptiness, irritability, or a loss of interest in everything.
And cognitive symptoms muddy the picture. Depression impairs concentration and memory, which can look very much like early dementia. This is common enough to have a name, and it matters because depression is treatable and being written off as cognitive decline is not a small mistake. It cuts the other way too: depression frequently accompanies genuine cognitive decline, and treating it improves quality of life either way.
Withdrawal from activities and people that used to matter. Neglecting self-care, medication or meals. Statements about being a burden, or that people would manage better without them. Persistent hopelessness about the future rather than about a specific situation. Increased alcohol use, which is markedly under-recognised in this age group. Unexplained physical decline with no medical cause found.
On the burden statements in particular: these are frequently treated by families as self-pity to be argued away. They are a recognised risk indicator and warrant a direct, calm conversation rather than reassurance.
Older men have among the highest suicide rates of any demographic group in Canada, and this is poorly known outside clinical circles. Contributing factors include social isolation, loss of role after retirement, bereavement, chronic pain, and a generational reluctance to discuss emotional difficulty.
It is worth saying plainly because families often do not consider the possibility at all for a parent or grandparent.
Often something identifiable and addressable. Bereavement, which may be multiple and recent. Loss of independence, particularly giving up driving, which for many people is the single sharpest loss of autonomy they experience. Chronic pain. Social isolation following a move into supported housing or after a spouse's death. Medication side effects, which are worth reviewing with a physician. Untreated hearing loss, which drives isolation more than most people appreciate.
Several of these have practical solutions sitting alongside the therapeutic ones.
There is a persistent belief, held by some older adults themselves, that counselling is for the young or that it is too late to change anything. The evidence does not support this. Older adults respond to psychological treatment at rates comparable to younger people.
Practical adaptations help: sessions in the home or online where mobility or transport is an issue, attention to hearing, and a pace that suits the person.
Where bereavement is central, grief counselling may be the more appropriate starting point.
You do not need to diagnose anything. Ask directly and without alarm. Mention what you have noticed rather than what you have concluded. Offer to help arrange an appointment, including with a physician to rule out physical causes and review medications, and offer to go along.
Expect some resistance. It usually softens.
Supporting Wellness provides counselling for older adults in Calgary, Red Deer and Cold Lake. Contact us to talk about options, including for a parent who is not yet sure they want to.
The Alberta Mental Health Helpline is 1-877-303-2642, and the Suicide Crisis Helpline is 988, both 24/7.
Related reading: Grief has no timeline, CNS Vital Signs cognitive testing and Depression counselling.
