Keeping up the connection to family has been particularly difficult this year. With many holiday gatherings now relegated to Zoom or FaceTime, many seniors are more isolated than ever. Although video visits can pale in comparison to in-person celebrations, they can be a lifeline to the socially distanced seniors in your life. Seeing your loved ones, even just on screen, offers an important window of opportunity with which to gauge their mental health.
Pre-pandemic research suggests that loneliness and isolation are more harmful to physical and mental health than obesity. Isolation has been linked to negative health effects such as shorter life spans, heart problems and depression. More recently, almost half of survey respondents over 65 said that worry and stress about coronavirus has had a negative impact on their health, according to a Kaiser Family Foundation poll from July.
It’s a misconception that depression simply comes with old age, says psychiatrist Judith Feld, MD, MPH, distinguished life fellow of the American Psychiatric Association and national medical director of Ontrak. And although it’s common, depression can be particularly difficult to spot in this age group, for a variety of reasons, she says.
“First, know that this is a shared concern and challenge — recognizing depression in the elderly is often missed by medical professionals as well, because it shows up differently,” Feld says.
Doctors can be biased in their assessments of the elderly because they, too, might believe that depression is an expected and normal aspect getting older.
“We need to treat depression in the elderly as a mental health condition and not as a normal part of the aging process,” Feld says. In addition, she says, “Seniors might internalize their vulnerability amid ageist attitudes, which could really negatively affect their mental health. So we have a lot of influences going on that make this assessment not simple across the board.”
Here are Feld’s suggestions for spotting signs of depression in faraway senior family and friends as well as how to show concern, not condescension.
Have Regular Check Ins
Beefing up your call or Zoom meeting schedule can help seniors in your life during these socially distant times.
“Regular contact with senior loved ones takes out some of the uncertainty we’re all struggling with right now,” Feld says. “It gives them something to look forward to and to feel grounded with.”
Connecting over video or phone can lend more insights than texting or email, because you can glean much more about a person’s mental state hearing their voices, Feld adds.
Look for Patterns and Changes
During video sessions, take note of subtle things that might indicate depression, such as if a regular reader seems not to be reading anymore, or a loved one who used to call often is no longer doing so, or he or she isn’t returning your calls when they always did before.
Looking for those sorts of clues can be more helpful than simply asking, “Do you feel depressed?” Feld says. “They might not even know they’re depressed. Sometimes that self-awareness isn’t that intuitive.”
Even if seniors do feel kind of sad or empty, they might not say so if you ask them flat out, due to generational views about mental health problems and therapy. Older folks, particularly people over 85, tend to shy away from asking for help or might view therapy as something for the weak.
It’s more helpful to look for changes in behavior, such as whether they seem to not be enjoying things they used to enjoy, Feld says.
“If a senior usually really enjoys a call with a grandchild, for example, but that seems to have changed, maybe you need to ask more questions, such as ‘How can we be of help?’”
Be Caring, not Paternalistic
You can glean more from an open dialogue than you can if you talk in a way that makes older folks feel like they need to be taken care of, Feld says. If you’re checking in regularly, you can ask what they’ve been doing and about activities in a more organic way than asking them to list any changes to their medications, for example. You do want to know if there have been changes in their medications, however, because sometimes medication side effects can mimic symptoms of depression.
“Rather than outright asking about trips to the doctor, you can say, ‘Tell me what’s been going on in your life. What have you been doing?’” she says. Use that as a starting point, then you can inquire about medical visits and any changes to medications more casually.
Chat Without the Kids Around, Too
Seeing the grandkids is likely a mood booster for faraway senior family and friends, but work in some screen time without the kids, too. Older folks might not mention health problems or feeling depressed in front of younger kids because they don’t want to scare or worry them. They might open up more to just you.
“That’s great advice regardless of COVID,” Feld says. “It’s important to make time to listen to our parents and share with our parents as well” out of kids’ earshot.
Look for Background Clues
Of course you want to focus on your loved one’s face and what they’re saying while on a video call, but notice whether they appear to be washing their hair or look disheveled, Feld says. (That doesn’t just go for seniors, either: When hygiene diminishes, it can tell you a lot about how people are feeling, Feld notes.)
Take a look at their surroundings, too. Are beds unmade, or are dishes piling up? Are things not in place in the home of a parent who used to value orderliness?
“That’s a fantastic orange flag that can give good info about how things are going,” Feld says.
Make Sure Substances Aren’t Being Misused
It’s not easy, of course, as substance misuse is easy to hide at home in isolation. But be aware that COVID-related alcohol consumption isn’t just a Gen Z or millennial issue, Feld says. “It’s not something we often associate with seniors, but substance use disorder is a concern for them as well,” she says.
Look for Depression Symptoms Particular to Older Adults
Keep an eye out for common signs of depression, such as loss of appetite, reports of trouble sleeping and lethargy. When people are depressed, it can look like they’re merely tired, Feld says. And we might not think it’s surprising that a person over 70 years old on a bunch of different medications seems tired. It’s also common for people to mistake depression for signs of cognitive decline, Feld says. In that instance, once the depression is treated, cognitive problems might go away.
Complaints about pain is a sign of depression more common among the elderly, Feld notes.
“If you hear increasing complaints about pain problems, keep that in the back of your mind,” she says. “Pain receptors, or brain receptors that mediate a lot of our mood, are connected. So an increase in pain could signal depression.”
Pain is complicated and complex, and it can be debilitating and affect our quality of life, Feld says. It can make people feel helpless, which can exacerbate depression.
Determining if a loved one could be experiencing depression, when even mental health experts find it challenging, can feel overwhelming. But you do have a powerful weapon on your side to help: familiarity.
People experience depression differently, and a diagnosis is sometimes best determined by noticing changes in behavior. In other words, someone who might seem sad or quiet might simply be a sad and quiet person ordinarily and not depressed. You know what your parents are like so you can be a great help in assessing problems and keeping them healthy, even if you’re far away.
“Isolation is now considered a social determinant of health, and it can be particularly damaging to seniors who might be questioning, ‘What is my value right now?’” Feld says. “Biologically, we’re wired to connect to each other. We need to socialize to stay healthy.”