Mental health in older age

Why this is under-recognised

Depression in older people often looks different from depression in younger adults — and is widely missed by family, GPs, and the people themselves.

• The generation that's elderly today often grew up with strong stigma around mental illness
• Symptoms get attributed to "just getting old," dementia, or grief
• Physical symptoms (fatigue, pain, poor sleep) often dominate the presentation rather than overt sadness
• Older men in particular tend to under-report distress and over-rely on alcohol
• Many GPs are time-pressed and don't routinely screen for depression in older patients

Suicide rates in New Zealand for men aged 75+ are among the highest of any age group. The combination of widowhood, social isolation, declining health, financial worry, and access to means is dangerous and unsentimental.

What depression looks like in an older parent

• Loss of interest — stopping hobbies, not bothering with the garden, refusing invitations
• Sleep changes — early-morning waking is classic; or sleeping much more than usual
• Appetite and weight — loss of weight without medical reason
• Fatigue and slowed movement — everything is "too much effort"
• Hopelessness or guilt — "I'm a burden", "I should just go", "what's the point"
• Increased physical complaints with no clear medical cause
• Increased alcohol use — particularly in widowed men
• Tearfulness or irritability that's new for them
• Cognitive slowing that mimics early dementia (sometimes called "pseudodementia")

Anxiety and grief

Anxiety often co-occurs with depression in older people — health anxiety, fear of falling, fear of being a burden, fear of the future. Grief after the death of a spouse is normal and can last 1–2 years. Grief that becomes complicated (paralysing, unending, accompanied by suicidal thoughts) is treatable — see the GP.

What helps

Start with the GP

• Book a long appointment (most general appointments are too short)
• Ask specifically for a mental health assessment
• Bring a list of changes you've noticed — written down, with examples
• Older patients can be reluctant to disclose; you may need to come along (with their consent)
• The GP can prescribe antidepressants, refer to talking therapy, or refer to a psychogeriatrician for complex cases

Talking therapies

• Free or subsidised: many GPs can refer to short-course therapy via Health NZ; Te Whatu Ora primary mental health services include brief intervention for older adults
• Just a Thought — free online CBT courses funded by Health NZ: justathought.co.nz
• Private psychologists / counsellors — $150–$220/session; check whether they have experience with older clients
• Telehealth options — useful for housebound parents

Medication

• Antidepressants work in older adults — but take longer (often 6–8 weeks) and need careful dosing
• Side effects and interactions are more common with age — ask the GP or pharmacist about polypharmacy
• Don't stop antidepressants suddenly — discontinuation effects can be severe

Beyond medication

• Exercise — strongest non-drug intervention for mild-to-moderate depression. Even daily walking helps.
• Social contact — see loneliness and isolation
• Sunlight — particularly important in NZ winters at southern latitudes
• Treating co-existing conditions — pain, hearing loss, vision loss, sleep apnoea all worsen mood
• Reducing alcohol — alcohol is a depressant and interacts badly with many medications
• Pet ownership or pet visiting — well-evidenced for mood

For older men in particular

Suicide risk is highest in older men, especially after retirement, after the death of a partner, with chronic pain, with hearing loss, or following loss of independence (driving, home).

• Men's Sheds — practical, side-by-side activity rather than face-to-face conversation. Often more acceptable than therapy. menzshed.org.nz
• Reduce access to means — if there is a firearm in the house, ensure it is properly secured separately from ammunition. This is one of the few interventions with strong evidence in older male suicide prevention.
• Direct, specific check-ins — "Are you having thoughts of ending things?" Asking does not increase risk; it usually decreases it.
• Routines — regular contact, regular outings, regular meals matter more than they sound