Depression - Age 65+ in United States

United States

Depression, also called major depressive disorder or clinical depression, is a common mood disorder that can negatively impact health. Risk factors for depression among older adults include loneliness, isolation, loss of loved ones, financial hardship, fear of death or dying, chronic health problems and a reduced sense of purpose brought on by major life changes, such as retirement. Depression in older adults may also be a side effect of certain medications.

If left untreated, depression may lead to:

• Decreased physical and cognitive functioning.
• Diminished health-related quality of life.
• Higher use of primary health care services.
• Suicide. 

Estimating the true prevalence of depression among older adults is challenging. For instance, older adults may assume depression and depressive symptoms are an inevitable part of aging, while others are isolated with few people around to recognize depressive symptoms.

There are significant societal costs associated with depression. The economic burden of depression in the United States is estimated at $326.2 billion a year, including direct medical costs, loss of workplace productivity and loss of life due to suicide.

According to America’s Health Rankings analysis, the prevalence of depression is higher among:

• Older women compared with older men.
• Older adults who are multiracial compared with those who are Asian. American Indian/Alaska Native, Hispanic and white older adults also have a high prevalence.
• Older adults with less than a high school education compared with college graduates.
• Older adults with an annual household income less than $25,000 compared with those with incomes of $75,000 or more.
• Older adults who have difficulty with cognition compared with older adults without a disability.
• LGBQ+ older adults compared with straight older adults.
• Older adults who have not served in the U.S. armed forces compared with those who have served.

Additionally, hospital patients and residents of long-term care facilities also have higher rates of depression.

Depressive disorders are treatable. If an older adult thinks they have depression, the first step is to discuss it with their medical provider. Many older adults experience improvements in their depressive symptoms when treated with psychotherapy or antidepressant drugs.

The Centers for Disease Control and Prevention (CDC) published a brief highlighting several evidence-based programs and web resources that communities can use to address depression among older adults. The CDC also provides the PEARLS toolkit, a treatment program that aims to help improve quality of life and reduce symptoms of depression in older adults. 

County Health Rankings & Roadmaps lists multiple evidence-based strategies for improving health outcomes among those with depression, including: 

• Behavioral health primary care integration.
• Changes in mental health benefits legislation.
• Community-based social support for physical activity.

The National Institute of Mental Health also recommends several treatment options for older individuals with depression. In 2022, the 988 Suicide & Crisis Lifeline was launched to provide an easy-to-remember number and 24/7 confidential support for people in distress, as well as prevention and crisis resources, by call, text or online chat.

Healthy People 2030 has multiple goals pertaining to mental health, including:

• Increasing the proportion of primary care visits where adolescents and adults are screened for depression.
• Increasing the proportion of adults with depression who get treatment.

Centers for Disease Control and Prevention, and National Association of Chronic Disease Directors. “Issue Brief 2: Addressing Depression in Older Adults: Selected Evidence-Based Programs.” The State of Mental Health and Aging in America. Atlanta, GA: National Association of Chronic Disease Directors, 2009. https://www.cdc.gov/aging/pdf/mental_health_brief_2.pdf.

Chang-Quan, Huang, Bi-Rong Dong, Zhen-Chan Lu, Ji-Rong Yue, and Qing-Xiu Liu. “Chronic Diseases and Risk for Depression in Old Age: A Meta-Analysis of Published Literature.” Ageing Research Reviews 9, no. 2 (April 2010): 131–41. https://doi.org/10.1016/j.arr.2009.05.005.

Donovan, Nancy J., Qiong Wu, Dorene M. Rentz, Reisa A. Sperling, Gad A. Marshall, and M. Maria Glymour. “Loneliness, Depression and Cognitive Function in Older U.S. Adults: Loneliness, Depression and Cognition.” International Journal of Geriatric Psychiatry 32, no. 5 (May 2017): 564–73. https://doi.org/10.1002/gps.4495.

Greenberg, Paul E., Andree-Anne Fournier, Tammy Sisitsky, Mark Simes, Richard Berman, Sarah H. Koenigsberg, and Ronald C. Kessler. “The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018).” PharmacoEconomics 39, no. 6 (June 2021): 653–65. https://doi.org/10.1007/s40273-021-01019-4.

Menchetti, Marco, Nadia Cevenini, Diana De Ronchi, Roberto Quartesan, and Domenico Berardi. “Depression and Frequent Attendance in Elderly Primary Care Patients.” General Hospital Psychiatry 28, no. 2 (March 2006): 119–24. https://doi.org/10.1016/j.genhosppsych.2005.10.007.

Penninx, Brenda W. J. H., Jack M. Guralnik, Luigi Ferrucci, Eleanor M. Simonsick, Dorly J. H. Deeg, and Robert B. Wallace. “Depressive Symptoms and Physical Decline in Community-Dwelling Older Persons.” JAMA 279, no. 21 (June 3, 1998): 1720–26. https://doi.org/10.1001/jama.279.21.1720.

Thakur, Mugdha, and Dan G. Blazer. “Depression in Long-Term Care.” Journal of the American Medical Directors Association 9, no. 2 (February 1, 2008): 82–87. https://doi.org/10.1016/j.jamda.2007.09.007.

Unützer, Jürgen, Donald L. Patrick, Paula Diehr, Greg Simon, David Grembowski, and Wayne Katon. “Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders.” International Psychogeriatrics 12, no. 1 (March 2000): 15–33. https://doi.org/10.1017/S1041610200006177.

Wilkinson, Philip, Catherine Ruane, and Katie Tempest. “Depression in Older Adults.” BMJ 363 (November 28, 2018): k4922. https://doi.org/10.1136/bmj.k4922.