Recognizing and Managing Depression in the Elderly: Reflections from a Daughter and Caregiver

Unlike the visible signs of a physical illness, depression can be quiet, subtle, and easily misattributed to aging itself.

But make no mistake: depression in older adults is real, common, and treatable.

Caring for our elderly loved one comes with a unique set of challenges. One that often goes unnoticed, or mistaken for something else is depression. Unlike the visible signs of a physical illness, depression can be quiet, subtle, and easily misattributed to aging itself. But make no mistake: depression in older adults is real, common, and treatable.

Our Journey | After Mama’s second hospitalization, she needed more assistance with tasks, she could no longer prepare her own breakfast, cook her delicious meals, garden independently, or even take care of her personal needs without assistance.

As her caregiver, I focused on helping her recover physically by arranging doctor’s appointments, managing medications, and trying to create a safe, comfortable environment for her at home. But as the months went on, I began to notice something that wasn’t as easy to fix with medical equipment or checklists. She was quieter, less engaged, less interested in the things she once enjoyed. And her usual spark seemed dim. Although it was hard for me admit it at first, I knew what I was seeing: Mama was showing signs of depression.

That realization opened my eyes to a reality many caregivers face but often struggle to talk about: depression in the elderly is common, especially after major life changes like hospitalization, illness, or loss of independence. Yet, it often goes unnoticed or unspoken, hidden behind the assumption that aging naturally brings sadness or withdrawal.

As caregivers, your role is not only to assist with physical needs but also to be attentive to emotional and mental well-being. Learning how to recognize the signs of depression and knowing what to do next can make a difference in your loved one’s quality of life.

Depression in the Elderly: More Common Than You Think

Depression in older adults is more common than many people realize.

What makes it challenging to recognize is that depression in the elderly can mimic other sign associated with aging.

Depression can be triggered by:

• Loss of mobility or physical ability

• Chronic illness or ongoing pain

• Isolation or reduced social interaction

• Cognitive decline

• Loss of a spouse or close friends

• Loss of Independence

• Major health events like surgery, hospitalization

• Major life transitions like retirement or moving out of their home

What makes it even more challenging is that depression in the elderly can mimic other sign associated with aging. It may appear as:

• Fatigue or low energy

• Changes in appetite or sleep patterns

• Physical complaints without a clear medical cause

• Irritability, unusually short temper

• Expressing Self-blaming or guilt (I’m a burden)

• Emotional outbursts

• Restlessness

• Talking about death, not having a purpose

• Loss of interest in social interaction

• Difficulty concentrating or making decisions

• Loss of interest in hobbies or daily activities

For Mama, the signs were subtle at first. But it soon became clear, especially after her doctor asked some important questions to help me figure out what was happening:

• Has this been going on for longer than two weeks

• Is it interfering with daily life or caregiving

• Are these new or unusual compared to their normal behavior

• Are accompanied by thoughts of death, or feeling like a burden

Why It’s Often Missed

Depression in older adults is often under-diagnosed because:

• Symptoms may overlap with dementia or other chronic conditions.

• Some seniors may feel ashamed or reluctant to talk about emotional struggles.

• It’s commonly mistaken for “just getting older” or grief after a loss.

How Caregivers Can Make a Difference

• Know what to look for

• Create a safe space for conversation

• Involve healthcare professionals

• Encourage Routine and Connection

• Promote daily healthy habits

• Don’t do it alone

As a caregiver, you’re uniquely positioned to see changes that others might miss. You're the one who knows what’s normal for your loved one and when something feels “off.” Here’s how you can step in and provide support if they are showing signs of depression:

1. Know What to Look For

• Trust your instincts. If your loved one isn’t acting like themselves, don’t brush it off as “just aging.” Pay attention of changes in mood, behavior, sleep, and appetite.

  • Are they less engaged than usual? Do they seem more tired, or down lately? Are they showing less interest in their favorite television show? Are they skipping meals, or staying in their room or bed more? Are they more forgetful, more agitated? Depression can sneak in quietly and is often masked by some of these symptoms.

• Keep notes of the changes you see. This can help you and their doctor figure out what might be happening.

With Mama, it was all of the above. She was talking to family less frequently or rushing off the phone when they called. She wanted to stay in her room during the day instead of spending time outdoors. Her appetite changed (she usually has a good appetite). She seemed tired, and malaise most of the time.

2. Create a Safe Space for Conversation

It can be hard for older generations to to talk about their mental health because they grew up in an era where emotional struggles were often kept private, and sometimes seen as a weakness. Let them know that feeling low or overwhelmed is more common than they think, and that there’s nothing to be ashamed of.

Mama would often say, when asked, “I’m alright.” Yet, her lack of engagement and enjoyment in activities said otherwise. I didn’t push, but I didn’t stop checking in either. Instead, I found small ways to help her find the words for what she was feeling.

You can use some simple caring prompts to open the door to a conversation:

• “You don’t seem like yourself lately.”

• “You don’t seem to be enjoying your “TV show” the way you used to. I miss hearing all about what happened in your soap opera.”

• “I’m here if you want to talk.”

• “You seem more tired/quiet/down lately. Is everything ok?”

• “Do you want to talk about anything?”

• “Is there anything you need?”

PRO TIP: I shared stories with Mama of the times she helped me out of a funk. Creating this space allowed her to eventually open up.

3. Involve a Healthcare Professional

Encourage your loved one to talk to their provider. If they are still taking care of their own medical appointments, offer to help make the appointment, and go with them if they’re open to it. Treatment options may include:

• Talk therapy or counseling

• Medication (e.g., antidepressants)

• Lifestyle changes like diet and exercise

• Social engagement opportunities

• Support groups

One of the best decisions I made was bringing Mama’s emotional health into medical conversations. She loves her primary care doctor and was comfortable talking to her about how she was feeling. I remember one of the conversations Mama had with her doctor, “I don’t feel like myself doctor, I just don’t know why.” The doctor helped to normalize how she was feeling by her reply, “Mrs. B, you went through a lot…, it’s ok to not feel like yourself.” This made her comfortable talking about her feelings.

Another thing that I did was request a social work assessment from the home health care agency that was providing post hospitalization care for Mama. They were able to provide some recommendations to support her emotional wellbeing.

4. Encourage Connection and Routine

Loss of structure and purpose can deepen depressive symptoms. Small, daily routines even just a morning walk, a shared cup of coffee/tea, or a daily phone call can restore a sense of normalcy and control. For Mama, this was definitely the case. Because of her recent illness, she could no longer take care of her personal needs independently. This weighed heavily on her. Maintaining some of her routines, even though it was with assistance, seemed to help her feel some level of control. Check out my blog Building a Routine to Nurture Stability and Independence for Seniors.

I found that simple, consistent connection mattered most to Mama. I didn’t need to fix everything.

I just needed to show up and provide the opportunities for connection.

Ultimately, I found that simple, consistent connection to loved ones mattered most to Mama. I didn’t need to fix everything. I just needed to show up and provide the opportunities for connection. For example, I reached out to my siblings for help. They checked in more often and the attention and connection seemed to help lift her spirits. Here’s some more on nurturing social well-being: Connect to Thrive: Nurturing Social Well-being in Seniors.

5. Promote Healthy Daily Habits

Integrating healthy habits into your loved one’s daily routine can have a big impact their mental health. Here are some other ideas to encourage:

• Regular physical activity (even gentle walking)

• Nutritious meals

• Social interaction (even through phone calls, a good belly laugh)

• Activities they once enjoyed, like gardening, music, or puzzles

• Small daily wins (to rebuild confidence and reduce feelings of helplessness).

For Mama, staying active, both physically and mentally became an important part of her healing. She kept up with her gentle walks and added in exercises from her physical therapist, building strength at her own pace. Because she’s always loved the outdoors, we made it a point to help her spend time on the patio each day, where she could soak in the sun and admire the vegetable and flower gardens she once tended so lovingly. She kept her mind sharp with her word search puzzles and filled her days with long conversations with the people she cared about most.

6. Don’t Do It Alone

Supporting someone with depression can be emotionally draining. There were times I felt helpless and overwhelmed. What helped me most was connecting others who understood, including my spouse and siblings. Caregivers need support too:

• Take breaks when you can

• Ask for help from family and friends

• Share responsibilities with family or get professional in-home help

• Join a local or online caregiver support group

• Talk to a therapist or counselor

• Use professional respite care

You can’t care well for someone else if you’re running on empty. Check out my other blogs on self care: Nurture the Nurturer: Tips for Family Caregivers on Balancing Self-Care with Caregiving; Care for the Caregiver: Recognizing and Managing Caregiver Burnout.

When to Seek Immediate Help

If your loved one expresses hopelessness, talks about death, or exhibits suicidal behavior, don’t wait. Seek immediate help by contacting a doctor, crisis hotline, or emergency services. for the U.S. National Suicide & Crisis Lifeline: Call or text 988.

It’s Not the End of the Story

My mother’s journey reinforced one of the most important lessons of caregiving: emotional healing matters just as much as physical healing. The small things, a good laugh, a good day, a meaningful conversation contributed to her return, slowly but surely.

If you’re walking a similar path, you’re not alone. Depression in older adults is common, but so is hope. With awareness, compassion, and support, you can help your loved one not only feel better, but feel seen.

You’re doing important, meaningful work. And every small act of care matters more than you know.