Mental health in older adults: Depression is not part of ageing

In Finland, 5.9% of people over 70 have depression (Mielenterveystalo: Loneliness and ageing). One in three over-65s feels lonely at times, and 4–5% have chronic loneliness. About 350,000 people over 65 live alone in Finland (MIELI ry: Living alone and loneliness).

Depression is the most common mental health problem among older adults, but it is not a normal part of ageing. About half of those over 65 with depression benefit from medication, and psychotherapeutic methods work well even in older age.

This article covers the specifics of older-adult mental health, distinguishing depression from ageing, loneliness, and routes to help.

What separates ageing and depression

Ageing brings changes: strength declines, health problems appear, loved ones are lost, social networks shift. This is natural and requires adjustment. Depression is something else: a continuous feeling of emptiness, sadness, or numbness lasting weeks or months and impairing function.

Depression in older adults often presents differently from younger people. Typical features include physical symptoms (pain, fatigue, loss of appetite), cognitive symptoms (memory difficulty, concentration problems: which can be mistaken for dementia), anxiety, restlessness and worry, and withdrawal from previously enjoyable activities.

"Pseudodementia" is a state where depression resembles a memory disorder. Treating the depression eases memory issues. This is why it's important that when memory problems are investigated, depression is also assessed.

Loneliness as a health risk

Chronic loneliness is a real health risk: not just an unpleasant feeling. The chronically lonely have shorter life expectancy than comparison groups, and greater susceptibility to infection, heart disease, and depression.

Loneliness and living alone are not the same. Many who live alone don't feel lonely; one can feel lonely surrounded by people. What matters is the felt sense of connection and meaningful relationships.

Sotkanet statistics show experiences of loneliness in over-65s have increased in recent years, but among the oldest there are also those who feel no loneliness at all. It isn't "inevitable" with age.

Treatment options for older adults

Käypä hoito guidelines do not draw a sharp line between treating younger and older adults. For depression in older adults:

Medication (SSRIs) is often effective, but doses and interactions with other medications need careful consideration. Psychotherapy is effective in older adults too: brief psychotherapy, CBT, solution-focused therapy, and reminiscence therapy are all research-supported. Kela rehabilitative psychotherapy is available for ages 16–67; for over-67s the service is arranged via other channels.

Exercise is one of the best-researched depression treatments and works in older adults too. Regular outdoor activity, group exercise, and light movement can significantly improve mood.

Group support: via parishes, organisations, the wellbeing services county, or pensioner organisations: particularly helps with loneliness.

Specific challenges

Grief and loss recur for older adults. Death of a spouse, siblings, or friends wounds deeply. Grief doesn't need "curing", but if it lengthens and turns into depression, treatment is needed.

Substance problems: especially alcohol: are more common in older adults than commonly understood. Loneliness, grief, and insomnia can drive increased alcohol use. This is important to raise when treatment is being assessed.

Suicide risk in older men is particularly high. Finland has done significant suicide-prevention work, but for lonely older men the concern remains warranted.

Path to help

Your own health centre or geriatric clinic are primary places for assessment. Wellbeing services counties' mental health services offer outpatient and home-based work where needed.

Memory clinics investigate memory symptoms, and depression is also assessed at the same time. This distinction matters because depression is treatable while dementia is not.

In acute crises, emergency or 112. MIELI's crisis line (09 2525 0111) is a confidential channel for older adults too.

Where to get help

Your own health centre for assessment and starting treatment. Wellbeing services county geriatric or mental health services. Eläkeliitto, Vanhus- ja lähimmäispalvelun liitto Valli ry, and parish diaconal work offer social support and conversation partners. MIELI ry's Tukinet (tukinet.net) offers conversation help. In acute crisis, MIELI crisis line 09 2525 0111 or 112.

Sources

• Mielenterveystalo: Loneliness and ageing
• MIELI ry: Living alone and loneliness
• Sotkanet: Loneliness in over-65s
• Finnish Red Cross: Loneliness Barometer 2023

Where to find a therapist

You can look for a therapist in several places:

• Search services run by the Finnish Psychological Association (Psykologiliitto) and professional bodies.
• Kela's service provider search, if you are applying for rehabilitative psychotherapy (only Kela-approved therapists qualify for reimbursement).
• The Valitse Terapia service and other directories.
• Your own health centre, occupational health service or student health service (YTHS), which can refer you onward.

You can contact several therapists and see with whom the collaboration feels natural.