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Grief vs. Depression in the Elderly: A Guide for Caregivers

With expert advice from Cleveland Clinic’s Center for Geriatric Medicine
By Sarah PratteMay 26, 2021
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As part of the aging process, older adults commonly experience losses like the death of a friend, family member, or pet; changes in health; and gradual declines of mobility and independence. These and other losses often lead to grief and mourning, and working through those feelings is an important part of your loved one’s emotional wellness. However, there’s no timeline for grief. So, as a caregiver, how do you know when your loved one is struggling and needs extra support?

The signs might not be easy to spot. “Depression in seniors is very unique,” says Ardeshir Hashmi, MD, section chief of the Center for Geriatric Medicine at Cleveland Clinic. Rather than tearfulness or crying, many seniors who have depression exhibit low energy, lack of motivation, and an unwillingness to leave the home. “The reason this gets missed is that a lot of people perceive these things as a normal part of aging,” Hashmi says. “It is not normal.”

Learn Hashmi’s tips for how to distinguish between grief and depression in older adults and ways to support a loved one who is feeling overwhelmed.

What is grief?

Grief is most often experienced as a number of intense, painful emotions that arise in response to a loss. Although it may be difficult to see a loved one grieving, it’s important to understand that grief is a normal, healthy response to major life-changing events, says Hashmi.

Most everyone will experience grief at some point in their lives. But the grieving process can vary greatly from person to person. Some common expressions of grief include:

    • Strong feelings of sadness
    • Feelings of anger, guilt, or anxiety
    • Denial or disbelief
    • Decreased concentration or lack of motivation
    • Temporary loss of interest in daily activities

Someone who is grieving may also experience:

    • Loss of appetite
    • Sleeping too much or, conversely, being unable to sleep
    • Low energy levels and fatigue

Grief usually feels most intense in the first days and weeks after a loss. As your loved one processes the loss, feelings of grief may come and go in waves, or the feelings may become more manageable overall.

What are some signs that my grieving loved one might have depression?

“There is considerable overlap between the symptoms of grief and the symptoms of depression,” says Hashmi. It can be tricky to distinguish between the two. Often, time is a key indication. Symptoms of grief that persist for weeks to months after a loss might point to depression.

Depression — also called major depressive disorder — is a common, treatable medical condition. It causes persistent, long-lasting feelings of sadness, worthlessness, and apathy. According to Hashmi, some signs that your grieving loved one might have depression include:

    • Feelings of grief that don’t change or improve over time
    • Feeling so overwhelmed that he or she is unable to participate in daily life for longer than six weeks after the loss
    • Changes in appetite that last long enough to cause significant weight loss
    • An inability to sleep or getting only minimal amounts of sleep for days or weeks at a time
    • Persistent, long-lasting feelings of hopelessness, guilt, and self-blame
    • Talk of suicide or hurting oneself or others

If your loved one has any of these signs, encourage them to schedule an appointment with their geriatrician or primary care doctor, says Hashmi. Depression isn’t something that your family member can “snap out of” on their own. But safe, effective treatment options — like talk therapy and medication — can help them feel better. Studies suggest that for many older adults, a combination of both talk therapy and medication is often more effective than either treatment option alone.

How can I help a grieving loved one?

If your loved one is struggling to cope with a loss, just being there for them can be a big help.

Encourage them to talk. At first, you may worry that you’ll say the wrong thing or unintentionally make things worse. But know that talking can help your loved one process the loss and work through their emotions. For example, if your loved one is grieving the loss of a friend or family member, let them know that it’s okay to talk about the person they’re missing. Ask your loved one to share memories or stories. Share what you remember, too.

Provide reassurance. Your loved one may be worried about showing their feelings. Or they may feel alone. As a caregiver, you are in a unique position to validate their feelings and normalize their experience, Hashmi says. Remind them that what they’re experiencing is common, that grief takes many forms, and that it takes time to heal.

Help them take care of their physical health and household. People who are grieving or depressed might find it difficult to muster the energy for daily tasks. If you notice that your loved one is struggling to prepare meals, care for the household, or get dressed, find ways to help. For example, you might prepare a few meals they can easily warm up when they’re feeling hungry. You might do a load of laundry, or wash the dishes. Or you could offer to help them get dressed for a short walk around the neighborhood, or to sit with you outside.

Encourage them to seek help for persistent symptoms. You know your loved one best. If you’re feeling worried, don’t ignore your concerns. Instead, be honest with your family member. Open up about your worries and gently ask whether they feel hopeless, depressed, or are having thoughts of self-harm or suicide. If so, remind them that depression is common and treatable, and help them schedule an appointment with their doctor as soon as possible.

“Depression is eminently treatable. It’s not an incurable illness,” Hashmi says. “The travesty would be if we don’t do something about it.”


A Place for Mom and Cleveland Clinic : Supporting seniors and their families

This article was developed in conversation with Ardeshir Hashmi, MD, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.


Sources

Hashmi, A. Cleveland Clinic. May 3, 2021.

Grief: Coping with the loss of your loved one. American Psychological Association. https://www.apa.org/topics/grief

Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/

Goveas JS, Shear KM. Grief and the COVID-19 Pandemic in Older Adults. Am J Geriatr Psychiatry. 2020; 28(10): 1119–1125.

Clinical practice guideline for the treatment of depression across three age cohorts. American Psychological Association, 2019. https://www.apa.org/depression-guideline/guideline.pdf

Author
Sarah Pratte

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