When I was a kid, I couldn’t understand why old people weren’t in a constant state of panic. I would look at my grandad, sitting there quietly reading the Birmingham Evening Mail, and wonder how he could stay so calm. How come he wasn’t as horrified as I was at the prospect of him dying before too long? If I was him, I thought, I would be running around the garden screaming in despair and terror. I just didn’t get it, and to some extent I still don’t, which is a considerable worry since I’m a good deal closer to old age than childhood myself.
Sorry to sound so miserable. Do read on; there are some positive thoughts further down.
Rather than panicking, an awful lot of the older people of my acquaintance are miserably unhappy. Most of my friends are in their 50s, with parents in their late 70s and 80s. When we ask each other how our mums and dads are doing, the answers are distressingly similar. Yes, there are those who are batting on, still hitting boundaries, determined to make the most of their innings no matter what, but many of them are just in despair. They’re generally unhappy and anxious and no longer find much joy in the things they used to enjoy. In all other age groups these would be considered classic symptoms of depression and, hopefully, treated accordingly. But when it comes to older adults the prevailing attitude seems to be: “Well, they’re old and knackered and probably lonely – what do you expect?”
For this reason, I suspected, depression among older people might be underdiagnosed and under-treated. Unusually, for me, it turns out I was right. “Sadly, it isn’t just people generally who think old people are bound to be depressed,” Charlotte Lynch of Age UK told me. “It’s health professionals as well. They often taken the same view and think: well, they’re living with multiple long-term conditions and they’re in a lot of pain – of course they’re going to feel like that. So let’s focus on their physical health instead of mental health. And the same level of support isn’t there for older people.”
I have spoken to a number of eminent specialists in the field of old-age psychiatry, and they all tell the same story of depression being normalised in older people. Their frustration is that this leads to diagnoses often not being sought or given, when all the evidence suggests that both talking therapies and medication are at least as effective for older people as they are for everyone else.
It doesn’t help that older people tend to be less open to discussing their feelings, for all kinds of reasons. Age UK says this is partly generational; they even suspect some older patients are at some level fearful that a discussion with a doctor over their mental health could lead to any manner of problems, up to and including being carted off to an asylum. More commonly, the charity says, they are actually up for the conversation with a doctor but don’t know how to go about it, and some GPs aren’t much help. “They presume, particularly when it comes to older men, that the patient might not want to talk about it, so, not wanting to make them feel uncomfortable, it’s better to leave it,” Lynch says. “In fact a lot of older people want to be asked, but they just don’t know how to start the conversation.”
Starting this conversation, in my experience, can be tricky for all concerned. A close friend of mine whose father is in poor physical health suggested to his mum that his dad might also be depressed. This went down badly, as if the very idea was somewhere between disrespectful and insulting. And there the conversation ended. I strongly suspect this scene is playing out daily in many families. And another old person, one way or another, goes without mental health support, when they’ve perhaps needed it most in their long lives. It doesn’t have to be this way.