Clinical presentation and specific symptoms

Depression in older adults has clinical features that distinguish it from other age groups, making its detection a real diagnostic challenge.

Symptoms are often not expressed directly, and older adults rarely explicitly verbalize feelings of sadness or depression. The key clinical features for identifying depression are detailed below.

Features of emotional expression in older adults

A key characteristic is reduced verbal emotional expressiveness. Older adults rarely come to a consultation saying “I feel sad”; instead, their distress is usually expressed indirectly. Somatic complaints such as diffuse pain, constant fatigue, gastric discomfort, or headaches predominate and persist despite adequate medical treatment.

In addition, there is a tendency toward social withdrawal and isolation, with a progressive loss of interest in activities that were previously enjoyable, which may go unnoticed or be normalized as part of aging.

Cardinal symptoms

As in other age groups, there are still two essential symptoms for the diagnosis of depression:

• Depressed mood, although this may be less obvious. It can be expressed in phrases such as “I am tired of living” or through attitudes of hopelessness, irritability, or frequent crying for no apparent reason.

• Anhedonia, i.e., loss of interest or pleasure in previously meaningful activities. A classic example is an older adult who stops participating in games, family gatherings, or hobbies that they once enjoyed deeply.

Together, these two symptoms must be carefully assessed, as they often overlap with normal aging processes or other medical conditions.

Common physical symptoms of geriatric depression

The most common physical symptoms include gastrointestinal disorders, musculoskeletal pain, headaches, loss of energy, and decreased overall functional capacity.

These symptoms, which appear without a clear medical cause, can lead to multiple visits to different specialists before being recognized as manifestations of depression. Another important indicator is decreased mobility, with both physical and cognitive slowing. Some patients also show deterioration in self-care, such as avoiding personal hygiene or appearing indifferent to their appearance.

Sleep and appetite disorders in depressed older adults

Sleep disorders are extremely common in geriatric depression. They can present as insomnia (difficulty falling asleep or staying asleep), frequent awakenings during the night, or excessive sleepiness during the day.

Sleep is often not restful, which perpetuates fatigue and reduces energy during the day. Appetite may be either decreased or increased, although decreased appetite is more common, leading to unintentional weight loss and poor nutrition.