The short answer
- Low mood that will not lift is not just part of getting olderTwo weeks or more of feeling flat, anxious or uninterested in things is worth a GP appointment, not something to wait out.
- The GP is the first call, day or nightFor a routine change, book an appointment. If you believe your relative is in danger of harming themselves, ask for an emergency assessment or call 111 and press 2.
- Depression can look like memory loss, so say what has changed and since whenLow mood can slow thinking and make someone seem more forgetful than they are, which is one reason the GP needs a clear account of when it started.
- Company and routine support treatment, they do not replace itRegular contact, a reason to get up, and someone to talk to all help alongside whatever the GP recommends.
This page is about recognising and getting help for a mental health change, not a medical diagnosis. If you are worried about immediate danger, call 999 or go to A&E.
Signs to watch for
Signs it is more than a bad day
Poor mental health in an older person is often spotted by the people around them before the person notices it themselves, particularly if they have always been the sort to keep things to themselves. A change in habits on its own does not mean much, but the same change lasting more than two weeks, or several changes together, is worth acting on.
An ordinary low day
A bad night, a hard anniversary or a grey week that passes within a few days, and the person is still themselves in between.
- Quieter or more tired than usual for a day or two
- Upset around a specific date, such as a birthday or an anniversary
- Still eating, sleeping and seeing people much as before
Worth a GP appointment
Low mood, worry or a loss of interest that has lasted two weeks or more, or has changed how the day runs.
- Flat, tearful or anxious most days for two weeks or longer
- Stopped doing things they used to enjoy, or stopped answering the phone
- Sleeping far more or far less than usual, or eating much less
- More aches, pains or complaints of tiredness than before, with no other cause found
Needs help today
Any sign that they might be a danger to themselves, or that their mental state is deteriorating quickly.
- Talking about not wanting to be here, or that others would be better off without them
- Giving away possessions, or making sudden arrangements that seem final
- A sudden, sharp change in how they think or behave over hours or days
You know your relative better than anyone assessing them for the first time, so it is worth writing down what you have noticed and when it started before you contact anyone. "More tired than usual" is easy to dismiss; "has not left the house in ten days and stopped answering the phone to her sister" is not.
Why it happens
Why depression and anxiety become more common in later life
Depression and anxiety are not a normal part of ageing, and most people in later life do not experience them. They do become more common around a set of life changes that tend to cluster together in this age group, and knowing which one applies often points straight at what will help.
Bereavement
A partner, sibling or close friend
Retirement and loss of routine
A sudden change in structure
Illness, pain or a new disability
Physical health affecting mental health
Isolation
Fewer reasons to leave the house
Depression in later life also tends to look different from depression in a younger person. Older people are more likely to talk about tiredness, aches and pains or trouble sleeping than about feeling sad, and to seem irritable or agitated rather than tearful. A GP who knows this will ask about it directly, which is another reason to see one rather than assume nothing is wrong because your relative has not used the word "depressed".
Depression or dementia
Why it matters which one the GP is treating
Confusion and memory problems are usually thought of as signs of dementia, but depression can cause them too, and the two conditions can also occur together. Telling them apart matters because depression usually responds well to treatment, and treating it can bring someone's thinking back to how it was.
| More typical of depression | More typical of dementia | |
|---|---|---|
| How it started | Over days or a few weeks, often after a clear trigger | Gradually, over months or years |
| Awareness of memory problems | Notices and worries about forgetting things | Often unaware, or plays it down |
| Effort on a task | Says "I can't" or gives up quickly | Attempts the task but gets it wrong |
| Mood | Low most of the time, often the main complaint | Can be low, but usually not the main feature |
How it started
- More typical of depression
- Over days or a few weeks, often after a clear trigger
- More typical of dementia
- Gradually, over months or years
Awareness of memory problems
- More typical of depression
- Notices and worries about forgetting things
- More typical of dementia
- Often unaware, or plays it down
Effort on a task
- More typical of depression
- Says "I can't" or gives up quickly
- More typical of dementia
- Attempts the task but gets it wrong
Mood
- More typical of depression
- Low most of the time, often the main complaint
- More typical of dementia
- Can be low, but usually not the main feature
These are patterns a GP or memory specialist looks for, not a way to diagnose either condition at home. The two can also exist together, particularly after a dementia diagnosis, which is its own reason to keep the GP updated on mood as well as memory.
There is no way to settle this from the outside, and trying to can delay the person getting the right treatment. What helps is telling the GP exactly what has changed, roughly when, and whether your relative seems distressed by the change or unconcerned by it. If memory and confusion are the bigger and longer-standing part of the picture, the seven stages of dementia and signs that dementia is getting worse go further into that condition specifically.
Getting help
What happens after the GP appointment
The route into help is the same whether your relative books it themselves or you help them make the call. It usually moves faster than families expect once the first appointment is made.
- 1
The GP appointment
This weekThe GP asks about mood, sleep, appetite and how long it has been going on, and rules out a physical cause such as a thyroid problem or a medication side effect, both common in older people and easily mistaken for depression. - 2
Assessment and a plan
Same visit or a follow-upFor a first, milder episode, NICE guidance for the NHS favours starting with the least intensive treatment likely to work, such as guided self-help or a talking therapy, before medication. - 3
Talking therapy, with or without a GP referral
Usually within weeksAnyone can refer themselves to NHS Talking Therapies without seeing a GP first, or the GP can refer them. It offers free CBT, guided self-help and counselling for depression and anxiety, in person, by phone or by video. - 4
Medication or specialist referral, if needed
If symptoms are more severeAntidepressants are considered where symptoms are more severe or have not improved with talking therapy alone. A GP can refer to a community mental health team for older people for anything more complex.
What helps day to day
What helps day to day, alongside treatment
None of this replaces a GP appointment or treatment, and a carer is not able to diagnose or treat a mental health condition. What it can do is fill the week with the routine, company and reasons to get up that make treatment more likely to work.
What tends to help alongside whatever the GP recommends
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Company and routine
If getting out or staying in touch has become harder
Activities to do in later life and activities with a companionship carer both have more ideas for filling the week, and the research on whether a lack of social contact raises the risk of dementia explains why company matters this much. If your relative lives some distance from you, caring for a parent remotely has more on keeping a regular check from a distance.
Questions
Questions families ask about elderly mental health
No. Most people in later life do not experience depression, and feeling persistently low, anxious or uninterested in things is a health condition worth treating, not something to accept as normal ageing. It becomes more common around events such as bereavement, retirement, illness and isolation, but the events raise the risk rather than make it inevitable.
You can call the surgery yourself to flag your concern, even without your parent there, and many GPs will phone the patient directly rather than wait for a booking. How do you get someone to accept care? has more on getting past a refusal without it becoming a battle.
Call 999 or go to A&E if you believe their life is at immediate risk. For something urgent but not life-threatening, call NHS 111 and select the mental health option to speak to a trained professional, available 24 hours a day. Samaritans are free to call on 116 123, any time, and you can call them yourself for advice on how to help someone else, not only if you are the person struggling.
Depression tends to start faster, often after a clear trigger, and the person usually notices and worries about their own memory problems. Dementia tends to develop gradually and the person is often less aware of it. The two can occur together, and only a GP or a memory specialist can tell them apart reliably, so the useful thing you can do is describe exactly what has changed and roughly when it started.
Usually not for a first, milder episode. NHS guidance favours starting with the least intensive treatment likely to help, such as guided self-help or a talking therapy, and moving to medication if symptoms are more severe or have not improved. Anyone can self-refer to NHS Talking Therapies without seeing a GP first.
A carer is not a healthcare professional and cannot diagnose or treat a mental health condition. What a regular companionship carer can offer is company, conversation and a predictable routine, which tend to support treatment rather than replace it. Companion carers on PrimeCarers charge £15 to £20 an hour with our fee included. More on companionship care.
It is a route through the GP surgery into local groups, activities or befriending services, run alongside or instead of a medical treatment. A link worker matches the person to what is available nearby. Ask the GP surgery whether they offer it.
Regular calls at a set time are easier to notice a change against than occasional ones, and it helps to ask specific questions about sleep, appetite and what they have been doing rather than only "how are you". Caring for a parent remotely has more on staying involved from a distance.