The experience of older adults facing depression for the first time in old age

Depression at old age is often seen as a natural part of growing old, even without a history of previous episodes before the age of 65. Although Late onset Depression (LOD) has received a significant attention in the research literature, studies often report conflicting results. These contradictions might be rooted in our failure to understand the essence of LOD and it's mislabeling as a sub type of depression. In the same manner, Existential Vacuum (EV) and Existential Neurosis (EN) share some similarities with depression. Yet, in this case, the depression masks the EN and EV since they represent the existential crises caused by the luck of a person's sense of meaning in life. EN and EV can also be masked by other conditions such as alcoholism. Labeling them as depression could cause such conflicting results as we see with LOD. Since the only well-replicated difference between LOD and Early On-set Depression (EOD) is a lower rate of family history of mood disorders in the former, it is possible that LOD is in fact a manifestation of the loss of meaning occurring at old age.

The present study aims to enrich the literature, to expand our understanding of LOD and to examine the way people experience depression which they encounter for the first time, over the life course, at old age. In order to resolve some of the conflicting results in the extant literature, as well as sounding the voice of those who are facing LOD, here I adopt a qualitative research method. I have conducted semi-structured, in-depth interviews with 15 elderlies who had been diagnosed with LOD, all of which are being treated at Shalvata Mental Health Center. The results were later analyzed according to the phenomenological research principles.

The findings point to four main themes: past life experiences, losses at old age, emotional reactions and coping strategies. Based on these three main themes, four different experiences emerged: Experiencing the loss, Experiencing the luck of loss, Experiencing the indirect loss and Experiencing the forced loss.

The first theme of each experience dealt with losses at old age. The three main losses that where mentioned by the elderlies —loss of health, loss of work, and loss of social ties – viewed as the main cause for the presence of LOD. It seems that each loss effected an essential part of the elderlies' lives which might have been a vital source for a sense of meaning. This suggest that a first episode of depression at old age might reflect a loss of meaning due to the specific impact of the losses on the elderlies' lives.

The main losses and their specific impact on the elderlies' lives defined each one of the four different experiences found in this study. Yet, the emotional reactions and the coping strategies, which were linked to the losses, revealed the depth of the existential crisis. The first two, , presented the characteristic of an EN and showed a direct link between the main loss, the emotional reaction and the coping strategy. The first was defined mainly by the loss of work and which generated an emotional reaction of shame and a coping strategy of an extreme reduction in the elderlies' daily functioning. The letter was defined by the luck of a main loss experienced at old age which was reacted by disinterest state and a passive coping strategy. Shame and disinterest were found alongside pessimism, a feeling of meaningless and a sense that the elderlies are not the same as they were. Yet, the extreme reduction in the first reflect a veggettive type of  EN while the passive coping strategy reflect a more nihilistic type.

With the two other experiences, the less sever clinical features that were found suggest a loss of meaning reflected by an EV. Also, this two haven't shown a direct loss-emotional reactions-coping strategy link. Both featured elderlies whose main loss was either loss of health or loss of social ties which yielded emotional reactions of helplessness and aloneness. However, in the first, the loss had an indirect effect on their lives while the in the letter the elderlies felt obligated to face their loss on daily basis. The indirect effect of the loss hasn't disrupted their sense of freedom thus, enabling them a coping strategy of avoiding unpleasant situations associated with their loss. Oppositely, the obligation to face the loss took a lot from the elderlies, including their entire sense of freedom. Thus, they reported a coping strategy of relief seeking which help them an emotional boost to face the unpleasant situations associated with their loss.

The present study reveals how issues such as freedom, existential meaning, and sense of isolation are important when considering the diagnosis and treatment of LOD. Moreover, this study sheds new light on a prevalent mental health issue and can serve as a foundation for later studies seeking to differentiate LOD from EOD.  This study also highlights the distinct characteristics of LOD, which might encourage policy-makers and healthcare providers to come up with new ways of preventing and reducing depression in old age.