Depression and Delirium in old age – an interview with expert Dr Alex Bailey

In this episode, Dr Alex Bailey, who is an old age psychiatrist working in Westminster, explains depression and delirium in old age.

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Show notes for this episode

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How to spot depression in older people

  • Depression can be hard to spot in older people. When older people become depressed, they won’t always go to the GP, as they might feel ashamed or embarrassed.
  • Depression looks different in older people. For example, this might present as memory problems, which people could mistake for dementia, though this could actually be down to the person not being able to concentrate, or because they are feeling overwhelmed. Depression can also have physical symptoms, such as bowel problems or unexplained pains.

How to treat depression in old age

  • Luckily, depression is very treatable, and older people tend to respond better to treatment than younger patients. There is an increasing focus on talking therapies in treating depression. Social and environmental factors are really important too – is the person getting out and about? Are they engaging in meaningful activities? Do they have people around them who they can talk to?
  • Bereavement and grief are risk factors of depression, but not the same as depression. When supporting an older person through bereavement, we need to distinguish between normal responses to loss and depression.
  • Be sure to read our 8 Sensitive Ways to Help an Elderly Person with Depression guidance. This provides tips on a sensible approach to start talking about feelings with older people, particularly in a generation where emotions aren’t generally discussed. We also have a more thorough guide on what treatments, medicated and natural, are available to tackle depression, which you can read here.

Preventing depression in older age

Things we can do to help prevent depression in older age are:

  • talking and asking the person how they are feeling.
  • Exercise is also really important, even if this is only for a couple of minutes a day inside the home.

How to diagnose delirium in old age

The symptoms of delirium are similar to those we experience when we have a really bad flu: feeling feverish, disoriented and having muddled thoughts, but this is much more severe for older people. The risk of dying is significant, as this is often missed in hospital.

Causes of delirium

Common causes of delirium are water infections and constipation. If an older person you know is suddenly acting differently, ask them if they are experiencing bowel problems.

How long can delirium last?

Delirium can last for months, long after the infection has been treated. Spot the signs of delirium early by paying attention to sudden changes in behaviour.

Types of delirium and symptoms

There are two types of delirium:

  • Hyperactive – where people become very disturbed and experience hallucinations;
  • Hypoactive – where people become sleepy, fatigued and disengaged, which can be hard to spot in hospital.

Other symptoms include suddenly seeing or hearing things that aren’t there, or fluctuation in concentration or alertness.

Treatment for delirium

The only treatment for delirium is to treat the underlying cause, e.g. the infection. However, this won’t be enough, as the person will require lots of supportive treatment to help them to recover and to reorientate them. Avoid medication, unless specifically prescribed by a specialist, as this can be dangerous.


Show credits

Visit our website at www.agespace.orgFacebook page (search for Age Space) and Twitter account (@agespace) for more information and free advice and support on all aspects of caring for elderly parents.

Show produced by Husain Husaini at Wire Free Productions.

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