Depression in later life: what the research means for families

NHS England says adult mental-health services should remove upper age limits and base access on need. This is a service expectation, not a guarantee that every local route works well. Older people may need help with travel, accessible information or an appointment format they can use [1].

A 2024 study in one English Talking Therapies service examined older people who did not take up treatment after referral. Its service records and interviews highlighted barriers between referral and attendance. Because it was observational research in one service, it cannot prove that a particular referral method caused better engagement [2].

For a supporter, the useful question is what happens next. With their agreement, help check whether they need to respond to a letter, make another call or arrange transport. Ask what alternatives are available if hearing, sight, fatigue or using an online service makes the appointment difficult.

Treatment can include psychological therapy as well as medicine. The Royal College of Psychiatrists describes options for older adults and the barriers that can make care harder to reach [3].

In England, adults can contact NHS Talking Therapies directly. Assessment helps establish what treatment is suitable. Elsewhere in the UK, use their GP or the mental-health care route for their nation. Ask how the service can accommodate their needs rather than assuming that age makes therapy unsuitable [4].

Behavioural activation is a structured treatment that helps someone work towards activities that matter to them when depression makes it difficult to do things. CASPER tested collaborative care, including this approach, in 705 people aged 65 and over. Their average age was 77. They had depressive symptoms below the threshold for major depression [5].

The intervention produced a small improvement in depression scores compared with usual care. At 12 months, 15.7% of those assessed in the intervention group met the study's depression questionnaire threshold, compared with 27.8% in usual care. These are not cure rates. More people dropped out of the intervention group, and the authors said the clinical importance of the primary symptom-score difference was uncertain [5].

This supports asking about structured help where appropriate. It does not establish that a family activity plan will have the same effect. Nor does a later analysis of session attendance establish a universal minimum of five sessions [6].

BASIL+ involved 435 older adults with long-term health conditions and depressive symptoms during the pandemic. Their average age was about 76. Participants were offered up to eight telephone sessions with trained support workers; they attended about five on average [7].

At three months, depressive symptoms were lower in the intervention group than with usual care and signposting. The average difference was 1.65 points on the PHQ-9 depression questionnaire. Emotional loneliness improved modestly; results for overall loneliness and social loneliness were less clear [7].

The finding concerns a structured programme, delivered in a particular setting. It does not show that routine family calls treat depression, or establish how long the benefit lasts. Ordinary calls can still provide company without becoming therapy sessions or repeated checks on symptoms.

A supporter can help with a chosen activity, share a meal or make getting out easier. Let the person decide what appeals and what they have energy for. An interest does not have to become a recovery task. You can talk about a programme, a memory or something happening in your own life without asking them to report on their mood every time.

These are practical suggestions for company, not activities individually tested by the trials above. The everyday support section and company and local services offer examples. Your availability matters too: a regular arrangement should be one you can sustain.

A 2024 review brought together 47 exercise studies in older adults. Results suggested benefits for depressive symptoms, but studies differed in participants, activities and methods. An analysis relating results to studies' average ages does not establish an age at which exercise stops helping an individual [8].

A separate 2025 review included 12 papers involving 994 middle-aged and older adults. It also found an average benefit, with differences between studies. Its subgroup finding favoured individual exercise; that is not a sufficient reason to tell everyone to exercise alone [9].

Preferences, access and health needs still matter. Someone might prefer a walk with company, an adapted class or an activity at home. If pain, frailty, falls or other health problems affect what they can do, ask their clinician or physiotherapist about suitable options. Avoid making family support depend on meeting a fixed exercise target.

An exploratory analysis of the ACHIEVE trial followed 977 people aged 70 - 84 with untreated hearing loss. It compared a hearing intervention, including audiological support and hearing aids, with health education [10].

Over three years, the hearing-intervention group retained more social connections and had a small difference in loneliness scores. The authors did not consider the loneliness change clinically meaningful. Depression treatment was not the outcome being tested [10].

Hearing difficulties are still worth addressing in their own right. Ask what would make conversations and appointments easier. If hearing is gradually worsening, a GP can arrange assessment; sudden or rapidly worsening hearing loss needs prompt medical advice [11].

A trial of 291 adults aged 60 and over compared cognitive behavioural therapy for insomnia, or CBT-I, with sleep education. Participants had insomnia and had not had major depression in the previous year. Follow-up was extended from two years to up to three years [12].

During follow-up, 12.2% of the CBT-I group developed or experienced a recurrence of major depression, compared with 25.9% of the sleep-education group. Not everyone completed the extended follow-up. This is encouraging evidence about prevention in people with insomnia; it does not show that CBT-I alone treats an existing episode of depression [12].

If sleep problems are persistent or affecting daily life, help them raise this with their GP. The NHS describes CBT as one possible treatment for insomnia, with access and format varying [13]. Helping someone reach suitable treatment is different from imposing a sleep schedule yourself.