Depression among the elderly
Isn’t depression a
part of the normal aging process?
 Depression is
easily the most common and reversible "noncognitive" psychiatric
disorder among the elderly in both the community and the nursing home
setting. Depression frequently goes unrecognized and is even commonly
dismissed as part of the normal aging process in long-term care
settings. There is absolutely nothing normal about depression, which
most often occurs in the context of multiple physical and psychosocial
problems. The symptoms can frequently be vague and variable (as with
somatic complaints and anxiety) and may even be manifested in symptoms
that you would not commonly relate to depression, such as agitated
behavior or withdrawal. Depression occurs in individuals with full
memory functioning as well as those with dementia, and its incidence
increases with age.
Prevalence of
depression among the elderly:
The prevalence of
major depression among the general population of noninstitutionalized
elderly is relatively low (1.8% to 2.9%) and in nursing homes is
approximately 6%. Late-life depression may cause multiple
dysfunctions (decreased energy, decreased appetite with poor
nutrition, anxiety, withdrawal) and excess disability for the
medically ill patient. It also significantly increases the risk of
premature death. Approximately 40% of elderly patients with depression
become chronically depressed if they remain untreated, with about 30%
to 40% showing a recurrence of symptoms within a year of recovery.
The severity of associated medical illness is often the most powerful
predictor of depressive symptoms. Many medical illnesses (See
Table 1) and medications (See Table 2) have been associated with
depression. Individuals who commit suicide after age 55 are likely to
have suffered from major depression, substance abuse or other high
risk factors.
Depression and
dementia:
Frequently, it is
difficult to distinguish between depression and dementia, particularly
in patients with mild dementia or moderate to severe depression.
Research has found that approximately 25% to 40% of elderly patients
with dementia also have mild to severe depressive symptoms that
require treatment, with about 80% of them being treated effectively
using combined medication and psychotherapy. Pseudodementia
refers to the cognitive impairment associated with depression in the
elderly and occurs in 10% to 15% of cases. Studies have found (and my
own professional experience as a psychologist working with nursing
home patients has confirmed) that cognitive deficits in the areas of
information processing and executive skills have been shown to improve
significantly with antidepressant treatment and frequently the use of
psychotherapy (studies continue to demonstrate the effectiveness of
psychotherapy for patients with mild-moderate dementia).
Depression and
treatment effectiveness:
Depression is the
most treatable of the psychiatric diagnoses for all age groups
including the elderly. There is clear evidence that elderly patients
respond to antidepressant medications in cases which include even
severe medical comorbidities (concurrent medical problems) and even at
very advanced ages. Positive outcome studies have demonstrated
success rates as high as 75% to 80% of individuals with depression
being treated successfully with adequate medication and psychotherapy.
Improving the level of recognition and treatment of late-life
depression in long-term care settings, could markedly reduce excess
disability and significantly improve the quality life for elderly
residents.
Some information
from Professional Psychology in Long Term Care by Victor Molinari
Ph.D.
Additional
information by Paul Susic MA Licensed Psychologist Ph.D. Candidate
Clinical Director of
Senior Care Psychological Consulting
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