Depression in the Elderly

Depression in the elderly is prevalent, persistent, disabling and sometimes fatal. All of us, seniors and caretakers alike, are burdened by the myth that depression is a natural result of aging. Yes, psychiatric needs of seniors are different from those of younger persons, and the causes leading to a change in personality are different. But what's important is that many elder individuals who are depressed often go unnoticed or are not offered treatment.

It is estimated that there are 2 million people over the age of 65 in the U.S. who are depressed. Because medicine can be too focused on chronic medical illness, physicians, as a result, do not have enough time to discuss issues regarding emotional health. As our population ages, it is imperative that society and physicians become more sensitive to emotional health concerns in order to improve the total well being of elders.

1. disability
2. decline
3. diminished quality of life
4. demand on caregivers
5. dementia

Other co-existing illnesses can affect an individual's mood. Patients who have had a heart attack or stroke are more likely to be depressed. Although not enough research has been done, alcohol abuse can also have an effect. Twenty percent of alcoholics suffer from depression(2) and remission of alcohol abuse increases the likelihood of depression remission.(3) Thirty-three percent of depressed elderly patients have an anxiety disorder. Depressed elderly patients may, additionally, have personality disorders — typically, avoidance and dependence, obsessive compulsive and passive-aggressive types, as compared to antisocial, borderline, histrionic and narcissistic types more commonly seen in younger patients with mood disorders.(4)

Family history of depression is an important risk factor for late life depression.(5) A survey done by the National Mental Health Association in 1996 showed that 58% felt depression was a normal part of the aging process, and 49% attributed depression to personal weakness. Although depression is more common in younger patients, 20% of suicides are in older patients (highest in any age group),(6) specifically older white men, who also had a greater rate of success of suicide. These men tended to live alone, were widowed, had chronic medical illnesses and saw their primary medical doctor a few weeks prior to suicide. Again, it is important to pay attention to the life stresses to raise awareness for suicide.

It has been shown that 50 to 70% of all medical visits by the elderly have, as a major component, emotional distress or dysfunction. These patients were less likely to have greater social contacts. They had an increasing feeling that their health was poor. As a result, they had more doctor visits and medical costs.

A study of outpatients showed that only 9% of doctors used routine questioning or screening for depression.(7) The diagnosis of depression was made 33% of the time by formal criteria. Fifty-eight percent of doctors asked about suicide. One-third of doctors offered 5 minutes of counseling. Seventy-two percent gave medicines and 38% referred to a psychiatrist.

In the presence of chronic medical illness, physicians are less likely to discuss depression but are very receptive to patient requests for medication. Older patients tended to have depression without sadness. It has been shown that 5 to 10% of nursing home patients are depressed, as well as 11% of inpatients and 12 to 22% of nursing home patients.(8) Loss of independent functioning has been associated with depression and the treatment of depression can improve function even when no change occurs in the medical condition that caused disability. It is also important to treat depression because, otherwise, medical burden is increased.