Depression – Defined

All people feel sad or unhappy at times during their lives, but persistent sadness may be depression, a serious illness affecting 15 out of every 100 adults over age 65 in the United States. Depression is not a normal part of growing old but rather a treatable medical illness that impacts more than 6 million of the more than 40 million Americans over age 65.

When depression occurs in late life, it may be a relapse of an earlier depression. If it is a first time occurrence, it may be triggered by another illness, hospitalization, or placement in a nursing homeUnlike the onset of depression in non-elderly populations, depression in the elderly is thought to be a psychological disorder triggered by specific stressors, such as medical illness. Another causal factor is grief following the death of a loved one.

An estimated 6 percent of people ages 65 and older in a given year, or approximately 2 million individuals in this age group, have a diagnosable depressive illness.

Depression affects approximately 25 percent of those with chronic illness and is particularly common in patients with ischemic heart disease, stroke, cancer, chronic lung disease, arthritis, Alzheimer’s disease, and Parkinson’s disease. Most disturbing among depression statistics is the fact that depression affects upwards of 50 percent of nursing home residents.

Clinical depression is characterized by symptoms that interfere with the ability to function normally for a prolonged period of time. The symptoms of depression in older adults vary greatly and may include:

• Persistent sadness lasting two or more weeks
• Difficulty sleeping or concentrating
• Feeling slowed down
• Withdrawing from regular social activities
• Excessive worries about finances and health problems
• Pacing and fidgeting
• Feeling worthless or helpless
• Weight/appearance changes or frequent tearfulness
• Thoughts of suicide or death

Families and friends should watch for signs of depression in older people and these clues should not be ignored. Serious depression may lead to disability; may worsen symptoms of other illnesses or may result in premature death or suicide. Clinical depression is often undiagnosed and under treated in elderly adults because symptoms go unrecognized in the context of multiple physical problems. Often, depression in older adults is mistaken for dementia, or the symptoms are so disabling that the individual cannot articulate their distress and reach out for help.

In clinical practice, when an older person experiences a significant loss distinctions between grief and depression. Grief following the death of a loved one is normal. It is distinguished from major depression by the limited duration of functional impairment – usually less than 2 months, as compared to 2 months or more for individuals with depression. It is common and normal for waves of grief to resurge periodically; if a person displays prolonged and consistent signs of sadness coupled with expressions of hopelessness and morbid preoccupation with one’s own worthlessness or death, clinical depressions should be suspected and immediate measures taken to seek professional help.

Depression among elderly Americans is widespread. Most often it occurs in the context of the multiple physical psychosocial problems that beset this population. Awareness of a variety of clinical and behavioral clues is useful. Persistent complaints such as pain, headaches, fatigue, insomnia, GI symptoms, arthritis, multiple diffuse symptoms and weight loss are well known primary presentations of depression in the elderly. However, they may be particularly confusing in the elderly because co-existing medical disorders may also cause some of these symptoms.

The lowest rate of clinical depression is found among elderly persons living independently in a community; prevalence increases with the prevalence and severity of medical co morbidity and disability.

Mood changes and signs of depression may also be caused by medication taken for heart disease or blood pressure.

Antidepressant medications work by increasing the level of neurotransmitters in the brain. Many feelings such as pain and pleasure are a result of the functioning of the neurotransmitters and when the supply of neurotransmitters is imbalanced, depression may result. It is critical that patients take prescribed medication as directed. Missing doses or taking more than the prescribed amount of the medication compromises the effect of the antidepressant. Medication is typically prescribed for 6 months to 1 year and results from the medication may not be evident until at least 4 weeks after the initial dosage.

Electro convulsive therapy (ECT) is a treatment that is safe and effective for severe depression. This treatment is used for life threatening depression that does not respond to antidepressants.

If you are caring for an individual displaying what may be symptoms of depression, consult a physician. The first evaluation is to assess whether the depression is a side effect of a pre-existing medical condition, a medication, or another cause. If the evaluation determines that the person is depressed, ask for a referral to a geriatric psychiatrist---geriatric psychiatrists are the specialists best suited to effectively and efficiently treat mental illness in older adults. Treatment for depression is highly successful and is not a normal part of growing older.

Several studies have found that many older adults who commit suicide have visited a primary care physician very close to the time of the suicide – 20 percent on the same day and 40 percent within 1 week of the suicide. This fact demonstrates the need for primary care physicians to be alerted to the signs and symptoms of depression.

Costs of Depression

The direct and indirect costs of depression have been estimated at $43 billion each year, not including pain and suffering and diminished quality of life. Late life depression is particularly costly because of the disability that it causes and the impact on the physical health of the older person.