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A Guide to Mental Wellness in Older
Age: Recognizing and Overcoming Depression
What is Late-Life Depression—The
Facts
Depression is a physical disorder of the brain that
impacts over 20 million adults overall and affects
more than 6.5 million individuals over the age of 65.
Depression impacts a person’s whole being—mental
health and physical health—and if left untreated
can disable those who might otherwise be healthy individuals.
Symptoms
Depression can take on many forms. Mild symptoms
may include loss of appetite or disturbed sleep. More
severe
episodes of depression may include unreal or strange
thoughts including thoughts of suicide. A clinical
depression is defined as a change in mood in which
an individual experiences a drastic low that can also
be accompanied by changes in sleep, appetite, energy,
and the ability to maintain everyday life at home.
The recognition of depression in the elderly is particularly
challenging. Since many older adults have physical
illnesses and/or do not have a strong social network,
health care providers, family members, and patients
themselves often incorrectly conclude that depression
is a normal outgrowth of those problems. Depression
is not a normal part of aging. The widely held belief
that depression is normal makes this illness more often
not diagnosed—and therefore, not treated.
The
symptoms of depression for an older adult may differ
from those for a younger person. For example, an older
person is more likely to have sleep problems as compared
to a younger person who experiences a more pronounced
depressed mood. Depression tends to last for a longer
period of time in older adults and may increase their
risk for physical health problems or death. Depression
in older adults is more likely to lead to suicide.
The risk of suicide is serious. Elderly white men are
at the greatest risk, and those ages 80-84 have a suicide
rate more than twice that of the general population.
Causes
There is no one cause for depression and the
onset of late-life depression can be attributed to
genetic,
biological, or neurological factors; life changes;
illnesses; or a combination. Some older adults with
depression have suffered from the illness for most
of their lives. For others, their experience with depression
may not begin until late life. An individual can be
70, 80 or even 90 years of age before he or she first
experiences depression. Depression in late life is
more common in women, widowed individuals, those who
lack a supportive social network, and those with physical
health problems.
Depression and Physical Health
Depression can also
occur at the same time as another illness, especially
after a bypass operation, hip fracture,
or stroke. The mind and the body are not separate—physical
illnesses such as heart disease and cancer may bring
the onset of depression. The same is true in the reverse—depression
impacts an older adult’s physical well-being.
When an older adult suffers from depression as well
as heart disease or diabetes, the recovery period for
the physical illness is longer and the treatment for
that physical illness may not be as effective. Late-life
depression exaggerates any existing health problems
and increases the risk of death.
Depression Among Nursing
Home Residents
Although few large studies have been
done to determine the rate of depression among nursing
home residents,
the studies that have been done conclude that depression
among older adults in nursing homes is very common.
Most studies to detect mental illness in nursing home
residents have taken place in urban areas; relatively
few rural facilities have been included in the studies.
Study limitations have resulted in reports that vary
widely in stating the percentage of residents with
depression. What is agreed, however, is that the number
of nursing home residents with depressive symptoms
is significant and this illness impacts the resident’s
quality of life. Depression can contribute to decreased
appetite, weight loss, and lower resistance to infections,
and have other side effects that can be associated
with increased risk of illness. It is important that
depression be diagnosed and treated appropriately in
this setting.
Stigma
Stigma that society places on depression (and
other mental illnesses) can discourage people from
getting
treatment. Some people are ashamed that they have depression—they
feel that it is their fault or that they should be
able to help themselves out of their depressed mood.
The stigma associated with late-life depression has
a chilling impact on individuals seeking treatment
and recovering from depression. Only 10 percent of
older adults receive treatment for their clinical depression.
Depression is not a weakness or a character flaw.
Depression is an illness that can be successfully treated. A Guide to Mental Wellness in Older Age: Recognizing
and Overcoming Depression
© Geriatric Mental Health Foundation 2004
7910 Woodmont Avenue, Suite 1050
Bethesda, Maryland 20814
301.654.7850
info@GMHFonline.org
www.GMHFonline.org
Expert assistance was provided by Lissy F. Jarvik,
M.D., Professor Emerita of Psychiatry and Biobehavioral
Sciences, University of California-Los Angeles, School
of Medicine; Susan Lieff, M.D., M.Ed., Assistant Professor,
Department of Psychiatry, University of Toronto; and
Stephen J. Bartels, M.D., M.S., Associate Professor
of Psychiatry, Dartmouth Medical School.
The Geriatric Mental Health Foundation grants permission
to print, photocopy, and distribute this material.
Please cite the Foundation, including the address,
phone and website.
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