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Late Life
Depression
A Fact Sheet
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 home. Unlike 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.
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,
gastrointestinal 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.
Treatment For Depression
Depression is one of the most successfully treated illnesses. When properly diagnosed and treated, more than 80 percent of those suffering from depression recover and return to their normal lives. Most depressed elderly people can improve dramatically from treatment.
The reasons for treating depression in the elderly are compelling. Untreated, the condition is likely to persist causing distress, disability, wasted health care dollars, substance abuse, and medical complications or death.
Common treatments for depression include psychotherapy, antidepressant medications, and electro convulsive therapy (ECT).
Psychotherapy can play an important role in the treatment of depression with or without medication. This type of treatment is utilized in cases of mild to moderate depression and is usually for a defined period of time (10-20 weeks).
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.
Suicide
The rate of suicide among older adults is higher than that for any other age group---and the suicide rate for persons 85 years and older is the highest of all, twice the overall national rate.
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.
RESOURCES
REFERRALS
Referrals to a geriatric psychiatrist in the U.S. or Canada are available
by visiting www.GMHFonline.org calling
(301) 654-7850. You will need
to note the city and zip code for the region in which you are or would like
the doctor to be.
PUBLICATIONS
For additional Publications
from the Geriatric Mental Health Foundation,
visit www.GMHFonline.org.
For publications from the American Association
for Geriatric Psychiatry, visit www.AAGPonline.org.
ADDITIONAL ASSOCIATION RESOURCES
National Mental Health Association
2001 N. Beauregard St., 12th Floor
Alexandria, VA 22311
1-800-969-NMHA
www.nmha.org
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
1-800-950-NAMI
www.nami.org
Depression and Bipolar Support Alliance
730 N. Franklin, Suite 501
Chicago, IL 60610
1-800-826-3632
www.dbsalliance.org
American Geriatrics Society
The Empire State Building
350 Fifth Avenue, Suite 801
New York, NY 10118
212-308-1414
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