Dealing with Depression In Later Life

Facts about depression in later life

Depression is the most common psychiatric disturbance in the elderly.

15-25% of the elderly are depressed. The number increases if there is chronic illness or the person is in a nursing homes-it far exceeds the frequency of Alzheimer's Disease.

Since 12% of the population is now over 65 and that number is expected to double in the next 50 years, attention need to be focused on how to improve the quality of life for this important segment of the population.

Depression in the elderly has not been studied intensively. It is often masked by organic disease.

There is a need for improvement in identification of depression in the elderly.

It is life threatening. It may be the precursor of suicide. 10-15% of people with major depression commit suicide. The risk of suicide increases with age.

Social issues that contribute to depression in the elderly and keep them from getting appropriate treatment:

• Our society focuses on and values youthfulness--the capacities and attributes of the elderly are consistently underrated and undervalued in our society.

• Older people may feel that their life is meaningless - that they no longer have value.

• They were taught to be independent and feel they should be able to take care of themselves and their own problems.

• They are not comfortable talking about, and tend to minimize, symptoms that have emotional or psychological components. Stigma worsens this problem.

• They fear of hospitalization, particularly psychiatric hospitalization.

• Loss related to age--family, friends, work, physical loss of abilities, appearance, home, self esteem, role, social status, support network--is a strong contributing factor.

• There are no longer have extended families that provide meaning, support and care.

• Depression may be worsened by poor health, poor diet, lack of exercise, light, money and social support.

• Elder abuse is sometimes a factor.

• The diagnostic procedure is complex, especially if there are medical problems which are common in the elderly.

• It's difficult to draw the line between what is depression and what is sadness connected to disappointment and loss.

• Symptoms such as apathy, asthenia, memory disorders and deterioration are viewed as part of the aging process when it is in fact depression.

• The elderly are afraid to talk about the confusion and memory loss of depression because they think it might be Alzheimer's.

Consequently, it is estimated that only 25% of the depressed elderly receive appropriate care.

The positive side of this picture is:

There is lots of hope. Many older people who have had short or long and even repeated episodes of depression have gotten well and stayed well for long periods of time. They are happy, healthy and enjoy being alive.

When is treatment necessary?

Treatment is necessary if:

• pain and sadness connected to a specific event last too long

• sadness, disappointment and loss persistently affect daily activities of work, study, family, leisure activities, social activities

• they have some of the following symptoms:
  • weight loss (not usual but occasional weight gain)
  • hypersomnia or insomnia
  • anorexia
  • constipation
  • agitation and anxiety
  • fatigue-loss of energy
  • isolation
  • lack of sexual interest-may lead to impotence in males
  • decline in personal hygiene
  • apathy
  • psychomotor restlessness
  • hypochondriac fears
  • feelings of loss of self esteem
  • delusions of ruin and poverty
  • confusion-psuedodementia
  • memory problems

Depression is more common if there is a previous episode or episodes of depression and if there is a family history of mood instability or alcoholism. Family members and supporters need to watch for subtle changes as the person may be unaware of symptoms or be willing to report them.