Depression in the Elderly
Clinical depression in the elderly
is common. That doesn't mean, though, it's normal. Late-life depression affects
about 6 million Americans age 65 and older. But only 10% receive treatment for
depression. The likely reason is that the elderly often display symptoms of depression
differently. Depression in the elderly is also frequently confused with the
effects of multiple illnesses and the medicines used to treat them.
Depression Symptoms
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Dennis Lee, MD
Depression is a very common condition that is believed by many experts to be
the number one cause of disability in the world. In the U.S., 17% of people will
experience depression at some point in their lives. An estimated 19 million
people in the U.S. are currently suffering from depression. Depression is more
common in women then in men, with 25% of women suffering from depression severe
enough to warrant treatment at least once during their lifetime.
It's important to remember that depression is an illness
that affects both the body and mind. It is not something that we can just wish
away or "snap out of," nor is it a sign of a weak character. The good news about depression is
that almost everyone suffering from this condition can be helped with treatment,
so it is important to recognize the signs and symptoms of depression.
How does depression in the elderly differ from
depression in younger
adults?
Depression in later life frequently coexists with other medical illnesses
and disabilities. In addition, advancing age is often accompanied by loss of
social support systems due to the death of a spouse or siblings, retirement, or
relocation of residence. Because of changes in an elderly person's
circumstances and the fact that elderly people are expected to slow down,
doctors and family may miss the signs of depression. As a result, effective
treatment gets delayed. Many seniors find themselves trying to cope with
symptoms that could have been easily treated.
Depression tends to last longer in elderly adults. It doubles their risk of
cardiac diseases and increases their risk of death from illness. At the same
time, depression reduces an elderly person's ability to rehabilitate.
Studies of nursing home patients with physical illnesses have shown that the
presence of depression substantially increases the likelihood of death from
those illnesses. Depression also has been associated with increased risk of
death following a heart attack. For that reason,
making sure that an elderly person you are concerned about is evaluated and
treated is important, even if the depression is mild.
Depression in the elderly, especially elderly white men, is more likely to
lead to suicide. The suicide rate in
people ages 80 to 84 is more than twice that of the general population. The
National Institute of Mental Health considers depression in people age 65 and
older to be a major public health problem.
How is insomnia related to depression in the elderly?
Insomnia is usually a symptom
of depression. New studies reveal that insomnia is also a risk factor for
depression onset and recurrence -- particularly in the elderly.
To treat insomnia, experts recommend the newer "hypnotic" drugs that are safe and effective in elderly people. If
there's no improvement in the sleep disorder and/or depression,
a psychiatrist or psychopharmacologist may prescribe medications and/or
psychotherapy.
What are risk factors for depression in the
elderly?
Factors that increase the risk of depression in the elderly include:
- Being female
- Being single, unmarried, divorced, or widowed
- Lack of a supportive social network
- Stressful life events
Physical conditions like stroke, hypertension, atrial
fibrillation, diabetes, cancer, dementia, and chronic
pain further increase the risk. Additionally, the following risk factors
for depression are often seen in the elderly:
- Certain medicines or combination of medicines
- Damage to body image (from amputation,
cancer surgery, or heart attack)
- Family history of major depressive disorder
- Fear of death
- Living alone, social isolation
- Other illnesses
- Past suicide attempt(s)
- Presence of chronic or severe pain
- Previous history of depression
- Recent bereavement
- Substance abuse
Brain scans of people who develop their first depression in old age often
reveal spots in the brain that may not be receiving adequate blood flow.
Chemical changes in these cells may enhance the likelihood of depression
separate from any life stress.
