Depression in Older Adults
Facts about Geriatric Depression
Geriatric depression is widespread with at least 16% of patients receiving care in a primary care setting and a higher percentage in hospitals and nursing homes exhibiting depression. (Reynolds and Kupfer, 1999). At least 15-20% of the elderly in the general population may experience depression (Kaplan and Sadock, 1998). Steffens and colleagues (2000) found that the point prevalence for depression in older adults was 4.4% in women and 2.7% in men, higher than previous estimates in the United States.
Yet depression in the elderly is a complex problem, particularly difficult to diagnose due to medical illness, dementia syndromes, and heterogeneity of patient populations (Small, 1998). Arriving at an accurate diagnosis requires that clinician to differentiate between such problems as dementia, stroke, and other types of brain injuries and illnesses.
Depression in the older adult can be disabling, contributing to problems with activities of daily living and thus increasing their dependence on others and the health care system (Oslin, Streim, Katz, Edell, and TenHave, 2000). Reynolds and Kupfer (1999) argue that depression in later life has serious consequences, including increased health costs, patient and caregiver distress, amplified disabilities, and increased mortality related to medical illness and suicide. In fact, there is evidence that depression in the elderly is strongly associated with poor cognitive function and decline (Yaffe, Blackwell, Gore, Sands, Reus, and Browner, 1999).
The older adult is more at risk for depression and suicide due to the losses they experience, including death of a spouse, death of friends, retirement, and medical illness and disability. With an increasingly older population, this group requires closer examination and understanding of the mechanisms by which depression is manifested and treated.
Sources:
Kaplan, H.I. and Sadock, B.J. (1998). Synopsis of Psychiatry. Philadelphia: Lippincott, Williams, Wilkens.
Oslin, D.W., Strein, J., Katz, I.R., Edell, W.S., TenHave, T. (2000). Change in disability follows impatient treatment for late life depression. Journal of the American Geriatrics Society, 48(4):357-62.
Reynolds, C.F., and Kupfer, D.J. (1999). Depression and aging: A look to the future. Psychiatric Services, 50 (9): 1167-72.
Small, G.W. (1998). Treatment of geriatric depression. Depression and Anxiety Suppl. 1:32-42
Steffans, D.C., Skoog, I., Norton, M.C., Hart, A.D., Tschanz, J.T., Plassman, B.L., Wyse, B.W., Welsh-Bohmer, K.A., and Breitner, J.C. (2000). Prevalence of depression and its treatment in an elderly population: the Cache County study. Archives of General Psychiatry, 57(6)601-7.
Yafffe, K., Blackwell, T., Gore, R., Sands, L., Reus, V., Browner, W.S. (1999). Depressive symptoms and cognitive decline is nondemented elderly women: a prospective study. Archives of General Psychiatry, 56(5): 425-30.
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Geropsychiatry Section - Department of Psychiatry
