Depression in the Elderly
Consequences, Symptoms and Treatment of Depression in Old Age
Jun 28, 2008
Depression is a biologically based illness just like diabetes or high blood pressure, with real physical consequences. In recognition of this, there is a growing movement of mental health practitioners and primary care physicians teaming up to identify medical patients in need of mental health treatment and to offer such treatment in the physician’s office. In most states, insurance companies are now required to cover the costs of treating biologically based mental health disorders like depression, the same as they would cover treatment for other physical illness.
Complications of Depression in the Elderly
Depression in the elderly leads to poorer health and slower recovery from physical illness. It also leads to increased death rates from other illnesses, increased physical pain, higher health care costs and lower quality of life.
Suicide Risk in the Elderly
The suicide rate among those age 65 and older is higher than in any other age group. According to the Centers for Disease Control, in those 85 and older it is twice the national average. This affects mostly men, whose suicide risk increases as they age. Women’s risk for suicide peaks at middle age and then declines.
Why the Elderly Often Don’t Seek Treatment for Depression
Stigma has prevented elderly people who are depressed from seeking help for depression. Because of the attitudes of the culture they grew up in, it is often difficult for some elderly people to believe that depression is not a sign of weakness or a reason for shame. Only 1/3 of older persons who need mental health services actually receive them.
Symptoms of Depression in the Elderly
According to the Diagnostic and Statistical Manual of Mental Disorders, the classic symptoms of depression are:
- loss of interest in pleasurable activities including sex
- decreased energy
- difficulty concentrating
- suicidal thoughts
- inappropriate guilt, feelings of worthlessness
- irritability, restlessness
- weeping and teariness
- anxiety
- sleeping too much or too little
- eating too much or too little
Depression often shows up in the elderly as:
- memory loss
- chronic pain
- vague physical symptoms and medical complaints
- irritability and restlessness
- feeling like one is going to die
- increased use of medical services
Treatment for Depression in the Elderly
Elderly patients with depression respond as well to medication as the general population according to Gail Patry in her August, 2004 article "Recognition and Treatment of Depression in Long Term Care Facilities", published in Medicine and Health Rhode Island. Because of possible drug interactions, care must be taken in prescribing. Treating the depression, whether through drugs or psychotherapy is critical because of all of the medical complications of depression, including suicide.
Various forms of psychotherapy are also proven to be effective with the elderly including:
- cognitive-behavioral therapy
- brief therapy
- group therapy
- and psychodynamic psychotherapies
Seek out a practitioner who has experience with the elderly.
Caregiver and Peer Support Groups are Effective
Caregiver support groups and services as well as faith-based peer support groups have been proven to be effective with those who are caregiving family members or experiencing loss. Results are improved caregiver mental and physical health including increased ability to manage stress and lower blood pressure. Attendance at caregiver support groups is associated with enabling family caregivers to delay placing their loved ones in nursing homes by more than a year.
Clinical depression is not “normal” in any age group. It has serious physical, financial, emotional and quality of life implications. Just as a broken leg, depression can and should be treated at any age.
Reference: Power Point presentation, "Mental Health and Aging" by Clinical Assistant Professor of Psychiatry at SUNY Stony Brook, Lory Bright-Long, MD, CMD.
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