Depression Among the Elderly

Everyone experiences moments of sadness -- it's a very normal and very human emotion. But sometimes, feelings of unhappiness can be overwhelming and may indicate that a person has depression. National Depression Screening Day, which is held every October during Mental Illness Awareness Week, helps bring attention to the need for routine screening by primary care physicians to determine those patients most at risk.

According to the American Association of Geriatric Psychiatry, depression affects 15 percent of adults older than 65 in the United States. Depression is not just a condition that occurs when people get older, but rather, it is a medical illness that is treatable. More than 40 million Americans are over the age of 65, and more than 6 million of them are affected by depression.

Depression screening is effective

"Screening the elderly for depression is going to pick up more individuals who are having difficulty with recent loss, whether it's physical or emotional," says Gary J. Kennedy, M.D., a geriatric psychiatrist professor of Geriatric Psychiatry at Montefiore Medical Center in Bronx, N.Y. He also is the author of Geriatric Mental Health Care: A Treatment Guide for the Health Professional, which was published in 2000.

Kennedy adds that screening is a positive tool, provided you have the treatment to back it up. "When screening fails, it's because people are sent out of the screening site without an appointment to get care immediately thereafter, so screening is really only as good as the follow-through."

The goal of National Depression Screening Day is to alert the general public to the vast number of those who suffer undiagnosed, treatable depression -- possibly our mothers, fathers, siblings, children, ourselves. Individuals can be screened for depression and other mental health problems and be offered treatment. Older Adult Outreach is a part of National Depression Screening Day and brings the screening program to places where elderly people can participate, including retirement communities, assisted living facilities, social clubs and nursing homes.

The screening form used for older adults included questions on generalized anxiety disorder in addition to the standard questions about depression and bipolar disorder. Anxiety disorders, which often coexist with depression in the elderly, have often been overlooked.

Depression triggers

Depression in the elderly is often triggered by some of the following events:

• A recurrence of a previous depression



• A new illness



• Hospitalization



• Moving into a nursing home



• Death of a loved one

Depression coexisting with chronic illness

According to Kennedy, coexisting medical illness complicates feelings of depression. For example, he says most physically ill people do not have suicidal thoughts, unless they have a major depressive disorder.

The American Association for Geriatric Psychiatry reports about 25 percent of people experience depression coexisting with a chronic illness. The illnesses that particularly affect mental health in the elderly include:

• Ischemic heart disease



• Stroke



• Cancer



• Chronic lung disease



• Arthritis



• Alzheimer's disease



• Parkinson's disease

Physical signs

Often depression in the elderly results in physical ailments that are in fact signs of depression. Sometimes, older people are reluctant to admit to emotional symptoms of depression, but they will talk about physical ailments. These signs are often overlooked because coexisting medical conditions also can have the same symptoms. Some common physical symptoms that may indicate depression in the elderly include:

• Generalized pain



• Headache



• Fatigue



• Insomnia



• Gastrointestinal complaints



• Arthritis



• Multiple diffuse symptoms



• Weight loss

Emotional signs

Kennedy says, "The best screening instrument is a physician or family member who knows the person well. A gradual loss of interest, increased irritability, thoughts of harming oneself and increased alcohol intake can be signs of depression, beyond the usual common sense identifiers, such as a person having a gloomy, pessimistic mood or crying all the time."

Relatives and friends of elderly men and women should be aware of signs that their loved one may be experiencing depression. It's important not to dismiss or ignore the signs, because severe depression can lead to disability or worsening symptoms of their coexisting disease may result in premature death or even suicide. These signs may include:

• Feelings of sadness that are persistent and last longer than two weeks



• Trouble concentrating or sleeping



• Weariness



• Indecisiveness



• Losing interest in social activities previously enjoyed



• Excessive worrying about financial and health problems



• Uncontrolled physical movements like pacing or fidgeting



• Feelings of helplessness or worthlessness



• Excessive crying



• Weight gain or loss



• Changes in appearance



• Suicidal thought



• Preoccupation with death

"Medication for depression is widely available," Kennedy says. "But what's not widely available is the kind of aggressive follow-through that makes sure the medication is working. More people are being treated, but that doesn't mean they are being treated effectively."

External Sources American Association of Retired Persons National Mental Health Association National Institute of Mental Health American Geriatrics Society Screening for Mental Health, Inc. Web site. National depression screening day: older adult outreach. 2002. Accessed October 18, 2002. American Association of Geriatric Psychiatry Web site. Patients & caregivers: late life depression: a fact sheet. 2002. Accessed October 18, 2002. American Association of Geriatric Psychiatry Web site. Patients & caregivers: depression in late life: not a natural part of aging. 2002. Accessed October 18, 2002.

This article was reviewed and updated June 2007.

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