Wednesday, February 24, 2010

Depression in the Elderly

Depression in the elderly is very common, although it is not a normal part of aging. Late-life depression affects about 6 million Americans age 65 and older, but only 10% receive treatment for depression. This is likely because the symptoms of depression in the elderly are often confused with the effects of multiple illnesses and the medicines used to treat them.

How Does Depression in the Elderly Differ from Depression in Younger People?

Depression in later life frequently coexists with other medical illnesses and disabilities. In addition, advancing age is often accompanied by loss of key social support systems due to the death of a spouse or siblings, retirement and/or relocation of residence. Because of their change in circumstances and the fact that they're expected to slow down, doctors and family may miss the diagnosis of depression in elderly people, delaying effective treatment. As a result, many seniors find themselves having to cope with symptoms that could otherwise be easily treated.

Depression tends to last longer in elderly adults. It also doubles their risk to develop cardiac diseases and increases their risk of death from illness, while reducing their ability to rehabilitate. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increased 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 is more likely to lead to suicide. The risk of suicide is a serious concern among elderly patients with depression. Elderly white men are at greatest risk, with suicide rates in people ages 80 to 84 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.

What are the Risk Factors for Depression in the Elderly?

Factors that increase the risk of depression in the elderly include: Being female, unmarried (especially if widowed), stressful life events, and lack of a supportive social network. Having physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer and dementia further increases that risk. While depression may be an effect of certain health problems, it can also increase a person's risk of developing other illnesses—primarily those affecting the immune system, like infections.

The following risk factors for depression are often seen in the elderly:

Certain medicines or combination of medicines
Other illnesses
Living alone, social isolation
Recent bereavement
Presence of chronic or severe pain
Damage to body image (from amputation, cancer surgery, or heart attack)
Fear of death
Previous history of depression
Family history of major depressive disorder
Past suicide attempt(s)
Substance abuse

Persons who develop their first depression in old age are very likely to have very small abnormal areas seen on head imagery that indicate tiny spots in the brain that may not be receiving adequate blood flow. Consequent chemical changes in these cells may enhance the likelihood of depression, apart from any life stress.

What Other Problems Affect Treatment of Depression in the Elderly?

The stigma attached to mental illness and psychiatric treatment is even more powerful among the elderly and is often shared by members of the patient's family, friends, and neighbors. This stigma can keep elderly patients from seeking treatment. In addition, depressed older people may not report their depression because they believe there is no hope for help.

Elderly people may also not be willing to take their medicines because of side effects or cost. In addition, having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines.

Alcoholism and abuse of other substances may interfere with effective treatment, and unhappy life events—including the death of family or friends, poverty, and isolation—may also affect the patient's motivation to continue with treatment.