Depression and the Elderly Cox

Depression and the Elderly

Cox (1993), reports in her research that physical impairment in the elderly is not the only cause for concern, our concern should span to include the impact that mental health problems pose, especially depression on the functioning of older adults, the report further states that in the elderly community between 15 to 22% are affected by depression. "It is a widespread and serious medical disorder. Significant depressive symptoms affect over 5 million of the 35 million people over the age of 65 years in the United States" (D'Mello, 2003, p. 3). The report further states that there are connections in existence between depression and frailty. Apathy, withdrawal etc. are conducive to frailty; these symptoms in turn affect the older adult's motivation and capacity for self-care. Depression effects their bathing habits, ability to climb stairs, dressing, socializing, walking, and work so extensively that the effects compare to those of serious heart conditions (p. 7). The consequences of this are substantial: impaired compliance with medical treatment, over utilization of health care resources, diminished quality of life, and premature mortality. Nevertheless, depression is frequently under diagnosed; when properly diagnosed, it is often under treated (D'Mello, 2003, p. 3)

Given the fact that depression can be a major contributor to frailty, the role of mental health services in meeting the needs of the elderly community must be examined more closely. Unfortunately, such services remain underutilized by the older population. Findings suggest that only 2.7% of services were utilized by individuals 65 and older. With these limitations on community mental health care, it may be anticipated that many of those in need of treatment do not receive it or are forced to move to an institution due to an inability to cope in society. In fact, a majority of those in nursing homes have mental disorders and disorientation that limit their capacity for self-care (Cox, 1993, p. 9). Depression ranks among the leading causes of disability worldwide even though medications, psychotherapy, and other treatments reduce symptoms related to the illness. However, the side effects of drugs, especially in older adults, and the less-than-universal effectiveness of current therapies prompt the continued search for alternate safe treatment interventions. Numerous research studies report the use of psychotherapeutic approaches and compare them to medical therapies. (Mcfarland, 2005)

Medical treatments have been assessed through various studies. Mcfarland, reports on studies on cognitive behavioral therapy. Research was conducted in hopes that there would be a significant change in coping ability, and significant changes in the older adult's feelings. Cognitive behavior of 102 elderly outpatients with mild to moderate depression is compared. The patients were randomly assigned to one of three groups: 1) desipramine alone, 2) cognitive behavioral therapy alone, or 3) desipramine plus cognitive behavioral therapy for 16-20 therapy sessions. Research results show that the groups that received desipramine plus cognitive behavioral therapy showed greater improvement than the groups taking medication alone, whereas the group receiving cognitive therapy alone showed only marginally more improvement. The study suggests that cognitive therapy alone and in combination with medication offers effective treatment for mild-moderate depression in the elderly (2005).