The authors of this research studied 690 individuals between the ages 65 and 89 over a five-year period. They called the survey the "Advanced Cognitive Training for Independent and Vital Elderly" study (ACTIVE) -- and the results indicate that "cognitive reserve reflects the persistence of earlier differences in cognitive functioning" as opposed to the differential rates of "age-associated cognitive declines" (Tucker-Drob, p. 431). Moreover, the authors offer a pair of conclusions highly germane to elderly issues. One, formal education achieved during the formative years is not directly related to "rates of decline in cognitive functioning during later life" (p. 441). And two, getting a good education "casually influences cognitive abilities" during youthful years and "these benefits seem to persist…until late adulthood." Indeed the authors hypothesize that these benefits "may also serve to protect against functional impairment" and hence have "substantial implications for everyday functioning in later life" (p. 441).

An article in Southern Medical Journal discusses the "…psychologic morbidity, particularly depressive symptoms" that can be brought on by the death of an elderly spouse (Williams, 2005). The negative and depressive experience of an elderly person who has lost a spouse can "exacerbate the health effects" that the surviving elderly person is already struggling with, Williams explains. Moreover, this "magnifier effect" tends to be "especially pernicious" due to the fact that "bereavement and depression both tend to increase cardiovascular mortality rates" (Williams, p. 90).

What a primary care physician should look for in an elderly person that has recently lost a loved one (in particular a spouse) is signs of "mood disorders"; in the event of a death of a spouse an elderly bereaved person should be encouraged to continue with any religious or spiritual observances, Williams adds. There may also be a need for psychotherapy and other psychosocial support, to help the bereaved person from falling too deeply into depression. Depression, in fact, is itself a killer; to wit, a group of Dutch investigators followed a "large cohort of [depressed] older persons" over a 4-year period and found that "major depression was associated with almost a twofold higher risk of death...

93).
Meanwhile Dr. Joseph I. Sirven, Professor of Neurology at the University of Minnesota, along with researcher Barbara L. Malamut (PhD) write that in long-term care facilities, there is only one mental disorder that is more common among elderly people than depression, and that is dementia. In the book Clinical Neurology of the Older Adult (Sirven et al., 2005) the authors assert that the annual rate of new cases of "major depression" is as high as 9.4%. The risk factors associated with depression -- and those are higher among females -- include: a) lower levels of education (which collaborates material provided earlier in this paper); b) a history of poverty beginning with childhood; c) sexual assault; d) parental divorce or separation; e) lower level of occupational profession; f) widowhood "or other unmarried states"; g) lack of social support network; h) "chronic financial or medical stresses"; i) "acute provoking events"; and j) a history of heavy consumption of alcohol (Sirven, p. 544).

One problem healthcare professionals in nursing homes confront in determining depressive symptoms in the elderly is that "When cognitive impairment is prominent, mood symptoms are even less likely to be reported" (Sirven, p. 543). Clinicians often require observable behaviors vis-a-vis an elderly patient's danger level, hence the conundrum.

References

Dierckx, E., Engelborghs, S., De Raedt, R., De Deyn, P.P., & Ponjaert-Kristoffersen, I.

(2007). Mild Cognitive Impairment: What's in a Name? Gerontology, 53, 28-35.

Sirven, Joseph I., & Malamut, Barbara L. (2008). Clinical Neurology of the Older

Adult. Hagerstown, MD: Lippincott Williams & Wilkins.

Tucker-Brob, Elliot, Johnson, Kathy E. & Jones, Richard N. (2009). The Cognitive

Reserve Hypothesis: A Longitudinal Examination of Age-Associated Declines

in Reasoning and Processing Speed. Developmental Psychology, 45(2), 431-446.

Williams, Jonathan Richard. (2005). Depression as a Mediator Between Spousal Bereavement

and Mortality From Cardiovascular Disease: Appreciating and Managing the Adverse

Health Consequences of Depression in an Elderly Surviving Spouse. Southern…