Depression in the elderly

Elderly Depression: A Review of Psychological Literature

When exploring the issues of aging there are important investigative studies available in the literature to aid the researcher in understanding key psychological aspects. This paper delves into several studies that embrace important components of the elderly experience -- in particular the problems encountered that relate to depression. The four studies that will be reviewed in this paper are all based on sound empirical psychological strategies and will be presented in a format that is both instructive and interesting.

It is not a revelation to learn that as humans get up in years, they begin to lose the alertness and clarity of thought, memory, and perception. For those unfortunate individuals whose cognitive skills diminish to the point of dementia the likelihood of becoming depressed is greatly increased. Hence researchers are continually monitoring the elderly to attempt to discover possible markers early in life that may portend dementia and depression in the later years.

Literature Review: In the journal Gerontology the authors point out that due to the definition gap between normal dynamics of getting older (the transitional stage that includes memory loss) and dementia, a new phrase has become commonplace in the literature. Indeed, "mild cognitive impairment" (MCI) is now being used in that context, and while MCI is certainly not as serious a problem for aging individuals as dementia, it nevertheless is referred to as a "heterogeneous clinical syndrome" for which no DSM-IV criteria has yet been established (Dierckx, et al., 2007). One of the key themes in this research article is an attempt to come to terms with the relationship between MCI and depression in elderly people. Also, the piece stresses that a better understanding of when, how and why older people fall into the MCI category can help in terms of screening for possible beginnings of Alzheimer's (AD).

Dierckx (p. 30) outlines the existing -- though not necessarily fully accepted in the literature -- criteria for determining if a person has moved into an MCI condition or not. One, if the individual has a "memory complaint" and that problem is collaborated by "an informant" then MCI may be present; two, if the person's "episodic memory" abilities are fading this indicates there may be serious neuropsychological impairment; three, if the person's cognitive functioning is "largely normal" there may not be a problem; four, if the "daily living" functions are "intact" MCI may not be in evidence; and five, use of the CAMCOG test should tell the clinician whether or not the individual is "more than 1.5 standard deviation below the mean for his (or her) age" (pp. 30-31).

Because about 25% of elderly people suffer from depression and cognitive impairment when they reach (and pass) 65 years of age, this research is important to the field of psychology and gerontology. Additionally, the authors believe that the "neuropsychological presentation of MCI and depression may be very similar" (p. 31). The association between depression and dementia can be broken down into four hypotheses, the authors explain. Those four are: a) depression is "an early stage of dementia"; b) depression is "a risk factor for dementia"; c) depression happens as a response to "the loss of function associated with the early cognitive decline of dementia"; and d) depression and dementia share "common risk factors such as cerebrovascular disease" (pp. 31-32).

At the conclusion of the piece the authors assert that further research might well be focused on tests and tools that can "predict conversion to dementia" and also researchers should attempt to make a "differentiation between progressive and non-progressive MCI" (p. 33).

Meanwhile a study in the journal Developmental Psychology looks into the issue of cognitive reserve, which is the generally accepted theory that those individuals who, earlier in life, achieved higher levels of education and training (and knowledge), would "…exhibit higher levels of cognitive functioning" later in life (Tucker-Drob, et al., 2009). This research is pertinent because the degree of loss of cognitive function in elderly people -- and the timing of that loss -- offers helpful data for those in the fields of psychology and healthcare.

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 among men and women" (p. 93).