Depression in the Elderly: Diagnosis, Risk Factors, and Treatment

Introduction: Depression Among the Elderly

Mental disorders are becoming more prevalent in today's society as people add stress and pressure to their daily lives. The elderly population is not exempt from mental illness simply because its members may be retired. In fact, mental disorders affect 1 in 5 elderly people. One would think that with disorders being rather prevalent in this age group there would be an abundance of treatment programs, but this is not the case. Because the diagnosis of an individual's mental state is subjective in nature, many troubled seniors remain untreated. Depression in the elderly population is a common occurrence, yet the diagnosis and treatment seem to slip through the cracks (Ellison and Verma, 2003).

Depression is often difficult to diagnose, and the healthcare industry contributes to the overlooking of depression in the elderly because of the overwhelming desire to keep costs down. The factors of depression are open to interpretation, which results in different doctors looking for different things. In addition, elderly people may not exhibit the traditional symptoms of depression. Older individuals may have symptoms of depression that go unnoticed because those symptoms are being attributed to a different ailment. Up to 50% of all depressed patients seen by general physicians are not identified as depressed. Furthermore, some of the indicators people look for when detecting depression are things that society tends to consider normal for older adults (Brody and Semel, 2006).

Challenges in Diagnosing Depression in Older Adults

In the natural order of things, bodies tend to wear down over time and people become higher-risk candidates for various health problems. It is this increase in health problems that allows some symptoms of depression to be overlooked. Doctors begin to attribute all problems and ailments to a primary condition, neglecting the possibility of depression. Because the diagnosis requires assessing background, cognition, and medical history, it remains a challenging task.

Symptoms of severe depression include: diminished interest in usual activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to concentrate, and recurrent thoughts of death or suicide. Depression does not always have to be severe. To be diagnosed with mild depression or dysphoria, the patient's mood would first need to be depressed for two years. In addition, two of the following characteristics would need to be present: low self-esteem, poor concentration, difficulty making decisions, overeating or poor appetite, low energy level, insomnia or hypersomnia, and feelings of hopelessness (Unutzer, 2003).

Differences Between Depression in the Young and Old

There appear to be a few fundamental differences between depression in the young and the old. Elderly people tend to have more ideational symptoms, which are related to thoughts, ideas, and guilt. Elderly depressed individuals are also more likely to experience psychotic depressive and melancholic symptoms such as anorexia and weight loss. Finally, older people tend to have more anxiety present in their depression than younger patients (Ibid).

Risk Factors for Depression in the Elderly

The prevalence of low blood pressure is one condition that does increase as an individual ages. The correlation of depression with low blood pressure also increases over time, particularly among men. A study by Barrett-Connor and Palinkas (1994) indicated that "men with low blood pressure scored significantly higher on both the emotional and physical items of a depression test." These same individuals also scored higher on measures of pessimism, sadness, loss of appetite, weight loss, and preoccupation with health than people with normal blood pressure. Some researchers believe that because low blood pressure can cause fatigue, individuals with both symptoms could plausibly be diagnosed with depression. This is a snowball effect in which low blood pressure causes fatigue, fatigue causes a person to feel useless, and that sense of uselessness further develops into other depressive symptoms. An interesting side note from this study was that the low blood pressure found in these patients was not directly related to any chronic health condition (Ibid).

Low blood pressure is not the only risk factor for the development of depression. Other factors include losses related to jobs, status, finances, physical ability, or relocation. Family problems involving divorce, siblings, children, or a death can also send a person on a downward spiral. Changes in the brain — such as decreased adaptive capacity, neurotransmitter and receptor changes, cognitive impairment, and dementia — increase the risk of depression. As more factors enter the equation and the patient becomes more depressed, the likelihood of a suicide attempt also increases (McFarland, 2005).