About Depression in the Elderly

It is well known that changes occur in the body as a person ages. Older people are more prone to certain illnesses. The elderly are also at greater risk of being depressed, which is one of the leading causes of suicide in the older population. According to the Centers for Disease Control and Prevention, people 65 years of age and older make up 12 percent of the American population, but in 2004 accounted for 16 percent of suicide deaths. Many laypersons and professionals are not aware that depression is a medical illness or confuse the symptoms with dementia. Further, some elderly are embarrassed about being ill or are concerned about being stigmatized. Instead of saying that they are depressed, they blame their problem on a medical illness.

Incorrect Assumption

• The National Institute of Mental Health (NIMH) reports that mental illness is a "widely under-recognized and undertreated medical illness." Studies find that many older adults, as many as 75 percent, saw a doctor less than a month before committing suicide. Such results stress the critical importance of the detection and treatment of depression by the health care providers.

Physical and Mental Illness Co-Occurrence

• The NIMH also reports that the risk of elderly depression is greater with other illnesses and decreased ability to function. Health care providers need to be more cognizant of the co-occurrence of illness and depression, so the two problems can be treated separately.

  This finding is also associated with the increase of depression of older individuals who require health care support or need to live in a elder-care facility. Older people who live on their own have a 1 percent to 5 percent risk of depression. However, this number rises to 13.5 percent with those who need home health care and 11.5 percent for those who are in the hospital.

Additonal Risk Factors

• In addition to becoming ill, there are a number of other factors that may cause depression in the elderly. Health care providers also need to be cognizant of these increased risks. Depression is more associated with women than men. Also, individuals more prone toward the illness are living alone, facing a great deal of stress in their lives, taking medications with depressive side effects, and coping with their body image from, for example, an amputation, heart attack or cancer. They have been depressed in the past and may have previously attempted suicide. Depression also is often genetic and runs in families. Recent studies are also recognizing the impact of insomnia on mental health.

Neuroimaging Offering New Insights

• According to a report by Dr. Frank Kozel at the Medical University of South Carolina, neuroimaging, or brain scans, of the elderly depressed offer "an exciting opportunity" for treatment. For example, the brain scans of individuals who become depressed for the first time when they become older show areas where there may be an inadequate flow of blood. These cells may be undergoing chemical changes that increase the chance of depression.

  A great deal of work is being done in neuroimaging, such as studying brain changes along with different depression treatments, such as medicine, cognitive-behavioral therapy, sleep deprivation, and shock therapy. Although most studies are only in the research stages, it is expected that these results will be able to help elderly depression in the future.

Treatment

• The NIMH also reports that studies and anecdotal research show how depression can be treated by antidepressants, which alter the brain chemicals called neurotransmitters, such as serotonin. There are many different kinds of antidepressants and the response to them varies. If one medication does not help a person, another one may be of help. Many elderly are now receiving antidepressants when their depression is recognized. Psychotherapy and electroconvulsive ("shock") therapy or a combination of the approaches can also be effective.

Distinction Between Depression and Dementia

• Dr. Brent Forester from McLean Hospital in Belmont, Massachusetts, provides ways that health care professionals can determine the difference between depression and dementia:

  Memory: Depressed individuals have difficulty concentrating, but those with dementia cannot store new information.

  Orientation: Individuals who are depressed normally know with whom they are talking, the time and date, but those with dementia show confusion about such things.

  Language: Depressed individuals may speak more slowly, but those who have dementia frequently forget common words.

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