Depression Among The Elderly Or Just Normal Aging?

Isn’t depression a part of the normal aging process?

Depression is easily the most common and reversible “noncognitive” psychiatric disorder among the elderly in both the community and the nursing home setting. Depression frequently goes unrecognized and is even commonly dismissed as part of the normal aging process in long-term care settings. There is absolutely nothing normal about depression, which most often occurs in the context of multiple physical and psychosocial problems. The symptoms can frequently be vague and variable (as with somatic complaints and anxiety) and may even be manifested in symptoms that you would not commonly relate to depression, such as agitated behavior or withdrawal. Depression occurs in individuals with full memory functioning as well as those with dementia, and its incidence increases with age.

Prevalence of depression among the elderly:

The prevalence of major depression among the general population of noninstitutionalized elderly is relatively low (1.8% to 2.9%) and in nursing homes is approximately 6%. Late-life depression may cause multiple dysfunctions (decreased energy, decreased appetite with poor nutrition, anxiety, withdrawal) and excess disability for the medically ill patient. It also significantly increases the risk of premature death. Approximately 40% of elderly patients with depression become chronically depressed if they remain untreated, with about 30% to 40% showing a recurrence of symptoms within a year of recovery. The severity of associated medical illness is often the most powerful predictor of depressive symptoms. Many medical illnesses (See Table 1) and medications (See Table 2) have been associated with depression. Individuals who commit suicide after age 55 are likely to have suffered from major depression, substance abuse or other high risk factors.

Depression and dementia:

Frequently, it is difficult to distinguish between depression and dementia, particularly in patients with mild dementia or moderate to severe depression. Research has found that approximately 25% to 40% of elderly patients with dementia also have mild to severe depressive symptoms that require treatment, with about 80% of them being treated effectively using combined medication and psychotherapy. Pseudodementia refers to the cognitive impairment associated with depression in the elderly and occurs in 10% to 15% of cases. Studies have found (and my own professional experience as a psychologist working with nursing home patients has confirmed) that cognitive deficits in the areas of information processing and executive skills have been shown to improve significantly with antidepressant treatment and frequently the use of psychotherapy (studies continue to demonstrate the effectiveness of psychotherapy for patients with mild-moderate dementia).

Depression and treatment effectiveness:

Depression is the most treatable of the psychiatric diagnoses for all age groups including the elderly. There is clear evidence that elderly patients respond to antidepressant medications in cases which include even severe medical comorbidities (concurrent medical problems) and even at very advanced ages. Positive outcome studies have demonstrated success rates as high as 75% to 80% of individuals with depression being treated successfully with adequate medication and psychotherapy. Improving the level of recognition and treatment of late-life depression in long-term care settings, could markedly reduce excess disability and significantly improve the quality life for elderly residents.

Some information from Professional Psychology in Long Term Care by Victor Molinari Ph.D.

Additional information by Paul Susic Ph.D Licensed Psychologist Clinical Director of Senior Care Psychological Consulting