By: Brian Neese
Around 7 million of the nation’s 39 million adults ages 65 years and older are affected by depression, according to the Centers for Disease Control and Prevention (CDC). Although a majority of older adults are not depressed, they have an increased risk of developing depression, which is a persistent sad, anxious or empty feeling, or a feeling of hopelessness and pessimism.
Unfortunately, depression in older adults is often not recognized or treated. Symptoms may be mistaken for natural reactions to illness or life changes that occur during aging. Geriatric depression is associated with an increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, reports the Annual Review of Clinical Psychology.
Due to its consequences, geriatric depression is regarded as a major public health problem. On a more positive note, the CDC says that it is “fairly easy to detect” and “highly treatable.”
Depression can cause feelings of sadness or anxiety that last for weeks at a time. Additionally, a wide range of other symptoms may be present.
- Feelings of hopelessness, pessimism, guilt, worthlessness and helplessness
- Irritability and restlessness
- Loss of interest in activities once pleasurable
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Sleeping difficulties or irregular sleeping patterns
- Overeating or appetite loss
- Thoughts of suicide
- Persistent aches or pains that do not get better, despite treatment
Depressed individuals over the age of 65 are less likely than younger individuals to exhibit dysphoria, which is a state of unease or general dissatisfaction with life, a study in the Journal of Gerontology found. Older individuals with depression are more likely than younger individuals to experience sleep disturbance, fatigue, psychomotor retardation, loss of interest in living and hopelessness, according to Psychological Medicine.
Additionally, older depressed individuals commonly complain of poor memory and concentration. The Archives of General Psychiatry found that patients with late-life depression had slower cognitive processing speed and performed poorer in all cognitive domains.
“Non-genetic biological risk factors for depression are particularly important in old age,” says the Annual Review of Clinical Psychology. Several factors have been associated with late-age depression.
- Endocrine dysregulation, bone loss and certain medications (beta blockers, central nervous system medications, hormones, anti-Parkinson agents, certain cancer medications and others) may cause late-life depression.
- Around 20 to 25 percent of heart disease patients experience major depression, and another 20 to 25 percent experience symptoms of depression not meeting criteria for major depressive disorder, according to Biological Psychiatry.
- Dementia may be a risk factor for depression, but diabetes is not. Rather, the evidence suggests that depression is a risk factor for diabetes.
- Stroke patients have the highest rates of major depression (20 to 25 percent) among other neurological disorders. Rates are intermediate (15 to 20 percent) for Parkinson’s disease compared to Alzheimer’s disease (10 to 15 percent).
- Anxiety disorder and sleep disturbance are also risk factors for depression among older adults.
Social risk factors for depression, though less important in old age, can become more significant in very old age when individuals face greater losses and fewer resources. As with other ages, Psychology and Aging found that late-life depression is linked to the number of stressful life events experienced. Also, troubled relationships can explain depressed older individuals, including spousal depression, marital conflict and perceived family criticism. In The Journals of Gerontology, financial trouble is one of the most common stressful life events experienced by older adults.
Treatment and Prevention
In a review of evidence-based therapies for depression in older adults, Clinical Psychology: Science and Practice named the following as beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and reminiscence therapy. A behavioral treatment plan for depression in nursing homes was successful in Clinical Case Studies. It found a strong increase in positive affect and activity level after a 10-session program for increasing pleasant activities was administered. In the Journal of Mental Health and Aging, a meta-analysis found that psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being in older adults by about one half standard deviation and clinician-rated depression by more than one standard deviation.
In 2007, an expert panel recommended home- or clinic-based depression care management (DCM) along with cognitive behavioral therapy for older adults with depression, the American Journal of Preventive Medicine reports. DCM uses a team approach with a trained social worker, nurse or other practitioner alongside a primary care provider who prescribes treatments in consultation with a psychiatrist. Clinical trials link DCM to a reduction in depression symptoms, higher remission rates and improvements in health-related quality of life, reports the CDC.
Prevention efforts are often directed to those who are at an increased risk of disorder. The American Journal of Psychiatry found that treating all patients with subsyndromal depressive symptoms could prevent 24.6 percent of new depression onsets in that period. In Aging & Mental Health, cognitive behavioral therapy demonstrated significant benefits in the prevention of depression in nursing home residents. Treatment of insomnia and other sleep disturbance is a valuable opportunity to prevent depression in older adults, given the highly effective nature of cognitive behavioral treatments for insomnia in this age group. The American Journal of Geriatric Psychiatry identified that individual educational interventions for subjects with chronic illness, individual therapy for at-risk bereaved older adults, cognitive-behavioral interventions to reduce negative thinking and life review were interventions with the most empirical support. Programs to reduce social isolation may also help prevent depression in older adults.
Helping Seniors in the Community
Human services professionals can join healthcare professionals and families to provide support for older adults who have or are at risk for depression. From clinics and nursing homes to homeless shelters, a variety of environments exist where individuals are particularly at risk for developing depression. Professionals trained to work with older adults and lead initiatives in the community can make a difference.
Southeastern University offers an online B.S. in Human Services and an online M.A. in Human Services to positively impact seniors. Both programs equip graduates with the knowledge and skills needed to work in and lead human service environments. The master’s program offers a gerontology specialization, and both degree options take place in a convenient online format.