Depression In Elderly

At one time, it was commonly thought that women were particularly vulnerable to depression when their children left home and they were confronted with "empty nest syndrome" and experienced a profound loss of purpose and identity. However, studies show no increase in depressive illness among women at this stage of life.

As with younger age groups, more elderly women than men suffer from depressive illness. Similarly, for all age groups, being unmarried (which includes widowhood) is also a risk factor for depression. Most important, depression should not be dismissed as a normal consequence of the physical, social, and economic problems of later life. In fact, studies show that most older people feel satisfied with their lives.

About 800,000 persons are widowed each year. Most of them are older, female, and experience varying degrees of depressive symptomatology. Most do not need formal treatment, but those who are moderately or severely sad appear to benefit from self-help groups or various psychosocial treatments. However, a third of widows/widowers do meet criteria for major depressive episode in the first month after the death, and half of these remain clinically depressed 1 year later. These depressions respond to standard antidepressant treatments, although research on when to start treatment or how medications should be combined with psychosocial treatments is still in its early stages.

Men must cope with several kinds of stress as they age. If they have been the primary wage earners for their families and have identified heavily with their jobs, they may feel stress upon retirement-loss of an important role, loss of self-esteem-that can lead to depression. Similarly, the loss of friends and family and the onset of other health problems can trigger depression. Nevertheless, most elderly people feel satisfied with their lives, and it is not "normal" for older adults to feel depressed.20 Depression is an illness that can be effectively treated, thereby decreasing unnecessary suffering, improving the chances for recovery from other illnesses, and prolonging productive life.

However, health care professionals may miss depressive symptoms in older patients, who are often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss, and who may complain primarily of physical symptoms.21 Also, it may be difficult to discern a co-occurring depressive disorder in patients who present with other illnesses, such as heart disease, stroke, or cancer, which in themselves may cause depressive symptoms, or which may be treated with medications that have side effects resembling depression. If a depressive illness is diagnosed, treatment with appropriate medication and/or brief psychotherapy can help older adults manage both diseases, thus enhancing survival and quality of life.

The importance of identifying and treating depression in older adults is stressed by the statistics on suicide among the elderly. There is a common perception that suicide rates are highest among the young; however, it is the elderly, particularly older white males that have the highest rates. Over 70 percent of older suicide victims have been to their primary care physician within the month of their death, many with a depressive illness that was not detected.22 This has led to research efforts to determine how to best improve physicians' abilities to detect and treat depression in older adults.23

Approximately 80 percent of older adults with depression improve when they receive treatment with antidepressant medication, psychotherapy, or a combination of both.24 In addition, research has shown that a combination of psychotherapy and antidepressant medication is highly effective for reducing recurrences of depression among older adults.25 Psychotherapy alone has been shown to prolong periods of good health free from depression, and is particularly useful for older patients who cannot or will not take medication.20 Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caregivers.