Diagnosing and Managing Depression in the Elderly

Gary Figiel, MD

By Gary Figiel, MD
Southeastern Geriatric Healthcare Group
Atlanta, Georgia

Member of the national ElderCare Matters Alliance,
Georgia chapter

Depression is a serious life threatening illness, which without question increases the risk of mortality in elderly patients and is linked with increased mortality of residents in nursing and assisted living homes, along with other long-term care facilities.
Studies reveal that the presence of major depression during admission to a nursing home facility more than doubles the likelihood of death one year later independently of other health conditions.

Additionally, a growing body of evidence shows that depression adversely affects the course of other illnessess common to the elderly such as: diabetes, cancer, cardiovascular disease, and Alzheimer’s Disease.

Depression and Alzheimer’s

Depression occurs in about 20% – 40% of people with Alzheimer’s and other late life dementias, according to the Alzheimer’s Association.

Because of the complexities involved in diagnosing depression in someone with Alzheimer’s, consulting a geriatric psychiatrist who specializes in identifying and treating depression in older adults can be helpful.

Essential elements of the evaluation will include:

  • a review of the person’s medical history.
  • a physical and mental examination, and
  • interviews with family members who know the person well.

Proper diagnoses and treatment of depression can improve an Alzheimer’s patient’s sense of well-being, quality of life, and individual function, despite an ongoing decline in cognitive ability.

What causes depression

Research in understanding the causes of depression in the elderly are actively ongoing.

Cerebrovascular disease and the psychological problems associated with the losses that occur during aging are believed to be leading risk factors.

However, a combination of many additional factors, including genetic components, personality, and environment all play a significant role in the manifestation of depression.

Symptoms of depression

Symptoms that commonly occur in older patients with depression include:

  • depressed mood;
  • loss of interest in the activities of daily living;
  • loss of appetite;
  • changes in sleeping patterns and energy levels;
  • cognitive decline;
  • delusional thinking; and
  • sucidal thoughts.

Treatments for depression

Clinical research indicates that both biological and psychological treatments are effective for treating different types of depression in the elderly.

  • Several antidepressants have been shown to be both safe and effective for the treatment of depression in the elderly. (For these medications to be effective, a therapeutic dose should be used for 4-8 weeks).
  • Counseling and/or psycholterapy has been shown to be effectively used in combination with antidepressants.
  • For patients with severe depression or depression that does not respond to medication, electroconvulsive therapy (ECT) remains one of the safest and most effective treatments for severe depression.

A manageable illness

Depression is a common, serous, life threatening illness in the elderly that is commonly misdiagnosed and improperly treated. However, if properly diagnosed, numerous advances in the treatment of depression have made it a very manageable illness.

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