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depression in the elderly

Depression is a continuing feeling of sadness, despair, or hopelessness. The feelings remain and affect daily living. Depression affects 3 to 5% of people over age 65. When the person has a medical illness, such as coronary artery disease, emphysema, stroke, or cancer, the rate increases to 40%.

What is going on in the body? 
The elderly face a lot of situations that can contribute to depression. Many important social support systems are lost. This may be due to the death of a spouse or close friend, retirement, or moving to a new home. The elderly are often also dealing with chronic illnesses. The illnesses can decrease activity, which also leads to depression.

What are the signs and symptoms of the condition? 
Signs and symptoms of depression in the elderly may include:
  • a loss of interest or pleasure in usual activities
  • sleep disorders
  • a loss of appetite and weight
  • a loss of energy
  • feelings of agitation
  • feelings of wanting to avoid other people
  • difficulty concentrating
  • feelings of guilt
  • feelings of worthlessness
  • thoughts of death or suicide
What are the causes and risks of the condition? 
Examples of causes and risk for depression in the elderly include:
  • medical conditions. These include cancer, heart and lung disease, strokes, arthritis, age-related hearing loss, and ageing changes in the senses. These disorders may trigger chemical changes that affect the brain. These medical conditions also create other concerns. The person may worry about finances, living arrangements, and a decreased ability to be independent.
  • a past history of depression
  • retirement. After years of being a productive member of society, people may feel that they are not accomplishing anything useful.
  • the death of a spouse or close friend
  • certain medications
What can be done to prevent the condition? 
Preventing complications of depression, such as suicide, can be accomplished by recognising and treating depression early.

How is the condition diagnosed? 
Depression is diagnosed based on symptoms. It is under-diagnosed in the elderly. The signs of depression may not be as clear as they are in a younger person. An elderly person may tell their doctor about aches and pains, or other mood states, such as agitation. Symptoms may be confused with other ailments common in the elderly, such as Alzheimer's disease. The elderly person may not be aware that he or she is depressed. Social attitude can be one of the biggest blocks for seeking help, since many people think depression will go away by itself. They may think they are too old to get help or that seeking help is a sign of weakness.

A complete medical history and physical examination should be done when an elderly person has symptoms of depression. A screening test such as the Beck Depression Inventory may be done. This test has 20 questions that are used to help diagnose depression.

What are the long-term effects of the condition? 
Untreated depression in the elderly can cause a person to spend their "golden years" in sadness and despair. This can lead to suicide.

What are the risks to others? 
This condition is not contagious.

What are the treatments for the condition? 
Treatment goals are to decrease symptoms, reduce the risk of relapse, and increase quality of life. Medications and counselling usually work the best. Anti-depressant medications elevate the mood, and work for about 60 to 80% of users. It may take up to 6 weeks before results are noticed. There are different types of counselling. Individual psychotherapy, support groups, and cognitive behavioural therapy are all used to treat depression in the elderly. In severe, continuing cases, electroconvulsive therapy, or shock treatment, is used. A short-acting anaesthetic is given before the procedure. A small amount of current is sent to the brain, causing a generalised seizure.

What are the side effects of the treatments? 
The side effects of anti-depressants include sleepiness, dizziness, insomnia, weight loss, and anxiety. Shock treatment can cause problems with short-term memory, headache, nausea, and muscle soreness.

What happens after treatment for the condition? 
Treatment can lead to partial or complete relief of symptoms. Treatment can improve the general mental, physical, and social functioning in the elderly. Treatment is usually maintained for at least 6 months after symptoms go away. If there is a history of depression, treatment may be recommended on a continuous basis.

How is the condition monitored? 
A person on anti-depressant medications may need to have blood levels monitored. This is especially important because about 70% of elderly people do not take their medication every time. This leads to wide fluctuations in medication blood levels.

Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 19/06/2005
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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