Depression in the Elderly

Clinical depression in the elderly is common. That doesn't mean, though, it's normal. Late-life depression affects about 6 million Americans age 65 and older. But only 10% receive treatment for depression. The likely reason is that the elderly often display symptoms of depression differently. Depression in the elderly is also frequently confused with the effects of multiple illnesses and the medicines used to treat them.

How does depression in the elderly differ from depression in younger adults?

Depression in later life frequently coexists with other medical illnesses and disabilities. In addition, advancing age is often accompanied by loss of social support systems due to the death of a spouse or siblings, retirement, or relocation of residence. Because of changes in an elderly person's circumstances and the fact that elderly people are expected to slow down, doctors and family may miss the signs of depression. As a result, effective treatment gets delayed. Many seniors find themselves trying to cope with symptoms that could have been easily treated.

Depression tends to last longer in elderly adults. It doubles their risk of cardiac diseases and increases their risk of death from illness. At the same time, depression reduces an elderly person's ability to rehabilitate.

Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increases the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack. For that reason, making sure that an elderly person you are concerned about is evaluated and treated is important, even if the depression is mild.

Depression in the elderly, especially elderly white men, is more likely to lead to suicide. The suicide rate in people ages 80 to 84 is more than twice that of the general population. The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.

How is insomnia related to depression in the elderly?

Insomnia is usually a symptom of depression. New studies reveal that insomnia is also a risk factor for depression onset and recurrence -- particularly in the elderly.

To treat insomnia, experts recommend the newer "hypnotic" drugs that are safe and effective in elderly people. If there's no improvement in the sleep disorder and/or depression, a psychiatrist or psychopharmacologist may prescribe medications and/or psychotherapy.

What are risk factors for depression in the elderly?

Factors that increase the risk of depression in the elderly include:

• Being female
• Being unmarried (especially if widowed)
• Lack of a supportive social network
• Stressful life events

Physical conditions like stroke, hypertension, atrial fibrillation, diabetes, cancer, and dementia further increase the risk. Additionally, the following risk factors for depression are often seen in the elderly:

• Certain medicines or combination of medicines
• Damage to body image (from amputation, cancer surgery, or heart attack)
• Family history of major depressive disorder
• Fear of death
• Living alone, social isolation
• Other illnesses
• Past suicide attempt(s)
• Presence of chronic or severe pain
• Previous history of depression
• Recent bereavement
• Substance abuse

Brain scans of people who develop their first depression in old age often reveal spots in the brain that may not be receiving adequate blood flow. Chemical changes in these cells may enhance the likelihood of depression separate from any life stress.