Depression In The Elderly 

Depression is a medical illness characterized by persistent sadness, discouragement,  and loss of self-worth. These feelings  are accompanied by reduced energy and concentration, sleep problems (insomnia), decreased appetite and weight loss. In  the elderly, depression is also frequently characterized by excessive concerns about bodily  aches and pains.

Causes, incidence, and risk factors 

Detecting  depression in the elderly may be complicated by several factors. Often  the symptoms of depression such  as fatigue, loss of appetite, and sleeping difficulties  are associated  with the aging process or a medical condition rather than with major depressive disorder. 

Contributing factors include the loss of a spouse or close friends, chronic pain  and illness, difficulty with mobility, frustration with memory loss, difficulty adapting  to changing circumstances such as moving from a home  to a retirement facility,  or changes within  the family. 

Depression can  also be  a sign of a medical problem. It  may be complicated by brain disorders associated with the aging process such as Alzheimer's disease. 

Depression  in the elderly is a widespread problem  that is often not diagnosed  and frequently undertreated. Many older individuals will  not admit  to signs and  symptoms of depression for fear  of being seen as weak  or crazy. 

Symptoms 

• depressed or irritable mood 
• feelings  of worthlessness or sadness 
• loss  of interest or pleasure  in daily activities 
• temper, agitation 
• change in appetite, usually  a loss  of appetite 
• change  in weight 

• difficulty sleeping 

• fatigue (tiredness  or weariness)
• difficulty concentrating 
• memory loss 
• abnormal thoughts, excessive or inappropriate  guilt
• excessively irresponsible behavior pattern
• abnormal thoughts about death 
• thoughts about suicide 
• plans to commit  suicide or actual suicide attempts

If these symptoms are present every day for more than 2 weeks, then depression  is likely present. 

Signs and tests

• a physical examination will help determine if there is a medical illness causing  the depression
• psychological evaluation 
• blood tests: CBC  or blood differential, thyroid function tests, liver  or kidney function tests 
• a variety  of other tests may be needed 

Treatment 

Sometimes depression can be alleviated by social interventions to help with isolation or loneliness such as group outings, volunteer work for the healthy elderly, or regular visits from concerned people. 

Treatment  of underlying medical conditions or  the discontinuation of certain medications may alleviate symptoms. 

Antidepressant drug therapy has been shown to increase quality of life  in depressed elderly patients. These medications are carefully monitored for side effects,  and doses are usually lower  and increased more slowly than in younger adults. 

Neuroleptic medications may help treat agitation in some individuals. Electroconvulsive therapy (ECT) may be indicated in the severely depressed if other measures are unsuccessful. 

Expectations (prognosis) 

If detected,  depression may respond to medical treatment. Undetected, it may lead to complications. The outcome is usually worse for those who have limited access to social services,  or to family or friends who can help promote an interest in activities. 

Complications 

Depression may be complicated by Alzheimer's disease or  other forms of dementia. It may also complicate other medical conditions in  the elderly. Untreated depression in  the elderly is associated with a high rate of suicide. 

Calling your health care provider 

Call your health care provider if you are feeling worthless or hopeless or if you are crying frequently. Also call if you feel  that you are having difficulty coping  with stresses in your life and want  a referral  for counseling. 

Go to  the nearest emergency room or call your local emergency number (such  as 911) if you are having thoughts  of suicide (taking your own life).

If you are caring for an aging family member and think  they might be suffering from depression, contact their health care provider. Often, older patients will not admit  to signs  and symptoms  of depression out  of pride. 

Prevention 
Prevention  is related  to the contributing factors. Social supports that help deal  with losses, mobility changes, and so on  can be helpful. In many cases, there is no effective prevention.