Depression is a medical disorder and is an intense feeling of sadness and worthlessness. Depression affects thoughts, feelings, physical health, and behaviors. Depression is not just “feeling blue” or “down in the dumps.” It is not an ordinary part of aging: whether depression is a long-term issues or newly diagnosed residents can get better with treatment.
Why is it important?
Depressed elderly men have a twofold risk of admission to hospital
Time spent in hospital for people with mental illness relative to other diagnoses is twice as long
15% - 25% of residents have symptoms of major depression (1)
25% to 30% of patients fail to respond to initial therapy (3)
Health problems: frailty, illness and disability; chronic or severe pain; cognitive decline; previous stroke, damage to body image due to surgery or disease.
Loneliness and isolation: a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
Reduced sense of purpose: Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
Fears – Fear of death or dying; anxiety over financial problems or health issues.
Recent bereavements –death of friends, family members, and pets; the loss of a spouse or partner.(4)
It is difficult to make a diagnosis of depression, particularly in patients with co-existing dementia and/or chronic medical illness; left untreated, mental illness can seriously affect physical health (3)
Depression red flags include:
abandoning or losing interest in hobbies or other pleasurable pastimes
social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
weight loss or loss of appetite
sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
increased use of alcohol or other drugs
fixation on death; suicidal thoughts or attempts
Often presents atypically which may include:
non-specific features of irritability
calling out and restlessness
may co-exist with dementia
Factors suggestive of higher risk of suicide include:
evidence of plan/intent
significant loss of support
Types of treatment include medication, psychotherapy and peer support. Treatment can be pharmaceutical (antidepressants) or non-pharmaceutical Factors to guide antidepressant choice can include previous response, concurrent conditions, type of depression, other medications, and risk of overdose. (1)ECT can be particularly effective in treating depression in the elderly.
2. Frank, C. (2014) Pharmacologic treatment of depression in the elderly. Canadian Family Physician (CFP) vol. 60 no. 2, 121-126, February 2014. Retrieved Feb. 2014 from: http://www.cfp.ca/content/60/2/121.full
2. Dickinson, J., Gorber, S.C., Jaramillo, A., Joffres, M., Lewin, G., Pottie, K., Shaw, E. and Tonelli, M. Canadian Task Force on Preventive Health Care, Recommendations on screening for depression in adults. CMAJ June 11, 2013 vol. 185 no. 9. Retrieved March 2014 from: http://www.cmaj.ca/content/185/9/775.full.pdf+html