Depression in Older Adults
By Barry D. Lebowitz, PhD
The relationship of vision loss to depression and other mental disorders late in life is one of the classic areas of research in psychogeriatrics. For at least three decades, since the pioneering work of British psychiatric investigators such as Sir Martin Roth and colleagues, there has been steady interest in this topic.
Research in depression was recently summarized and evaluated at the NIH Consensus Development Conference on the Diagnosis and Treatment of Depression in Late Life. Following are the overall conclusions.
Depression in Older Adults Widespread, Serious
Depressive
illness is widespread among the elderly. Of the 31 million Americans
age 65 and over, nearly 5 million suffer from serious and persistent
symptoms of depression, and 1 million suffer from major depression (as
defined by DSM-FV). Prevalence is particularly high in nursing homes
and other long-term residential care settings.
Depressive illness in late life is a serious public health concern. Depression is a serious illness in its own right. It is not a normal outcome of natural aging. Depression is associated with significant functional disability in older patients. If untreated, depression increases the risk of premature death; it is also the leading cause of death by suicide in the elderly.
Medical comorbidity with depressive illness is particularly problematic in the older patient. Depression influences physiological function and alters the pattern of psychosocial risk factors for disease. Consequently, depression represents a major contributing factor for additional morbidity and mortality. Depression coexisting with medical illness is a major source of excess disability, in geriatric patients, and it significantly alters the course and outcome of treatment for medical illness.
Diagnosis and Treatment
Depression can be
diagnosed in elderly patients and can be separated from normal aging.
The diagnosis of depression is a clinical diagnosis according to DSM-IV
criteria; severity of symptoms may be assessed clinically and with use
of standard clinician rating scales and instruments. As in adult
depressions, no biological, electrophysiological, or radiological tests
show sufficient specificity and sensitivity for diagnostic purpose.
Acute treatment for depression has been shown to be safe and efficacious in elderly patients. The broad array of treatments for acute episodes of depression that are effective in adult patients are appropriate for elderly patients. Considerable data exist for psychopharmacologic approaches and for electroconvulsive therapy, and suggestive data exist for selected psychosocial interventions.
Depression is a recurrent illness and close attention must be paid to continuation and maintenance treatment in order to prolong the period of remission and recovery. Recommendations on the advisability of long-term treatment are largely based upon extrapolation from adult patients, but include continuation of treatment for at least six months beyond remission for those experiencing their initial episode of depression in late life, and continuation of treatment for at least 12 months bevond remission for those with histories of depression.
Depression is a chronic, recurring, and life threatening disease. In the context of medical illness on physical handicap, depression must be a special concern in psychogeriatrics because of the excess disability it brings to already complex questions of clinical care, treatment, and rehabilitation. Particular attention must be paid to identifying and treating depression in rehabilitation programs, since the achievement of rehabilitation objectives can be significantly altered in individuals with untreated depression.
References:
Birren J, Sloane RB. Cohen GD (1992) Handbook of Mental Health and Aging. San Diego: Academic Press.
NIH
Consensus Development Panel on Depression in Late Life (1992).
Diagnosis and treatment of depression in late life. JAMA 268:8 (August
26.1992), 1018-1024.
Schneider LS. Reynolds CF, Lebowitz BD,
Friedhoff AJ (Eds.) (1994). Diagnosis andi Treatment of Depression in
Late Life Washington. D,C.:American Psychiatric Press.
Barry D. Lebowitz, PhD, is Chief of Mental Disorders of the Aging Research Branch, National Institute of Mental Health, Washington, DC.
Source: The Lighthouse Inc.'s Aging & Vision News newsletter (Spring 1995 issue)
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