We can talk about depression in older people in a variety of ways. In very general terms, for example, there is evidence that depression is less common in older years than younger. However, dig a little deeper and we discover that rates of depression in the very old (say 85 and over) actually seems to increase. Then we can look at depression in a more focused way. For example, researchers at the University of Missouri suggest depression affects up to 40 percent of nursing home residents. If this is the case we have to question whether depression in the elderly is being ignored, or whether other factors appear to mask depression?
There's certainly something about the elderly population that seems to invite misunderstandings. Even today depression is commonly viewed as some natural manifestation of age. The lack of energy and retreat in sleep that frequently accompanies depression can easily be written off as senescence. The illnesses and ailments that so frequently accompany old age often impair mobility. This restricts normal levels of activity and interaction. The additional medications needed for conditions associated with aging, can themselves have side effects, including depression. Socially, many elderly people live isolated lives and have little in the way of income. Put together, the combination of issues provides a platform for the development of depressive symptoms and suicidality.
In places where care and companionship are on hand it seems, to me at least, remarkable that rates of depression appear at such high levels. The Missouri study, previously mentioned, discovered a series of indicators that appear to be outside of the classic mood indicators that would normally indicate depression. Study author, professor Lorraine Phillips, states that increased verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability and decline in performance of daily living activities, are all associated with the development of depression. Phillips goes on to say that residents with increased verbal aggression were 69 percent more likely to be diagnosed with depression.
The key to successfully diagnosing depression in elderly residents is prompt diagnosis and treatment. Significantly, it is important to realize that the development of clinical needs often coincides with the development of depression.
Phillips, L.J., Rantz, M., Petroski, G.F. (2010) Indicators of a New Depression Diagnosis in Nursing Home Residents. Journal of Gerontological Nursing. DOI: 10.3928/00989134-20100702-03.