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Depression in the Elderly

of a elderlyman

Don't Ignore the Senior Death Wish

*** Suicide is the leading cause of death for the elderly. ***

Many people think that depression is something you just have to live with when you get older, but it's not. (You can read more below.)

In 2006, there was one elderly suicide every 90 minutes. That’s about 14.5 elderly suicides each day.

Something to think about: The statistics for elderly suicides will never be accurate. Family members do not want to admit to the world that an elderly person in their family committed suicide. The obituary will most likely read, died of natural causes.

Elderly Depression Test

It is a myth that depression is part of the aging process. It is not normal for people of any age to suffer from depression; this includes our elderly population. Major depression (also known as clinical depression) is a medical illness. It is a chemical imbalance in the brain and can appear in people regardless of age, race or economic status. The illness can appear after a triggering event or for no apparent reason at all.

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.

Vincent van Gogh's 1890 painting
Sorrowing old man ('At Eternity's Gate')

of a sad man

What are risk factors for depression in the elderly?

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

• Being female
• Being single, unmarried, divorced, or widowed
• Lack of a supportive social network
• Stressful life events

Physical conditions like stroke, hypertension, atrial fibrillation diabetes, cancer,
dementia, and chronic pain 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

Old age, I decided, is a gift.

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.

What types of treatment are available for depression in the elderly?

There are several treatment options available for depression. They include medicine, psychotherapy or counseling, or electroconvulsive therapy. In more difficult to treat cases, a combination of these may be appropriate.

How do antidepressants relieve depression in the elderly?

Most of the available antidepressants are believed to be equally effective in elderly adults. But the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older antidepressants -- such as amitriptyline and imipramine -- can be sedating or cause a sudden drop in blood pressure when a person stands up. That can lead to falls and fractures.

Antidepressants may take longer to start working in older people than they do in younger people. Since elderly people are more sensitive to medicines, doctors may prescribe lower doses at first. In general, the length of treatment for depression in the elderly is longer than it is in younger patients.

Can psychotherapy help relieve depression in the elderly?

Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are helpful. Psychotherapy is especially beneficial for those who prefer not to take medicine. It also is helpful for people who cannot take drugs because of side effects, interactions with other medicines, or other medical illnesses. Psychotherapy in older adults can address a broad range of functional and social consequences of depression. Many doctors recommend the use of psychotherapy in combination with antidepressant medicines.

Who may benefit from electroconvulsive therapy (ECT)?

ECT can play an important role in the treatment of depression in older adults. When older patients are unable to take traditional antidepressant medicines because of side effects or interactions with other medications, ECT is an effective alternative.

What other problems affect treatment of depression in the elderly?

The stigma attached to mental illness and psychiatric treatment is even more powerful among the elderly than among younger people. That kind of thinking is also often shared by members of the patient's family, friends, and neighbors. This stigma can keep elderly patients from acknowledging they are depressed, even to themselves.

Depression may be expressed through physical complaints rather than traditional symptoms. That delays appropriate treatment. In addition, depressed older people may not report their depression because they believe there is no hope for help. Elderly people may also be unwilling to take their medicines because of side effects or cost. In addition, having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines. Alcoholism and abuse of other substances may interfere with effective treatment. And unhappy life events -- including the death of family or friends, poverty, and isolation -- may also affect the person's motivation to continue with treatment.