Depression in the Elderly

ConditionsDepression

Most older persons are satisfied with their lives and are not psychologically predisposed to depression. Nevertheless, some experience a demoralization and a despair resulting not only from incapacities due to aging but also from a sense of not having fulfilled their life expectations (e.g., leading up to and/or after retirement).

Geriatric depression can occur when older persons need to adapt to many adverse life experiences. They must adapt especially to the losses of relatives and friends. In these circumstances, they are often appear to respond to these losses without difficulty compared to persons who are younger. This in part is because older persons, for example, expect that they will lose family and friends through death, and those family and friends whom they do lose often have suffered chronic illnesses for some time, thus allowing older persons to grieve the loss, in part, before the actual loss.

As a result, an adjustment disorder with depressed mood secondary to physical disability and/or chronic illness is among the most frequent causes of depressed mood among older individuals. Geriatric depression is often accompanied by anxiety symptoms and/or insomnia.

Source of late-life depression:

  • Loss of a relationship
  • Loss of body parts or function
  • Loss of control or independence
  • Chronic pain
  • Guilt

Characteristics of older adults with depression:

  • Do not complain of depression spontaneously
  • Lose weight but rarely gain weight
  • Complain of insomnia but rarely of sleeping too much
  • Complain of problems with concentration and memory loss
  • Test positive for impairment on psychological testing
  • Suffer from loss of interest in previously pleasurable activities
  • May exhibit psychotic symptoms more than middle-aged adults

Consequences of Depression

  • Poor compliance, nutrition, hygiene, and giving up
  • Passive or active suicidality

Interventions and how to treat depression

  • Listen and understand
    • Encourage expression of sadness/grief related to illness
  • Offer specific and realistic reassurance
    • Emphasize a constructive treatment plan
    • Mobilize the patient’s support system
  • Combat learned helplessness
    • Elicit expression of preferences, encourage active steps
  • Psychiatric consultation for medications or TMS
    • Persistent and out of proportion symptoms or suicidality

Resource

Our geriatric psychiatrist, Dr. David Merrill, offers kind, compassionate, thorough clinical evaluations and follows depression treatment guidelines, helping the patient to stay connected with the activities and people who matter to them. Contact us at 310-582-7641 to schedule a consultation.

Anxiety

Insomnia