Depression
While many older adults suffer from depression, it is not considered a normal part of the aging process. It affects approximately 6 million Americans over the age of 65, and yet only 10% of those receive treatment. Perhaps one reason for this it that the symptoms of depression are often attributed to the effects of coexisting physical illnesses. One serious concern among elderly patients with depression is the increased risk of suicide. Older white men are at greatest risk, with suicide rates in people over 80 being more than twice that of the general population.
While improved mental health screening in primary care settings may be of use in helping older adults receive treatment, a study published December 2007 in the Journal of the American Geriatrics Society suggests that relying on medical doctors to serve as the gate keepers is problematic. According to this study, primary care visits last approximately 16 minutes, with less than 2 minutes of that time addressing mental health topics with their patient. Doctors participating in the study varied widely in their efforts to provide care for a mental health issue. Most fell into one of three patterns of care: 1) listening to the patient for an extended period of time and referring him or her to a mental health care specialist; 2) gathering information but providing inadequate treatment; or 3) being dismissive toward the patient and his or her emotional distress, and failing to follow up.
Therefore, it is much more likely that family and close friends may be the most effective resource in recognizing and calling into question the need for mental health services. The following are the symptoms of depression. When at least 5 of these symptoms have been present for at least a 2 week period of time and represent a change from previous functioning, it may be useful to contact a mental health professional.
1) Depressed mood most of the day (as reported by feelings of sadness or emptiness)
2) Loss of interest or pleasure in all or most activities.
3) Significant weight loss or weight gain
4) Sleep disturbances such as insomnia or hypersomnia
5) Excessive psychomotor agitation or retardation
6) Fatigue or loss of energy nearly every day
7) Feelings of worthlessness or inappropriate guilt
8) Inability to think or concentrate
9) Recurrent thoughts of death with or without a specific plan or attempt
Depression in later life frequently coexists with other medical illnesses and disabilities. In addition, advancing age is often accompanied by loss of key social support systems due to the death of a spouse or siblings, retirement and/or relocation of residence. Because of their change in circumstances and the fact that they're expected to slow down, doctors and family may miss the diagnosis of depression in elderly people, delaying effective treatment. As a result, many seniors find themselves having to cope with symptoms that could otherwise be easily treated.
Tai-Seale M, McGuire T, Colenda C, Rosen D, Cook MA. Two-minute mental health care for elderly patients: inside primary care visits. Journal of the American Geriatrics Society. 2007 Dec. 55:1903-1911.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (text revision). Washington, DC: Author.