Recognizing and Treating Depression in the Elderly

Mark D. Miller, MD

Medscape Psychiatry & Mental Health eJournal. 1997;2(2) 

In This Article

Overview

The Epidemiological Catchment Area study of community dwellers estimated that 15% of the elderly showed significant depressive symptoms.[3] A smaller subset (1% to 2%) met criteria for a major depressive disorder. This sample did not include those in nursing homes, where the prevalence of depression can be as high as 25%.[4] Rates of depression in primary care clinics have ranged from 5% to 37%.[5,6]

Depression is not a normal response to aging, but it remains underdiagnosed and undertreated in geriatric patients. This may be because health care providers are often more focused on medical problems and frequently have lower functional expectations for elderly patients.[5]

Luber and colleagues[7] found that depressed patients at any age require almost twice as many office visits, are more likely to use multiple medications, and have longer stays when hospitalized.[4] In addition, depression in the geriatric population is a highly recurrent disease, with rates of repeat episodes as high as 40% to 80%.[5] Thus, it appears that it is no longer sufficient to relieve the initial depression. Clinicians must be aware of these high recurrence rates and should understand that long-term management of depression is often required.[8]

Suicide rates are the highest among elderly white males and are higher in general among the elderly than in younger age groups (Fig. 1). More than two thirds of suicides in the elderly take place in the context of depression, and 75% of all geriatric patients who complete suicide had seen their primary care physician in the previous month.[5] Depressed elderly persons with suicidal ideation (active or passive) have higher depression ratings than depressed elders without suicidal ideation.[9] Any suicidal ideation should be taken seriously, since the elderly are less prone, compared with other age groups, to use suicide talk as a threat to manipulate others.[10]

Suicide rates by age, race, and gender in the UD through 1992. Data from Conwell.[8]

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