Depression linked to decline in elderly ?
Q.This has been a well-known and documented phenomenon for quite some time. It is referenced in decade-old psychiatry manuals as well as the _Merck manual of Geriatrics_. It's ben discussed in the psychology newsgroups, the geropsych mailing lists, various geropsych Web sites... Where has the government been all this time? Has anyone notified them that the Earth is round?
A.There are indeed psychosocial stressors that may be linked to higher incidence of depression in the elderly. However, major depression (as distinct from discontent or dysphoria related to the circumstances of growing older) is clearly identified as the cause of physical decline and death in older adults. The incidence of major depression is twice as high in institutionalized elderly (e.g., nursing homes) as in community-dwelling elderly in the U.S. About one-third of nursing home residents typically meet the criteria for major depression, depending on which research you review. Depression tends to be slightly more prevalent among the elderly than the adult population, although this has to be taken with a grain of salt. First-episode depressions may be actually *less* common among the elderly than among young adults. Depressed elderly tend to become irritable, withdrawn, anenergic, anhedonic and present a distinct risk for "failure to thrive" syndrome. Weight loss is endemic among depressed elderly and tends to result in dehydration, malnutrition, complications of these including weakness, falls with injury, urinary tract infections causing delirium, decubiti, medication toxicity related to dehydration, bowel obstruction, etc. Major depression is a major source of morbidity and mortality among the elderly... not even including suicide. Males with painful illnesses, living alone, over the age of 80 are one of the highest risk groups for suicide. Also, depressed elderly are often profoundly affected by depression in terms of cognitive status and may appear confused and demented; they are often misdiagnosed as having Alzheimer's or other dementing illnesses. Depressed elderly may be mistakenly assumed to be "failing" due to age/illness, rather than considering depression, which can result in unnecessary deaths among this population, typically from malnutrition, dehydration and/or nosocomial infections such as pneumonia. The good news is that elderly patients respond well to standard forms of treatment including antidepressant medications (preferably avoiding the tricyclics with significant anticholinergic side effects- SSRIs are the treatment of choice for the elderly unless there are other serotonergic medications prescribed), psychotherapy and ECT. Aggressive, multidisciplinary treatment is quite possible in the nursing home setting, allowing higher dosing of antidepressants, better compliance with treatment, targeted psychosocial interventions such as therapeutic recreation, restorative nursing, nutritional support, etc. Dementia is a contraindication for psychotherapy, although cognitive status may improve dramatically with the resolution of the depression. I have seen people go from 5/30 on the MMSE to 30/30 with the treatment of their depression.
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