Diagnosis and Treatment of Depression in the Elderly Mental disorders are becoming more prevalent in todays society as people add stress and pressure to their daily lives. The elderly population is not eliminated as a candidate for a disorder just because they may be retired. In fact, mental disorders affect 1 in 5 elderly people. One would think that with disorders being rather prevalent in this age group that there would be an abundance of treatment programs, but this is not the case. Because the diagnosis of an individuals mental state is subjective in nature, many troubled people go untreated regularly (summer 1998).
Depression in the elderly population is a common occurrence, yet the diagnosis and treatment seem to slip through the cracks. Depression is an example of a metal condition that may slip through the cracks when it comes to detection. The health care industry contributes to the overlooking of depression in the elderly because of the overwhelming desire to keep costs down. The factors of depression are open for interpretation, which results in different doctors looking for different things. In addition to that, elderly people may not exhibit the traditional symptoms of depression either. Aged individuals may have symptoms of depression that go unnoticed due the fact that those symptoms are being attributed to a different ailment.
“One half of all depressed patients seen by general physicians are not identified as depressed (August 1995).” Also, some of the things people look for in detecting depression are things that society seems to think are the norm for our elders (October 1999). In addition, there appear to be a few fundamental differences between depression in the young and old. Elderly people tend to have more ideational symptoms, which are related to thoughts, ideas, and guilt. Elderly depressed individuals are also more likely to have psychotic depressive and melancholic symptoms such as anorexia and weight loss. Finally, older people tend to have more anxiety present in their depression than younger patients do (winter 1996). In the natural order of things, bodies tend to wear down somewhat and people become higher risk candidates for various health problems.
It is the increase in health problems that allows for some symptoms of depression to be overlooked. Doctors begin to attribute all problems and ailments to the primary problem, neglecting the possibility of depression. The prevalence of low blood pressure is one of those items that do increase as an individual ages. The correlation of depression with low blood pressure also increases as time passes, particularly among men. A study by Barrett-Connor and Palinkas indicated “men with low blood pressure scored significantly higher on both the emotional and physical items of a depression test (February 1994).” These same individuals also scored higher on measures of pessimism, sadness, loss of appetite, weight loss, and preoccupation with health than did people with normal blood pressure.
Some believe that because low blood pressure can cause fatigue, anyone with these two symptoms could possibly be diagnosed with depression. This is a snowball effect where the low blood pressure causes the fatigue, which in turn causes someone to feel useless, which further develops into other possible depressed symptoms. An interesting side note to this study was that the low blood pressure found in the patients was not directly related to any chronic health condition (February 1994). Low blood pressure is not the only risk factor for the development of depression. Some other factors include losses dealing with jobs, status, finances, physical ability, or relocation.
Family problems dealing with divorce, siblings, children, or a death can also send one on a downward spiral. Changes in the brain such as decreased adaptive capacity, neurotransmitter and receptor changes, cognitive impairment, and dementia increase the risk of depression (winter 1996). As more factors enter the equation and the patient becomes more depressed, the likelihood of a suicide attempts increases. As previously mentioned, diagnosing depression in the elderly can be a challenging task due to all of the factors involved. When considering if an individual is depressed, one must examine the individuals background, cognition, medical history, etc. In order to diagnose depression, there are written and oral inventories of a persons mind that need to be performed.
Symptoms of severe depression include: diminished interest in usual activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to concentrate, and recurrent thoughts of death or suicide. Depression does not always have to be severe. To be diagnosed with mild depression or dysphoria, the mood of the patient would first need to be depressed for two years. In addition to that, two of the following characteristics would need to be present: low self-esteem, poor concentration, difficulty making decisions, overeating or a poor appetite, low energy level, insomnia or hypersomnia, and feelings of hopelessness (August 1995). Diagnosing depression can be a difficult task due to the human element involved.
A recent study by Jackson and Baldwin tested nurses skills of observation in detecting depression in hospital patients. They were asked to categorize patients as definitely not depressed, probably not depressed, probably depressed, and definitely depressed. The responses given by the nurses were checked against written inventories that had been filled out and analyzed. The results indicated the nurses were not accurate in their assessment until those labeled as “probably not depressed” were moved into the “definitely depressed” category. This illustrates that the patient may have exhibited symptoms of depression, but those symptoms were attributed to another health problem leading to the diagnosis of depression being overlooked (September 1993). Another way to diagnose a patient is by having the patient complete the GDS, or Geriatric Depression Scale once he or she had been treated for the primary illness. This is a 30-question survey of things happening to a patient, both physically and mentally.
These results are then analyzed using the Geriatric Mental Status Schedule (GMSS) on a computer. The GMSS compares psychiatric symptoms in stage 1 to organic disorders in stage 2. Preferences are given to organic disorders in stage 2 because it is believed that these are the primary causes. In GMSS stage 1 the patient must score a severity level of 3 (out of 5) to be classified as syndromal depression. In the experiment conducted by Jackson and Baldwin 36% of the sample was classified as having syndromal depression. This sample was made up of elderly medically ill hospital inpatients.
The selection appears to reflect the general population fairly well, as it is believed that between 9% and 45% of the medically ill elderly experience depression (September 1993). There are many ways to go about treating depression in the elderly. According to American Family Physician (April 1996), “there are 7 guidelines to follow: 1) correct any underlying illness; 2) avoid, if possible, prescribing medications that may cause or exacerbate depression; 3) decrease isolation due to sensory deprivation; 4) increase stimulation; 5) consider psychotherapy; 6) consider psychiatric referral for severe depression, and 7) consider the use of antidepressants.” Cognitive therapy has been used successfully to treat depression in young and middle aged individuals. It is this success that has brought on the growing interest in the results of cog …