Geriatric Depression: Identifying, Treating, and Supporting Senior Patients

Increasing numbers of people across the world are living longer due to improvements in healthcare and nutrition. But alongside longevity, many people are experiencing chronic diseases, including depression. As the leading cause of disability across the world, depression affects up to 20% of the world's aging population. And some studies show that more than 50% of older adults who experience depression have never had a prior depressive episode.

What are the leading causes or contributions to depression in later life? Like other forms of mental illness, depression in older adults is typically due to a complex combination of factors. Factors associated with geriatric depression include:

• Being single or divorced
• Bereavement
• Childhood trauma
• Chronic illness or poor overall health
• Cognitive deficiency
• Feeling or living alone
• Female sex
• Lack of religious affiliation
• Lack of social involvement
• Lower education level
• Low income
• Low self-esteem
• Older age
• Previous depressive episodes
• Smoking regularly

Despite its prevalence, depression among older adults often goes undiagnosed and untreated, making it difficult for patients to live otherwise full and healthy lives. Late-life depression is associated with increased morbidities, increased suicide risk, increased self-neglect, and a decrease in physical, mental, and social functioning.

Signs of Depression in Senior Patients

Given the significant impact that depression can have on older adults, correct and timely diagnosis is imperative to holistic health. Aging adults often do not seek help for depression because they view it as a natural reaction to life's changes or illness. So, they are often undertreated or misdiagnosed.

Signs of depression in senior patients may include weeks of sadness or anxiety, but also:

• Chronic bodily aches, pains, or digestive problems that do not improve with other treatments
• Difficulty with memory, concentration, and decision-making
• Extreme change in appetite
• Feeling hopeless or more pessimistic
• Feeling guilty, helpless, or lacking worth
• Increased fatigue and decreased energy
• Increased irritation or restlessness
• No longer enjoying their favorite activities
• Sleep problems, including waking too early, insomnia, or sleeping excessively
• Suicidal ideation or attempts

Depression Treatment for Seniors

Treating depression in aging patients requires knowledge of any co-existing medical conditions or medications that may be contributing to it. Management of a patient with depression may require changing their other medications when possible. Some medications that may contribute to depression are beta-blockers, corticosteroids, calcium channel blockers, and many others.

In addition, many chronic illnesses are associated with depression. Sometimes, the development of depression can trigger disease development, but the opposite can occur as well. It is important to treat both illnesses concurrently, if possible.

Evidence-based psychological interventions for late-life depression include but are not limited to behavioral therapies such as:

• Cognitive-behavioral therapy focuses on changing thought patterns and developing coping skills.
• Life review therapy can help adults acknowledge and process the many experiences of their lives in their later years. This can build appreciation for one's life and a change in perspective that can help depression.
• Problem-solving therapy helps patients adopt a realistic yet optimistic approach to coping with life stressors or negative experiences. It is additionally useful in older patients because it provides an opportunity for cognitive exercise.

Prescribing medication for depression as mono- or combination therapy is also an option, but studies to support the practice are limited in these populations. Many adults can also be referred to psychiatrists for electroconvulsive therapy (ECT), which caused improvement in over 80% of patients in most trials. However, significant side effects, such as cardiac complications or memory loss, may also occur.

There are many possible approaches to treat depression in older patients. The most important aspect of treatment is diagnosis and taking steps to combat it.

Support Your Senior Patients

Knowing whether or not your patient is experiencing depression can significantly impact their well-being. At ChenMed, we strive to approach each patient with a holistic methodology. By looking at the whole person and getting to know them, we hope to detect signs of depression and other threats to their health in the early stages. Join our team and make a greater difference in your patients' lives.