Depression in the elderly

Received from the Geriatric Medicine/Gerontology Division of General Internal Medicine, and the Department of Psychiatry. Medical College of Ohio, C. S. # 10008, Toledo, OH 43699.     

Depression in the elderly.

Depressions in the elderly have many similarities to depressions in other age groups, particularly in their episodic nature, their tendency to remit, and their potential for favorable immediate outcome. They may, however, be far more easily overlooked. They often are considered to be consistent with senescence because of their frequent association with metabolic disturbance, with a variety of physical illnesses, with impaired cerebral function, and with hypochondriacal manifestations that may be viewed as characteristic of old age. It is important, therefore, that the clinician who treats these older patients be aware that depression is the psychiatric symptom he will most often encounter in the elderly and that it is as distressing in this age group as it is in younger persons. It represents an entity that often is reversible with prompt and appropriate treatment.     

Depression and suicide in the elderly]

The suicidal behavior in 155 patients older than 60 years is analyzed. Patients were treated for endogenous, neurotic, or reactive depression. Differences between diagnostic categories and sex are discussed in detail. Motivation and recent causes of suicidal behavior are analyzed. Psychopathological symptoms correlating with suicidal behavior in endogenous depression in the elderly are depicted. The social environment of and the therapeutic approach to suicidal elderly patients are discussed. The problem of rational suicide and the demand for voluntary death are mentioned.     

Depression in the elderly; future prospects

Extensive research has been achieved on the old age depression during the last decades. Specific clinical features and management have been reported. Indirect clinical and behavioural indicators, and even biological ones should be considered for the detection of depression. Cognitive assessment must be promoted in standard practice to differentiate depression from incipient dementia, but also in depression occurring in long stay care, vascular depression and in the depression-executive dysfunction syndrome. Distinction between recurrent depressive episode and late-onset depression has to be clarified. Therapeutic strategies have to be reconsidered in duration, according to the trend toward chronicity of late life depression. They remain based on the use of pluri-aminergic antidepressants. Depressive disorder in the elderly is associated with hippocampus dysfunction, but other biological variables should be taken into account according to a dynamic stress-vulnerability model.     

Depression of elderly outpatients

Objective:To determine primary care physicians’ attitudes and practice patterns concerning the diagnosis and treatment of depression in elderly outpatients. Design:Survey of primary care physicians’ attitudes using a 22-item questionnaire. Current practice patterns were identified from a computerized medical record system. Setting:Academic primary care group practice at an urban ambulatory care clinic. Patients/participants:Thirty-five faculty general internists and 118 resident internal medicine physicians who had cared for 2,759 patients 65 years of age and older in the previous year. Measurements and main results:Attitudes: Eighty percent of all physicians considered the diagnosis and treatment of depressed elderly patients to be their responsibility. Fifty-five percent of the internists felt confident in accurately diagnosing depression, and 35% felt confident in prescribing antidepressants for this population. Residents reported more difficulties in dealing with depressed elderly patients than did faculty. Practice patterns: Of patients ≥ 65 years old, 8% were prescribed antidepressants, 5.4% had current diagnoses of depression, and 2% were seen for evaluation by psychiatry professionals. Age was negatively correlated with depression diagnosis, antidepressant drug use, and psychiatry evaluation. Conclusions:Internists in this primary care group practice accept responsibility for the treatment of depressed elderly patients but perceive their clinical skills as inadequate and are frustrated with their practice environment. Interventions aimed at improving the diagnosis and treatment of depressed elderly patients may be more effective if they are able to improve knowledge, attitudes, and the practice environment. Received from the Departments of Medicine and Psychiatry, Indiana University School of Medicine, and the Regenstrief Institute for Health Care, Indianapolis, Indiana. Supported by a grant from the John A. Hartford Foundation, Inc., New York, NY.     

Depression and physical illness in the elderly.

The authors' study confirmed the high prevalence of depressive symptoms in elderly medical inpatients but found no relationship between the diagnosis of or symptoms of depression and mortality or hospital use. Other studies examining the impact of depression on outcome for elderly patients may not have adequately controlled for the severity of the accompanying physical illness, which may perhaps have been responsible for the reported adverse effects of depression on outcome. An alternative explanation is that the authors' study involved a 1-year follow-up and a longer period of time may be necessary. The study demonstrated that routine screening for depression in acute elderly medical inpatients may be a useful way of detecting coexisting psychiatric morbidity. The routine screening measures were acceptable to patients and may be of considerable potential value in alerting staff to accompanying psychological distress. This study also illustrated the high prevalence of depression in patient samples and the importance and usefulness of screening geriatric inpatients. There are, however, several questions that remain unanswered both in studies reviewed in this article and in the authors' own work. The etiology and mechanism of the association between physical illness and depression are unknown, and there has been a dearth of studies assessing the feasibility and utility of specific treatments for depression in the elderly physically ill.     

Depression in the elderly: current management concepts

Fear of possible cardiovascular side effects has prevented many physicians from treating older patients with antidepressants. However, we believe that it is the rare patient who cannot or should not be treated with some agent. Start with a low dose of desipramine, doxepin, or trazodone, depending upon the tolerance for sedation and anticholinergic side effects. Barring specific contraindications, the choice of drugs is usually based on the side-effect profile, rather than any differences in efficacy.     

Depression and organic brain diseases in the elderly

Depressive symptoms are observed in many organic brain diseases in the elderly, particularly in stroke, degenerative or vascular dementias and Parkinson's disease. In many cases, an accurate estimation of the respective part of neurobiological abnormalities, adjustment disorders, disability and narcissistic wounds related to the disease appears very difficult for the practitioner. Specific data on the therapeutical aspects of secondary depressive disorders remains quite scarce. The efficacy of antidepressant drugs may be less important in geriatric depression with cerebral disorders or "secondary depressions" than in primary ones. Consequently, electroconvulsive-therapy may appear as an interesting therapeutical option for these patients.     

老年人的抑郁症及自杀的防治

老年期抑郁症是指首次发病于老年期，以持久的抑郁心境为主要表现，情绪低落、焦虑、迟滞及诸多躯体不适主诉为主。这些精神障碍不能归因于躯体疾病或脑器质性病变，且具有缓解和复发倾向，部分患者预后不良。抑郁症是老年期最常见的功能性精神障碍之一。65岁以上发生抑郁症者，据国外统计占总人口的7％～10％，老年人患有躯体疾病时，     

Depression in the elderly: pharmacologic considerations in treatment

The pharmacologic treatment of depression in the aged is complicated by an increased frequency of concurrent medical disease and multiple drug use. In addition, age-related physiologic changes may alter the pharmacokinetics and pharmacodynamics of the antidepressant medications. As a consequence, the variability of response and the incidence of adverse effects are increased in the elderly. The clinical implications of these factors and guidelines for the use of antidepressants in the elderly are discussed.     

Depression and sex hormones in elderly women

We aimed to study the relation between sex hormones and depression among elderly women. The study was carried out on 74 volunteered female subjects above 60 years of age. Each subject was asked to fulfill the geriatric depression scale (GDS) questionnaire and further evaluated for clinical depression by a psychiatrist using the DSM IV diagnostic criteria. For statistical analysis, subjects were later divided in two groups, according to the presence of clinical depression. Cognitive functions were assessed with the standardized mini mental test (SMMT). Disability in the activities of daily living was assessed with instrumental activities of daily living (IADL) scale. Plasma levels of estrogen, testosterone, progesterone, and dehydroepiandrosterone sulfate (DHEA-S) were measured with chemiluminescent methods, and plasma levels of androstenedione were measured with radioimmunoassay. Among 74 subjects, 34 (39%) had clinical depression. Age, number of years spent in education, SMMT scores, and IADL scores did not differ between the depressive and non-depressive groups. Plasma sex hormone levels were not found to be different between the two groups.     

Depression in the elderly: new concepts and therapeutic approaches

Depression is one of the leading causes of suffering in the elderly, but it is often under-diagnosed and under-treated, partly due to the false belief that depression is a common aspect of aging. Depression in the elderly is frequently comorbid with medical illnesses, may often be expressed by somatic complaints, and may be a risk factor for other diseases such as dementia and coronary artery disease. Depression decreases the quality of life and increases disability and the risk of mortality, also due to suicide. Although several effective antidepressant drugs are available, with a favorable therapeutic index, non-pharmacological treatments, such as psychotherapy and exercise, should receive greater attention, since combination therapy is probably more effective.     

老年期抑郁和痴呆与潜在的神经系统疾病

<正> 根据WHO对于老年人年龄的界定标准,年龄≥65岁的老年人进入老年期。世界各国由于经济发展和人口寿命的差异,发展中国家年龄≥60岁可视为老年期。我国2005年11月全国1%抽样人口调查数据显示,目前年龄>60岁的老年期人口占总人口数的11.03%,而年龄>65岁的老年人口已达到1.004亿,占总人口数的7.69%。老年人不仅是抑郁和痴呆的高发人群,也是多种神经系统疾病的高发人群,老年人抑郁和痴呆与潜在神经系统疾病的关系需要引起神经内科和老年医学科医务人员的关注。     

Depression in elderly hospitalized patients with medical illness

Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.