Aging and depression
The first signs of depression appear more frequently in old age than in any other stage of life. The depressions last longer, are often not recognized as such and are not sufficiently treated.
Gerontopsychiatry is based on the assumption that there is no old age depression as such, but that older people experience more often various depression-related symptoms. For this reason, old age depression is often referred to.
As a result of increasing life expectancy, the growing number of people with dementia or other chronic illnesses has become a central theme. Depression of older people, however, is receiving much less attention. Nevertheless, statistics show that the probability of being affected by depression may increase as years go by. This concerns especially people who are in hospitals or in homes. Also, the suicide rate is highest among people aged 65 and more.
Depression can have many causes
There are many risk factors for depression in older people. One of them is the normal aging process, in which hormonal imbalances or neurotransmitters metabolic disorders often take place, thus creating a favorable environment for the emergence of depression symptoms.
Also, as regards other disabilities or illnesses that may occur in older age, such as dementia, cardiovascular diseases, cancer or any other life-threatening illnesses, depression can appear as an accompanying illness. Diseases of the musculoskeletal system, often accompanied by pain, can also lead to depression, as well as nutritional deficiency or the intake of certain medication.
Aging process is experienced in various ways
Most often however, life and experiences are most determining in a person’s predisposition to depression. Aging is a process that most people have in common. However, each aging person experiences this process in a different manner, which again is depending on a variety of factors. Among such factors, the most frequent ones are the loss or death of life partner, a friend or a family member, loneliness, feeling useless, the loss of cognitive faculties, or fear of aging or of death.
Depression or plain mood swings?
The combination of physical, emotional and social causes and factors may make it more difficult to establish a depression diagnosis. Mental and emotional lows are often perceived as being a normal process or as plain mood swings. Elderly people often do not admit such mood swings to be problematic or to acknowledge them as an illness.
Signs of a depression
Many signs may indicate a state of depression, which is basically no different than depression in younger people. These signs may manifest themselves on the emotional or on the physical level, and lead to altered behavioral or thinking patterns.
- Long-lasting sadness or feeling of dejection
- Feelings of helplessness, loneliness, guilt and fear
- Withdrawal and distance
- Loss of interest
- Lack of motivation, day-to-day life is perceived as being overwhelming
- Negative thinking, pessimism
- Concentration disorders
- Tiredness and weariness
- Inner restlessness, irritability
- Sleep disorders
- Loss of appetite and weight loss
Considering the various factors that may cause depression, a diagnosis may not be easy to establish. Even specialists may have difficulty to recognize it accurately. Therefore, a complete diagnosis and treatment of physical symptoms should also be complemented with a psychiatric diagnosis.
Some questions that may bring clarity
The Geriatric Depression Scale (GDS) may provide some key elements to the physician in charge in order to establish whether depression is an issue. This test was designed specifically for older people and contains 15 yes or no questions concerning life satisfaction, feelings of helplessness of fears and withdrawal.
Should the physician establish a diagnosis of depression, he can recommend the patient to a specialist. On the other hand, should the patient identify himself depression symptoms, he can consult a specialist on his own initiative.
Therapy: psychotherapy and medication
Therapies for depression for the elderly are generally-speaking no different than for younger people. Usually, psychotherapy and a medication treatment will be taken into consideration. However, the age of the patient will also be taken into account.
Text: Patrick Gunti – 03/2013
Questionnaire: Sheikh & Yesavage, 1986