Depression in the Elderly: Risk Factors to Know
By CareerSmart Learning Contributor, November 25, 2016, as published by Healthcare Hot Spot
Many people believe that depression and aging always go hand in hand. The truth is that depression is not part of the normal process of growing old. In fact, a 12-month study conducted by the National Survey on Drug Use and Health suggested that the depression rate is less prevalent in older adults (4.8%) as compared to younger adults (10.3%) (NIH, 2015). However, late life depression can have serious consequences.
Older adults are at higher risk of experiencing depression, and the risk factors are unique when compared to the lifestyle and health of the general population. For instance, place of residence is one risk factor that can contribute greatly to depression for the elderly. Many older adults, due to failing health, lose their ability to live independently and require some form of long-term care arrangement. While about 5% of elderly living in community settings meet criteria for major depression, between 12-30% of elderly living in institutional settings meet criteria for depression. The difference in rates of depression from community settings to institutional settings pales in comparison to the statistic that up to 50% of elderly living in long-term care facilities meet the criteria for depression (Park & Unützer, 2011). While it might be easy to simply apply the blame for depression on the place of residence, several other risk factors for depression in the elderly could also help explain the difference, including:
1) Loneliness is a significant issue for the elderly, but it is not solved merely by visits from friends and family. Living alone and having few social contacts does not automatically incite loneliness, just as having many friends and family does not equate to fulfillment. The quality of those relationships helps determine the level of loneliness, or lack thereof. One study found that “an expressed dissatisfaction with available relationships is a more powerful indicator of loneliness” (Singh & Misra, 2009). Loneliness in the elderly is also impacted by the death of a partner/spouse, as well as the deaths of friends over the years. Assessing an elderly patient’s quality of relationships, including the loss of people, can help in determining their risk of depression.
2) Chronic pain and illness can take a toll on someone both physically and mentally. For elderly who experience depression for the first time late in life, it is often connected to health issues. Most older adults have at least one to two chronic health conditions, and depression is more common in those whose lifestyle is challenged by physical and social limitations.
3) Signs and symptoms of depression may be missed by healthcare providers as part of the elderly’s chronic health condition or a reaction to aging. Older adults themselves also may not speak up to seek help or may believe that they are supposed to feel depressed because they are getting older.
Our aging population is growing, and according to the World Health Organization, the number of adults age 60 and older will increase from 12% in 2015 to 22% by 2050 (WHO, 2016). It is important that we are prepared to meet the specific needs of our aging adults through ongoing training and education. Clinical depression is treatable but often underdiagnosed in older adults. Prompt recognition and intervention for depression in older adults is essential. As healthcare providers, we have the responsibility to facilitate and optimize the mental health and emotional well-being of our elderly population.
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Park, M, & Unützer, J. (2011). Geriatric depression in primary care. Psychiatric Clinics of North American, 34(2). Doi: 10.1016/j.psc.2011.02.009.
Singh, A. & Misra, N. (2009). Loneliness, depression and sociability in old age. Industrial Psychiatry Journal, 18(1): 51-55. Doi: 10.4103/0972-6748.57861
World Health Organization (WHO)/Mental Health and Older Adults (Fact Sheet). Last upate, April 2016. http://www.who.int/mediacentre/factsheets/fs381/en/
National Institute of Mental Health (HIH)/ Major Depression Among Adults. 2015. https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml