Thursday, December 10, 2009

Elderly and Depression: How to Understand Depression in the Elderly

11/30/2009 - Articles
Elderly and depression: How to understand Depression in the elderly 1/4
By: Heinz Redwood

Depression in the elderly is very common. It can be triggered by social isolation and the emotional reaction to the loss of loved family members or friends. Depression in the elderly can make them withdraw from all social contact. ‘Depression is perhaps the most frequent cause of emotional suffering in later life’ said Dan G Blazer, Professor of Psychiatry at DukeUniversity. Being socially isolated, particularly after the death of a partner, and co-existing illness may contribute towards depression in elderly. Depression often goes undiagnosed or untreated so it becomes an increasing public health issue in our ageing society. The challenge, then, is more one of managing depression effectively in later life rather than understanding the condition.

How widespread is depression among older people? Recent surveys suggest a prevalence between 1.8% in the over 55s to 15% in those over 85. While depression is actually less prevalent among the old, compared to the young, major depression may be more common. There is also a clear link between chronic disease and depression, with those in nursing homes showing higher rates than those living in the community. But is the link a causal one? We know that illness can cause depression (and vice versa), but we cannot be sure residents of nursing homes are depressed because they are ill or because their care is not sufficiently ‘caring’.

And when it comes to the gender gap, it’s well known that women are more prone to depression in Europe and North America. But a new study from China, covering 2,633 adults, showed that the gender difference is insignificant, save in the 35-49 age group where lifetime prevalence for major depression for men was 3.6% compared to 2.3% for women.

There is also a cultural dimension to elderly depression. A meta-analysis of nine European centres revealed a prevalence of 8.8% in Iceland in the 88-89 age group compared to 23.6% in Munich in the over 85s. And, among the ‘oldest old’ 2% declared ‘life not worth living’ and 3% ‘wish to be dead’ in Iceland, compared to 16% and 25% in Berlin and 30% and 29% in Munich. The researchers wondered if some lingering distress from the Second World War could account for high rates of depression among very elderly Germans.

Causes of depression in the elderly:

Pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events, and perceived inadequacy of care have all been linked to depression in the elderly. Living alone or being socially isolated is also a risk factor for depression. It is certainly possible that, if personal privacy were very important to the resident, a perceived lack of privacy could contribute to feelings of depression. Browse through HealthandAge's Information for Caregivers for tips on choosing nursing homes/care facilities and recognizing depression in the elderly.

Finally, a number of risk factors for elderly depression have been identified, including medical burden, bereavement, chronic insomnia, cerebrovascular disease, Alzheimer’s disease and Parkinson’s disease.

If you are concerned about Depression in the elderly, you might want to read the following articles:
Menopause and Depression: Myth versus RealityAlcohol and Depression: Is There a Relationship?Depression and Sexual ActivityWhen the Problem is 'Depression'
adapted from ‘Elderly depression. 1. Its prevalence, causes and implications for society’ Heinz Redwood, August 2009.

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