Depression in the Elderly
Depression is not brought on by aging, though one recent study has found an association between depression in elderly patients and changes in a portion of the white matter—the intercellular wiring—of the brain. The significance of that finding for diagnosing and treating late-life depression remains to be established [26]
While it is not true that depression or its manifestations are a normal part of aging, depression is quite common among those 65 and older. It is estimated that one to two percent of elderly Americans living in the community (i.e., not in nursing homes) suffer from major depression and another two percent suffer from dysthymic disorder. NIMH studies also show that between 13 and 27 percent of older adults have milder forms of depression that are associated with increased risks of major depression, physical illness and increased use of medical services. [27]
The seriousness of depression in the elderly is underscored by suicide statistics. While those 65 and older make up only 13 percent of the population, they account for more than 18 percent of suicides. The suicide rate is nearly 13 per 100,000 for those over 65, increasing to nearly 18 per 100,000 for those over 75—nearly double the overall national rate. Among white males over 85, the suicide rate is nearly 60 per 100,000—the highest for all age and gender groups and nearly six times the national average. [28]
The high incidence of depression is linked, in part, to the higher rates of other illnesses among the elderly. The resulting depression, in turn, can worsen the symptoms of the triggering medical condition. Diseases with a high accompanying incidence of depression include:
Because they share a number of signs and symptoms, depression is often mistaken for the very early stage of Alzheimer’s disease. Those common signs include:
However, there are also symptoms, signs and elements of medical history that distinguish the two conditions:
|
DEPRESSION Symptoms begin and progress rapidly Patient has history of depression Complains of cognitive deficits Complains in detail Emphasizes cognitive complaints Highlights personal failures Makes little effort at tasks Does not try to keep up Is in distress |
DEMENTIA Symptoms begin and progress slowly No history of depression Does not complain of cognitive deficits Vague complaints Conceals or explains away deficits Delights in personal accomplishments Struggles with tasks Relies on notes, calendars, etc., to keep up Is unconcerned [31] |
Sophisticated brain imaging techniques using magnetic resonance imaging (MRI) and Single Photon Emission Computed Tomography (SPECT) scanners are used in further differentiating diagnosis between the two conditions.
[26] Taylor WD, MacFall JR, Payne ME, et. al., Late-Life Depression and Microstructural Abnormalities in Dorsolateral Prefrontal. Cortex White Matter; Am J Psychiatry.2004; 161: 1293-1296.
[27] NIMH statistics cited in , Prevalence and Incidence of Depression; 2003, available at http://www.wrongdiagnosis.com/; accessed 29 June 2004
[28] Pearson JL, NIMH Research on Geriatric Depression and Suicide; Testimony before the U.S. Senate Special Committee on Aging, 2003, available at http://www.hhs.gov/asl/testify/t030728.html; accessed 6 July 2004
[29] American Association for Geriatric Psychiatry, Depression in Late Life: Not a Natural Part of Aging; 2004; available at http://www.aagpgpa.org; accessed 6 July 2004
[30] Dubin M, Distinguishiung Depression from Early Alzheimer’s Disease in the Elderly; Univ, of Colorado, Available at http://dubinserver.colorado.edu/, Accessed 6 July 2004
[31] Adapted from Dubin M, Some Common Observable Features that Distinguish Depression from Dementia, Univ, of Colorado, Available at http://dubinserver.colorado.edu/, Accessed 6 July 2004
