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depression in the elderly

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:

  • Cancer
  • Parkinson’s disease
  • Alzheimer’s disease
  • Heart disease
  • Stroke [29]

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:

  • Depressed mood
  • Sleep changes
  • Changes in appetite or weight
  • Slowed speech or thought
  • Fatigue
  • Memory problems
  • Difficulty concentrating
  • Disinterest in previously pleasurable activities [30]

However, there are also symptoms, signs and elements of medical history that distinguish the two conditions:


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


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; 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; accessed 6 July 2004

[29] American Association for Geriatric Psychiatry, Depression in Late Life: Not a Natural Part of Aging; 2004; available at; accessed 6 July 2004

[30] Dubin M, Distinguishiung Depression from Early Alzheimer’s Disease in the Elderly; Univ, of Colorado, Available at, Accessed 6 July 2004

[31] Adapted from Dubin M, Some Common Observable Features that Distinguish Depression from Dementia, Univ, of Colorado, Available at, Accessed 6 July 2004


In The Know: At Risk Pamphlet/ DVD Package
In The Know: At Risk DVD Package