Resources: Senior Health Issues at Hebrew SeniorLife

What is Depression

While depression can be common in elderly people, it is not a normal part of aging. A disorder that affects mood, feelings, behavior and even physical health, depression is a medical condition that can and should be treated.

Depression affects nearly 6 million Americans over the age of 65; however, only about 10 percent receive treatment, which means that the normal functioning of million of seniors is interfered with on a daily basis. Among seniors, approximately 10 percent of primary care patients and nearly 20 percent of long-term care residents suffer from major depression, the most severe form of depressive illness. Suicide, which is closely linked with depression, is almost six times higher for white males over the age of 85 than it is for the general population. Beyond its direct effects on seniors' quality of life, depression is a risk factor for increased mortality and disability.

Social isolation and loneliness; the presence of other illnesses such as Parkinson's, Alzheimer's, cancer or stroke; recent bereavement; the use of certain medications (some of which can cause or worsen the symptoms of depression); and family history of depression can increase a senior's risk of suffering from depression. Doctors and family members may miss the signs of depression in seniors. As a result, many seniors end up having to cope with symptoms that otherwise could be easily treated.

It is not unusual for older adults to experience sadness when faced with changes that are associated with aging; however, clinical depression may exist when persistent sadness does not lift and this altered mood affects the individual's ability to function normally, says Eran Metzger, M.D., a psychiatrist at Hebrew SeniorLife.

Family members and doctors should look for the following signs if they suspect an older adult may be depressed:

  • Agitation
  • Anxiety
  • Social withdrawal
  • Decreased appetite
  • Unexplained weight loss or gain
  • Lack of attention to personal care
  • Sleep disturbance
  • Loss of interest in normally pleasurable activities
  • Feelings of discouragement or hopelessness.

A physical exam can determine if a medical illness is contributing to or causing the depression, while blood tests can rule out thyroid, kidney or liver problems, some of the symptoms of which can mimic depression. A psychiatric evaluation can help determine what is depression and what might be dementia, a significant loss of intellectual and cognitive function.

The most common treatments for depression in seniors include treatment of underlying medical conditions; psychotherapy, which involves talking about your condition and related issues with a mental health professional; antidepressant medications (these are often used with caution due to side effects and because they may take longer to work in older adults); and, for cases of treatment-resistant depression, electroconvulsive therapy, or ECT.

Medications such as selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants work by increasing the amount of the neurotransmitter serotonin, which plays an important role in the regulation of mood, in the brain. Monoamine oxidase inhibitors (MOAIs) prevent the breakdown of serotonin, but carry potentially serious side effects, so they are used infrequently.

Properly treating depression in older adults may help reduce the likelihood of death from physical illness, prevents suicide, and reduces health-care costs, which are nearly 50 percent higher for seniors with depression.

"While most seniors are happy, content and positive, others need assistance in helping them adjust to life's changes as they get older," says Dr. Metzger. "Social interaction with family and friends can help them adjust to losses and change. Participating in activities, either alone or with others, can help keep seniors occupied and their minds engaged. And exercise has been shown to be an effective measure to ward off depression or to prevent symptoms from worsening."

Unless resources improve, treatment of psychiatric illness in the elderly will fall far short of meeting the country's needs. To that end, Hebrew Rehabilitation Center has begun a new Psychiatric Support Service, funded in part by a Practice Change Fellowship from The Atlantic Philanthropies, for the long-term care residents at Hebrew Rehabilitation Center. The program will provide psychiatric education for HRC's medical staff to ensure compliance with psychiatric practice guidelines and to track patient response to treatment.

Given that primary care physicians manage much of the first-line treatment of depression at HRC, the Psychiatric Support Service will "increase the effectiveness of treatment of depression in the primary care setting to ensure adequate psychiatric care," says Dr. Metzger 

This program, as well as enhanced vigilance by doctors and family members, will help caregivers recognize the signs and symptoms of depression so that seniors can get treated--and so they can maintain and even enhance their quality of life as they age. 

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