Depression is a common occurrence in older adults making it one of the most underrecognized and undertreated illness. Some of those who recognize its severity worry that its treatment is costly. Contrary to popular belief, depression in older adults is not a regular part of aging. It is not a sign of weakness nor is it a character flaw as some people believe.
When a person is depressed, they tend to feel physically ill, and many would take this an early sign of diseases like Alzheimer’s and other chronic diseases. However, depression can also make an individual’s physical health worse thereby increasing the mortality. Late-life depression (LLD), as it is known in adults over the age 65, will eventually have a profound impact on a person’s life. They could just lose interest in activities they were finding pleasurable before, appetite and even have significant memory loss.
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Depression has also been linked to suicide in adults over the age of 65 (Conwell, 1995). Many of these older adults, about 75 percent, are known to have visited their physician a month before their death (Conwell, 2001). Depression will not affect only those with it but also those around them. A caregiver may have trouble in dealing with a depressed patient. As the illness gets serious so does the suffering and pain experienced by the family of the patient.
The impact that depression has on the patient’s life and of those around him or her points to the need for better detection, prevention and treatment strategies. Ensuring early detection will go a long way in reducing not only the risk of suicide among older adults but also increase the chances of successful treatment. Fortunately, there are effective treatment strategies that exist that have been shown to treat the illness ultimately.
Review of the Literature
Depression is an illness known to occur in people of all ages. However, when it occurs in older adults of 60 and above, it is known as late-life depression (LLD). It is an undertreated and underrecognized common depressive disorder that in most cases will be considered normal. Furthermore, it has been known to comorbid with other illnesses common in older people (Blazer, 2000). Studies conducted in older patients recovering from heart conditions have shown that depression is always common during this period (Blazer, 2000). This has ultimately affected the interest health professionals have in diagnosing and treating the disease. Physicians have been known to treat depression as a mere response to serious illnesses among the older adults’ population.
Late-life depression is a common mental health problem, a fact that plays a role in why its impact is not only limited to its patients but to their families and friends too. Studies done in both rural and urban communities among adults older than 60 showed that about 27 percent had depressive symptoms, 4 percent had severe depressive symptoms, and 0.8 percent met the criteria for a potentially major depressive episode (Blazer, Hughes & George, 1987). Estimates in the United States show the prevalence rate for major depression to be 3 cases per every 1000 with the number of subjects in their fifties having increased (Eaton et al., 1989).
The link to suicide gives more reason for the early diagnosis and treatment of LLD by health professionals. In the United States, the frequency of suicide among adults older than 65 in 1998 was estimated to be 16.9 per 100,000 every year (Conwell, Duberstein & Caine, 2002). Among the white men of the same age group, the number of suicides peaked at 62 per 100,000. This is an indication of the effects that depression might have if left untreated.
Detection of LLD plays a significant role in its treatment. It offers the patient with an assurance that all will be okay once the treatment is started. There are outlined methods of LLD detection that exist. The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) offers some criteria for detection of LLD. The criteria are symptoms that are possibly associated with LLD. They are a significant loss of interest or pleasure, loss of appetite or weight, chronic pain, fatigue or even a feeling of worthlessness. However, these criteria may overlap with symptoms associated with other illnesses (Blackburn, Wilkins-Ho & Wiese, 2017). Efficient detection is assured when predisposing factors such as the previous diagnosis of clinical depression and precipitating factors such as the recent loss of a loved one are considered.
As stated earlier, treatment of LLD exists and is very effective. Psychotherapy has been found to be an effective method of treatment although its magnitude is dependent on the type of patient (Blackburn, Wilkins-Ho & Wiese, 2017). Despite this, it remains one of the most prescribed treatments for depression in older adults (Blazer, 2003). Another alternative for treating LLD is medication. Antidepressants are used in the treatment of moderate to severe depression in most older adults. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are the two types of antidepressants used in treating LLD (Koenig et al., 1992). Of the two, SSRIs are preferred as the choice of treatment as they have fewer side effects.
The studies conducted as discussed show that LLD is prevalent across all communities. Its impact on the lives of the elderly is also profound with suicide rates being one of the effects. Detection and subsequent treatment of LLD have also been shown to be possible. This evidence is enough to provide strategies that can be used to not only treat LLD but to even prevent it.
Prevention and Resource Strategies
Prevention has always been perceived as better than cure. This notion also applies when dealing with LLD. Prevention efforts in medicine are categorized into three: primary, which involves reducing the incidence of disorder; secondary, which involves reducing the prevalence of the disorder; and tertiary, which involves reducing the disability associated with the disorder.
Primary prevention is further divided into three: universal, are interventions focused on the public; and selective, which target individuals who have a higher risk of developing a mental illness (Raghavendran, 2015). Universal intervention for LLD can be achieved by organizing group sessions that are meant to help the individuals develop better skills in handling disagreements and pressure; and selective intervention, can be used to prevent protracted depression after the loss of a loved one this is one by pairing widows with a widow contact who will provide emotional support.
Secondary prevention is a strategy that is used when the objective is to lower the prevalence of an already established illness in a population. Early detection and treatment of the already diagnosed diseases is the best method to be applied in this scenario (Raghavendran, 2015). Early detection can be achieved using assessments such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria available to all health professionals (Depression in Older Adults, n.d.). Symptoms of LLD may include unexplained chronic symptoms such as pain; memory loss; and behavioral changes like suicide thoughts.
Tertiary prevention involves the treatment of the disorder itself. LLD can be treated using two main methods: medication and psychotherapy. These methods may be applied alone or at the same time. LLD is effectively treated using antidepressants that act on the brain neurotransmitters that are responsible for mood control (Depression in Older Adults, n.d.). As stated before, selective
serotonin reuptake inhibitors (SSRIs) are preferred when treating older patients. Examples of SSRIs available in the U.S. are sertraline (Zoloft) and fluoxetine (Prozac) .
Psychotherapy is a form of therapy treatment that is also known as talk therapy. There various forms of psychotherapy: cognitive-behavioral therapy, where the patient is helped by a therapist to identify and change any pessimistic thoughts that may cause depression; supportive therapy, where the patient is given emotional support; problem-solving therapy, that involves the patient learning effective ways to help manage their problems; and interpersonal therapy, where the therapist works together with the patient to help improve any relationship problems that contribute to depression (Depression in Older Adults, n.d.). It may take two months or more for psychotherapy to be effective mental health resources are however limited nationally and worldwide in regarding infrastructure and manpower. Demand for healthcare resources is set to increase as the population continues to age. To effectively manage and treat LLD, the focus should be placed on amassing more infrastructure, personnel, and resources.
Summary
Late-life depression is common disorder among adults who are older than 60. However, it is one of the most untreated and underrecognized illnesses. Its impact on the older adults has been severe with death by suicide as a significant effect yet it is treatable. There exist two main treatment options: psychotherapy and medication. All treatment options have been proven effective. However, early detection is possible and makes it easier for subsequent treatment. Early detection can be achieved through the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Prevention can also be achieved on primary and secondary levels. However, resources are still limited making it harder to manage and treat LLD. To do away with these challenges, measures should be taken in ensuring that these resources are availed. This will go a long way in fighting depression in older adults.
References
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