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Depression, Geriatric

Depression, Geriatric is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Depression is a primary mood disorder characterized by a depressed mood and/or a markedly decreased interest or pleasure in normally enjoyable activities most of the day, almost every day for at least 2 weeks, and causing significant distress or impairment in daily functioning with at least four other symptoms of depression.

Epidemiology

Prevalence rates among the elderly vary largely depending on the specific diagnostic instruments used and their current health and/or home environment:

  • 2–10% of community-dwelling elderly
  • 5–10% seen in primary care clinics
  • 10–37% of hospitalized elderly patients
  • 12–27% of nursing home residents

Etiology and Pathophysiology

  • Significant gaps exist in the understanding of the underlying pathophysiology.
  • Ongoing research has identified several possible mechanisms, including the following:
    • Monoamine transmission and associated transcriptional and translational activity
  • Epigenetic mechanisms and resilience factors
  • Neurotrophins, neurogenesis, neuroimmune systems, and neuroendocrine systems
  • Depression appears to be a complex interaction between heritable and environmental factors.

Risk Factors

  • General
    • Female sex
    • Lower socioeconomic status
    • Widowed, divorced, or separated marital status
    • Chronic physical health condition(s)
    • History of mental health problems
    • Family history of depression
    • Death of a loved one
    • Caregiving
    • Social isolation
    • Functional/cognitive impairment
    • Lack/loss of social support
    • Significant loss of independence
    • Uncontrolled or chronic pain
    • Insomnia/sleep disturbance
  • Prevalence of depression in medical illness
    • Stroke (22–50%)
    • Cancer (18–50%)
    • Myocardial infarction (15–45%)
    • Parkinson disease (10–39%)
    • Rheumatoid arthritis (13%)
    • Diabetes mellitus (5–11%)
    • Alzheimer dementia (5–15%)
  • Suicide
    • Suicide is the 11th leading cause of death in the United States for all ages.
    • Elderly account for 24% of all completed suicides.
    • Suicide rates are highest for males aged >85 years (rate 55/100,000).

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Citation

Stephens, Mark B., et al., editors. "Depression, Geriatric." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116949/all/Depression_Geriatric.
Depression, Geriatric. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116949/all/Depression_Geriatric. Accessed June 16, 2019.
Depression, Geriatric. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116949/all/Depression_Geriatric
Depression, Geriatric [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 June 16]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116949/all/Depression_Geriatric.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Depression, Geriatric ID - 116949 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116949/all/Depression_Geriatric PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -