Depression, Geriatric

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Basics

Description

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

Epidemiology

Incidence
  • 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

Prevalence
  • The Global Burden of Disease Study (2015) estimated the prevalence of depressive disorders among older adults (>60 years old) of 4–6% among males and 5–8% among females.
  • Suicide is the 11th leading cause of death in the United States for all ages.
    • The elderly account for 24% of all completed suicides with the highest rates for males aged >85 years.

Etiology and Pathophysiology

  • A complex interaction between heritable and environmental factors
  • Abnormalities in neurotrophins, neurogenesis, neuroimmune systems, and neuroendocrine systems

Genetics

Possible mechanisms, including genetic influences on

  • Monoamine transmission and associated transcriptional and translational activity and dysregulation in biologic processes and proteostasis involving C-peptide, FABP-liver, and ApoA-IV proteins

Risk Factors

  • 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

Commonly Associated Conditions

Chronic disease (e.g., stroke, cancer, Parkinson disease)

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Basics

Description

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

Epidemiology

Incidence
  • 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

Prevalence
  • The Global Burden of Disease Study (2015) estimated the prevalence of depressive disorders among older adults (>60 years old) of 4–6% among males and 5–8% among females.
  • Suicide is the 11th leading cause of death in the United States for all ages.
    • The elderly account for 24% of all completed suicides with the highest rates for males aged >85 years.

Etiology and Pathophysiology

  • A complex interaction between heritable and environmental factors
  • Abnormalities in neurotrophins, neurogenesis, neuroimmune systems, and neuroendocrine systems

Genetics

Possible mechanisms, including genetic influences on

  • Monoamine transmission and associated transcriptional and translational activity and dysregulation in biologic processes and proteostasis involving C-peptide, FABP-liver, and ApoA-IV proteins

Risk Factors

  • 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

Commonly Associated Conditions

Chronic disease (e.g., stroke, cancer, Parkinson disease)

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