Depression, Geriatric

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.
• Depression is not a normal result of aging.

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).