Depression, Geriatric

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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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