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- 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.
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.
- 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
- 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 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).