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It is possible to have depression rated as higher because of the similarity of some of the symptoms between depression and dementia. Geriatric psychiatric studies have shown a relationship between prefrontal cortex function and successful treatment of geriatric depression1. Geriatric patients who had a positive result during depression screening were studied to determine the pharmacological impact on their recovery. 110 depressed geriatric patients (over age 60) were treated with medication after an assessment that tested the pre-frontal cortex function (to establish a baseline). After three months the study group was reevaluated and a correlation between higher pre-frontal cortex function and depression remission levels was made2. The study showed that depression in the elderly can be diagnosed and successfully treated. The study also showed a relationship between prefrontal cortex function and depression and may indicate a secondary way to identify depression in the elderly (especially non-verbal patients).
Detecting depression in the elderly is no easy task because of the reluctance to self-report. In addition to the standard characteristics of depression (ie. insomnia, sadness, and loss of self worth), elderly patients may show signs of over concern about bodily aches and pains. Some symptoms of old age (loss of appetite and weight loss) are also symptoms of depression. Obviously, if one is diagnosed with depression and the treatment (medications and/or talk therapy) works, that would confirm the diagnosis. Appendix A contains a typical screening for depression in the elderly.
Elderly that suffer from depression often don’t take good care of themselves. As their self-care drops so does their compliance level when it comes to medication and diet. This group reports as having a higher incidence of suicide and suicidal ideation than the general population. Studies have shown that suicides in the elderly often use highly lethal methods and are successful more often than in the general population3. This same study found that 20% of elderly patients that committed suicide had seen their health care provider within the 24 hours prior to the suicide, 41% within a week, 75% within one month. This indicates that geriatric practitioners should screen for depression and suicidal ideation at each patient visit rather than a random screen or no screen at all.
There is a higher incidence of depression among elderly that are caring for an elderly spouse4. These caregivers often feel older than their age. “Caregivers for impaired spouses experience a kind of distress that isn’t easily measured,” Kiecolt-Glaser says5. The caregiver’s in the study died at a higher rate than other seniors who were not caregivers. These caregivers would benefit from a screening program targeting those who provide ongoing care to their spouse.
Teaching and learning strategies need to be in place to deal with depression in the elderly. Both the elderly and their caretakers need to be informed about the causes and symptoms of depression and how to get appropriate care. They also need to understand that they need not feel stigmatized by the diagnosis. Once depression is diagnosed, treatment and education should begin.