Reclassification of Depression in the Medically III Elderly

Psychiatric Clinics of North America, 1997

Journal of Affective Disorders, 2004

Background: Various studies support the notion that the clinical picture of depression in the oldest old differs from that in younger elderly. Moreover, withstanding the serious negative effects of depression on well being and functioning, the detection rate of depression in several medical settings is low. Methods: Prevalence of depression, correlates and the rate of recognition by general practitioners were assessed in an 85-year-old community-based population. The GDS-S was applied in 500 participants with a MMSE >18, from a representative sample of 599 community based 85-year-old subjects. Demographic data, daily functioning, health correlates, use of medication and recognition of depression were recorded in home visits and from the general practitioner and pharmacists registers. Results: The prevalence of depression, as measured with a GDS-S score of 5 points or more, was 15.4%, which is comparable to previous studies. No demographic factors were correlated with depression. Perceived health, loneliness, impaired mobility, cognitive decline and functional disability were major correlates of depression. From the participants who were seen by their general practitioner, 25% were recognised as depressed. Antidepressive pharmacotherapy was almost nonexistent. Limitations: Formal diagnosis of depression was not available. The data were collected crossectionally. Conclusions: Depression is highly prevalent in the oldest old and strongly associated with functional disability and cognitive impairment. It is important to enhance recognition of depression in community based oldest old as a first step to possible interventions. D

2019

Introduction: Depression is a very common mental disorder among older people. It limits life activity and interests. It causes difficulties in making decisions or actions. It introduces somatic and emotional changes, which in older people becomes a problem on a large scale. Diagnosis of depressive disorders has very high clinical value.Depression is often associated with chronic diseases that often accompany the elderly. Material and Methods: The paper reviews literature using the EBSCO and Google Scholar databases. Articles have been analyzed using the keywords depression, depression of the elderly, care for the elderly, treatment of depression, diagnosis of depression, clinical symptoms. The article presents depression as a problem among older people, its symptoms, treatment and care for such people. Results: Treatment of depressive disorders is based on pharmacology and psychotherapy. Care and the presence of loved ones are very important. Commitment to physical activity improves...

Archives of Gerontology and Geriatrics, 2010

Journal of Affective Disorders, 1995

In a community study of 1173 very elderly ( 2 77 years) subjects, a screening interview was followed by a CAMDEX diagnostic interview in a subsample of 461. The estimated prevalence of DSM-III-R major depressive disorder in the community sampled was 2.4% (95% CI 0.9%, 4.0%). Using CAMDEX criteria, the prevalence of depressive illness was 3.0% (95% CI 0.7%, 5.3%). 10% of those who had a diagnostic interview were rated as having depressive symptoms of mild or moderate severity. Of these, -l/3 met diagnostic criteria for major depressive disorder. The significance of these findings and the possible need for wider criteria for depression in the elderly are discussed. 01650327/95/$09.50 0 1995 Elsevier Science B.V. All rights reserved SSDI 0165-0327(95)00030-5

Archives of Gerontology and Geriatrics, 2011

Journal of Affective Disorders, 1986

In this study we conducted a resurvey at 33 months of elderly general medical clinic outpatients previously classified as depressed or not using the Zung Self-Rating Depression Scale. Resurvey results and review of medical records permitted characterization of the point prevalences of depression at the time of the initial and follow-up surveys, and identification of physical illness factors associated with depression. The point prevalences of depression were approximately equal (20%). although only about 10% were depressed at both occasions. Among the initially nondepressed, the number of new physical diagnoses during follow-up was the best predictor of depression at retest. Other factors associated with depression at one or both occasions were: alcohol abuse, obstructive pulmonary disease, and a relatively greater number of medical diagnoses. Thus, among elderly outpatients, depression appears common with roughly equal rates of remission and incidence; also, new medical illness may precipitate depression.

Background: Rates of depression increase with age, and it is estimated that almost 1 in 4 older people is depressed. However, the majority of such depressed elderly go unrecognized and untreated due to various patient, clinician, and systemic factors. Aim: We intend to review the epidemiology, assessment and diagnosis of depression to provide necessary information to help mental health clinicians to correctly identify and assess patients with late-life depression. Method: Comprehensive literature search using online databases in the field of late-life depression. Results: Risk factors for depression in the elderly include chronic medical illnesses, social isolation, being a carer, poor social support, bereavement, past history of depression, substance use, and cognitive impairment. Suicide is more common in the depressed elderly than in younger age groups and deserves particular attention during assessment. Syndromal depression often goes unrecognized as it can present in the elderly as somatization, hypochondriasis, and psychomotor retardation or agitation. Accurate and timely diagnosis is also complicated by the fact that late-life depression is often associated with cognitive impairment, physical disability, and anxiety. A diagnosis should only be arrived at after a comprehensive history taking, observation of the patient's behaviour, and corroborative history from a reliable informant. Conclusions: Depression is common in older adults, and is a major public health issue. Very few depressed elderly consult their general practitioners for help, and consequently remain unrecognized and untreated. Timely screening and appropriate assessment can lead to effective treatment and resolution of symptoms and thereby can significantly reduce morbidity and mortality.

Encyclopedia

Depression is not a sign of weakness, nor a lack of will or laziness. It is not a simple “being sad” or bored, but rather a pathology that needs intervention, treatment, and monitoring by professionals with expertise in mental health. It is a disorder that impacts the lives of people who do not receive timely help affecting not only the individual himself in his feelings, thoughts, and behaviors but also harming his relationships and daily life and is prevalent among elderly people. Depression manifests through multiple symptoms, is caused by numerous factors, and is preventable with specific practices. It is described as the “most frequent mental health problem worldwide,” has a higher prevalence in women, is different from mourning and sadness, and needs to be addressed to avoid extreme situations, such as suicide.

BMJ, 2011

Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030. w1 Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes from physical illness. Most clinicians will encounter older patients with depression in their day to day practice, but although treatment is as effective for older patients as for younger adults, the condition is often under-recognised and under-treated. According to WHO data, proportionately more people aged over 65 commit suicide than any other age group, and most have major depression. Older people who attempt suicide are more likely to die than younger people, while in those who survive, prognosis is worse for older adults. 1 With a progressively ageing population worldwide, identification and treatment of depression in older adults becomes increasingly important, especially as older patients may have different presentations and needs than younger ones. We consider recent systematic reviews, meta-analyses, and randomised controlled trials to provide generalists with an understanding of current approaches to the diagnosis and management of patients who develop late life depression.