Depression in the Elderly - lecture series sw559

Depression

1. Depression in the Elderly
Dr Crystal Lim
SWK 559
17 October 2020

2. Late life depression
•Depression onset after 65years old.
•Differentfromearly-onsetdepressionthatrecursinlateryears.
•Usually happens in the contextofmedical and neurological disorders
(Alexopoulos, 2005).
•Iatrogenic (caused by the treatment for a medical condition)

4. •In those aged 65 and above:
▫3.7% prevalence for depression
▫13.4 % prevalence for subsyndromal depression
•Compared to the Chinese, Indians are 5.2x and Malays 3.2x more likely to have
depression.
•Compared to those 60-74 years, the elderly aged 75-84 years are 2x more likely to be
depressed.
•Association between depression and more disability, more disease co-morbidity and
lower QoL.
•An association between mental illness and chronic illness
•Severity of depression is a stronger risk factor for suicide than psychosis in mood
disorders.
•2/3 of those clinically depressed have suicidal thoughts or thoughts of dying.
Source: Prevalence of Depression among Older Adults—Results from the Well-being of the Singapore Elderly Study)

5. Whyshould we be concerned?
•Under-diagnosed problem
•Difficult to diagnose
▫Reduced cognition in the elderly
▫Concomitant symptoms from other diseases
•Theelderly likely do not realize they have the condition, and even if they do, may have difficulty
verbalizing it because of reduced cognition
•Aggravates existing physical and medical conditions
•Increases stress on the family and caregiver
•Suicide risk
•Increases health care cost, including longer hospitalization

6. Signs of elderly depression
•Feeling persistently sad, moody and down
•Becoming increasingly withdrawn (e.g. avoiding family and friends)
•Sudden change in eating habits (either eating too little or a lot)
•Change in sleeping habits (insomnia or the opposite, sleeping a lot more than usual)
•Poor concentration
•Always feeling tired
•Having negative feelings such as excessive guilt, worthlessness and helplessness
•Expressing suicidal thoughts

7. Late Onset Depression: An Update
(2016).
Ananya Mahapatra,
Pawan Sharma,
Sudhir Kumar Khandelwal

8. What can cause it?
1.Biological factors
▫Imbalance (deficiency) in serotonin levels, a neurotransmitter.
▫Certainneurohormonal pathways having been affected.
▫Illness co-morbidities
▫Elderly persons with cardiovascular accident (CVA), i.e. stroke, Parkinson’s
disease, and those who suffered a heart attack have increased risk for
depression.
a
▫Dementia (vascular dementia results in ischemic damage that causes
cognitive deficits that can cause depression
b.
▫Medications(e.g.anti-hypertensives, Parkinson’s meds, chemotherapy
drugs)

9. What can cause it?
2.Psychosocial factors
▫Low socio-economic status (SES)
▫Experiencing negative life events
▫Inactivity
▫Deathofaspouseorother significant person (10-20% within 1
st
year)
▫Isolation
▫Loneliness
▫Live stressors
▫Going to a nursing home (when one does not wish to)
▫Disability. (Disability affects sense of worthiness, hopelessness; stressful
condition). Holmes T, Rahe R. The social readjustment rating scale. J Psychosomatic Research 1976;22:213-18.

10. Late Onset Depression: An Update
(2016).
Ananya Mahapatra,
Pawan Sharma,
Sudhir Kumar Khandelwal

11. George S Alexopoulos. (2005).
Depression in the elderly
Lancet 2005; 365: 1961–70

12. Intervention
1.Medication
▫Anti-depressants (common side effects: headache, gastric disturbance, increased
anxiety).
2.Combination treatment: medication with psychotherapy
3.Psychosocial intervention
▫Counselling (most elderly prefer this to medications)
▫Therapy (reminiscence, life review, CBT)
4.Alternative therapy
▫Massage
▫Complementary medicine (little or no research on efficacy)
▫Music therapy

13. References
•Mahapatra, A., Sharma, P. & Khadelwal, S. K. (2016). Late onset depression:
An update. Journal of Mental Health & Human Behaviour, 20(1), pp4-11.
•(a & b) are cited in: SekhonS, Patel J&SapraA.Late Onset Depression.
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK551507/
a)LiebetrauM, Steen B, Skoog I. Depression as a risk factor for the incidence of
first-ever stroke in 85-year-olds. Stroke. 2008 Jul;39(7):1960-5. [PubMed] [Ref
list]
b)ShelineYI, et al. Regional white matter hyperintensity burden in automated
segmentation distinguishes late-life depressed subjects from comparison
subjects matched for vascular risk factors. Am J Psychiatry. 2008
Apr;165(4):524-32. [PMC free article] [PubMed] [Ref list]
•George S Alexopoulos. (2005). Depression in the elderly. Lancet2005; 365:
1961–70