How does depression affect the elderly?

Depression is one of the most common psychiatric disorders with an estimated annual prevalence of 2% to 3% for men and 8% for women. This means that 1 out of every 5/6 people suffers, has suffered or will suffer from depression during their lifetime.

The definition of depression is given according to the criteria of the ICD-10 (International Classification of Mental Illnesses of the WHO) and its main characteristics include:

  • Decreased attention and concentration
  • Loss of self-confidence and feelings of inferiority.
  • Having ideas of guilt and worthlessness (even in mild episodes)
  • Having a gloomy outlook on the future – Suicidal or self-harming thoughts and actions
  • Sleep disturbances
  • Loss of appetite

Mood depression varies little from day to day and does not usually respond to environmental changes, although it may have characteristic circadian variations. The clinical presentation may be different in each episode and in each individual. Atypical forms are particularly frequent in adolescence. In some cases, anxiety, malaise and psychomotor agitation may predominate over depression.

The mood disturbance may be masked by other symptoms, such as irritability, excessive alcohol consumption, histrionic behavior, exacerbation of pre-existing phobias or obsessive symptoms, or hypochondriacal preoccupations.

How is depression diagnosed?

For a diagnosis of a depressive episode of any of the three levels of severity, a duration of at least two weeks is usually required, although shorter periods may be acceptable if symptoms are exceptionally severe or of abrupt onset.

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What is the perception of depression?

The boundaries of the disorder have been blurred and the meaning of the term ‘depression’ has been devalued by colloquial attribution to disappointments, losses or setbacks such as a ‘slump’ or a ‘slump’ which are superficial and transient and of course do not meet the criteria defining the illness. A major depressive episode greatly affects the patient’s thinking, concentration and attention, which can make it more difficult to ask for help. A severe depressive illness may lead the patient to think about suicide.

How can depression affect the different periods of our lives?

  • Housewives (adulthood and especially over the age of 60) find themselves unable to take on household chores that are complex and require foresight, resolution and responsibility.
  • Students are unable to focus, perform and pass their assessments. In the workplace, it is just as complicated, since they have lost their possibilities for action, their security and they are trying to keep up their best. This leads to ‘presenteeism’ as an alternative to absenteeism, for fear of being fired.
  • During adolescence we see a defiant attitude, loss of the meaning of life, and we begin to ask questions such as “where are we going, where do we come from”. Sometimes there is a depersonalization that makes the patient not know who he/she is. The age of onset is puberty in the vast majority of cases. Young people consider dropping out of high school, a considerable percentage does so. Sometimes depression is also linked to the consumption of intoxicants such as cannabis and alcohol. It has been shown that the increased use of social networks and the Internet in these patients is associated with an increase in adolescent depression.
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Depression in the elderly

“Depressive illnesses in the elderly tend to be recurrent and affect 15% of those who live in the community, but can occur in one out of every two people who live in a nursing home”, stresses the specialist in Psychiatry at the Clínica Universidad de Navarra (CUN), Dr. Jorge Pla Vidal. He also points out that depression in the elderly, as in other adult patients, is more common in women than in men.

In elderly patients, depression is one of the most frequent psychogeriatric ailments affecting the health of the elderly and presents with symptoms characteristic of this population. The aging of the population increases the number of elderly people with serious health problems, functional disability and multiple diseases that require special care. Many of these are chronic, with mental disorders being common problems in this age group.

What are the most frequent psychiatric disorders in the elderly?

Depression, cognitive impairment and dementias are the most frequent psychiatric disorders in the elderly. The prevalence of dementia in the population over 65 years of age is 10%. It can reach 55.7% in primary care patients and 60-80% in nursing home residents.

The prevalence of depressive disorders in primary care patients can reach 41%, reaching 65% in hospital patients and nursing home residents, 2/3 of whom do not receive treatment.

The relationship between depression, cognitive impairment and dementia is complex. Epidemiological studies relate depression to the development of Alzheimer’s disease, raising the question of whether depression is a risk factor for the development of dementia, or a prodromal manifestation of the dementia disease that could be expressed with cognitive impairment. Depression is often undiagnosed and untreated, complicating care, prolonging stays in institutions and causing greater functional, mental and social impairment, with a decrease in quality of life.

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According to the Hospital Vithas Valencia al Mar, some of the symptoms that can hide a depressive episode in the elderly are: weight loss, poor digestion, reflux, muscle pain, memory loss or psychomotor slowness.

Many times, the elderly patient goes to the doctor with a physical symptom without knowing that it may be a veiled manifestation of depression. To prevent this from happening, it is necessary to go to the family physician to rule out organic causes and to refer to a psychiatrist if necessary.

Bibliography

  • Jerónimo Saiz. Depression and its difficult treatment.
  • Celida Rosario Romero Valadez, Mería Elena Flores, (Depressive symptoms in older adults with depression).
  • Blanca Sánchez Sánchez (Triple D, depression, cognitive impairment and dementia).