Depression is a sad mood. It is characterized by an alteration of mood in which sadness is disproportionate, the person loses interest, and even the illusion, to live, feeling unable to perform their previous activities.
Along with this sadness may appear sleep disturbances, loss of appetite or somatic symptoms such as malaise, fatigue or feeling of suffocation, among others. In fact, it is very rare for an elderly person to consult a geriatric specialist because of sadness, but he/she will usually explain these somatic problems that mask the true diagnosis of a depressive syndrome.
It is not easy to talk about the incidence of depression in the geriatric population because it is an underdiagnosed pathology that is erroneously related to a “normal” process of aging. It is estimated that up to 30% of elderly people living at home suffer from depression, a figure higher than 35% if they are institutionalized in geriatric centers or up to 45% when they are hospitalized coinciding with an acute intercurrent process that affects their health.
Causes of depression in the elderly
The most frequent causes of depression in the elderly are:
- Loneliness: this is one of the main reasons for depression in the elderly. It is important to note that a person may feel lonely despite being accompanied. In the context of the elderly it is closely related to widowhood, despite the probable support of children and/or relatives.
- Functional dependence: may justify the need for third parties to perform basic activities of daily living, especially if accompanied by pain. It may trigger a depressive mood.
- Presence of multi-pathology: it involves polymedication and, probably, frequent visits to the doctor, either at the doctor’s office itself or with repeated hospital admissions. It may justify the fear of dependence and/or death, and trigger depressive symptoms.
- Mood and cognitive deficit go hand in hand: the cognitive capacity of people, both to incorporate information and to recall any information recorded in the brain requires a predisposition of attention, alertness, which is not present in depressive states, which justifies some diagnoses of depression in patients who come to the clinic to rule out dementia. At the same time, and especially in the early stages of cognitive impairment, where the person is still aware of his or her lack of memory and “absent-mindedness”, it can lead to reactive depression.
- Retirement: this is one of the causes usually recognized as a trigger for depression, mainly among men. In recent years it has decreased its prominence probably thanks to active aging policies that are achieving a change in the lifestyle of the elderly and a positive view of this stage of life.
How to treat an elderly person with depression?
If there is a suspicion of a depressive process in the elderly, it is important to request a specialized geriatric assessment. The action plan is based on three pillars:
- Determine the cause that has triggered the depression. To this end, doctor-patient communication is crucial, preferably alone, without any family members, which will allow us to delve into issues such as loneliness, death or dependence. Subsequently, the therapeutic plan and management should be shared with family members, who should “help” the patient to overcome this pathological process.
- Pharmacological treatment is essential. An individualized antidepressant should be administered depending on each person and the predominant symptoms: if apathy, insomnia or lack of appetite predominate, or if it is associated with anxiety. It is important not to forget the higher risk of side effects of antidepressants in the geriatric population and/or interaction with other drugs.
- Non-pharmacological therapy is also essential. It is important to recover self-esteem and overcome certain “fears”. For this purpose, communication and participation in psychomotor, reminiscence or handicraft activities that facilitate an “active” state of the person should be encouraged. Although there is not much experience with meditation or mindfulness techniques in the geriatric population, with respect to other areas such as oncology and/or care in young people it can help in the management of the depressive process, although its success in the elderly population is probably less given this multifactorial component of depression in the elderly.