Concerns when Assessing for Depression in Older Adults

If you have been keeping up with the earlier posts, you have learned that depression is the most common mental illness diagnosis in the aging population.  Something you might have missed that depression is not a normal part of aging, regardless of what the general population might think (National Institute on Aging, 2013; Geriatric Mental Health Foundation, 2013). Sadness and grief are normal reactions to situations, such as loss of a loved one and loneliness, and are experienced by people at all stages of life.  However, in older adults, depression can be mistaken for grief and sadness because of the stigma related to discussing this population discussing their symptoms, in addition to clinicians not recognizing more subtle changes in behaviors and cognitions (National Institute on Aging, 2013).  

You might wonder: why do we need to be concerned with older individuals not receiving mental health services to treat depression?  According to the Geriatric Mental Health Foundation (2013) “the direct and indirect costs of depression have been estimated at $43 billion each year, not including pain and suffering and diminished quality of life. Late life depression is particularly costly because of the disability that it causes and the impact on the physical health of the older person.”  Thus, depression in older adults not only have an impact on their own physical, mental, and emotional well-being, but it also results in a financial cost to society.  Helping professionals need to be aware of the signs and not dismiss symptoms that may indicate feelings of despair and hopelessness because this error puts the aging population at risk for suicide (National Institute on Aging, 2013). 

Furthermore, helping professionals sometimes normalize and under-diagnose depression in older adults, possibly contributing to this population’s suicide rate of 14.9% (P Span, 2013).  Moreover, many experts believe that suicide rates are under-reported in older adults, especially when the means is a medication overdose (P Span, 2013).  Improved screenings and treatments for depression have decreased the rates of suicide in older adults, but many clinicians are still not looking at the big picture.  Aging individuals are more than the sum of their parts- they are more than their physical and mental disabilities.  Practitioners may view an older client as being physically disabled, dismissing the other systems at work; the psycho-social functioning of the aging population is sometimes overlooked, which could have dire consequences for their clients. For instance, an older client exhibiting symptoms of confusion and loss of memory may be medicated to treat dementia when the root source of the problem is clinical depression. According to Rebecca Smith, the Acting Director of the Gerontology Specialization at the University of Louisville Kent School of Social Work, over-medicating is a major problem in regards to this population (R. Smith, personal communication, June 13, 2014).  It seems a simpler solution to offer patients and clients a pill rather than offering talk therapy to treat depression. However, mental illness is a complex issue with many factors contributing to its severity and duration. As helping professionals, we need to be able look for the signs of depression and link older individuals with the most appropriate (not easiest!) intervention(s).

 

Let's get to work on preventing suicide related to untreated/undiagnosed depression in the aging population!

Here’s a quick guide from the Geriatric Mental Health Foundation (2013) for what to look for when assessing for depression in older individuals:

• Persistent sadness lasting two or more weeks
• Difficulty sleeping or concentrating
• Feeling slowed down
• Withdrawing from regular social activities
• Excessive worries about finances and health problems
• Pacing and fidgeting
• Feeling worthless or helpless
• Weight/appearance changes or frequent tearfulness
• Thoughts of suicide or death

References

Geriatric Mental Health Foundation. (2013). Depression in late adulthood: A fact sheet. Retrieved from http://www.gmhfonline.org/gmhf/consumer/index.html

National Institute of Aging. (2013). Depression. Retrieved from http://nihseniorhealth.gov/depression/aboutdepression/01.html

P Span. (2007, Aug 7). Suicide rates are high among the elderly. [Web log comment]. Retrieved from http://newoldage.blogs.nytimes.com/2013/08/07/high-suicide-rates-among-the-elderly/?_php=true&_type=blogs&_r=0