Depression in the Elderly

Approximately 10 percent of women and 5 percent of men will experience at least one major depressive episode during their adult life. Depression affects people of all races, incomes, and ages. Depression is a major cause of disease and disability in the elderly in the nursing home setting. It also increases their risk of death. Elderly white men over the age of 80 are at greatest risk, with suicide rates more than twice that of the general population. Suicides have even occurred in the nursing home setting.

Detecting depression in the elderly is complicated and may even go undetected. Symptoms are often associated with the aging process or a medical condition.

What is the harm in not treating depression?

Untreated depression can lead to social isolation. Those who are depressed are often not motivated. They rarely change body position (increasing their risk for pressure sores), may not call for assistance with toileting, and not eat or drink (leading to malnutrition and dehydration).

Why does depression occur in the elderly?

Depression is often caused by abnormalities in the levels of certain neurotransmitters in the brain. Situations can cause neurotransmitters to become unbalanced. Risk factors for depression include being unmarried, female, loss of close friends, pain, chronic illness, impaired mobility, memory loss, family and personal history of depression, substance abuse, advanced age, low socioeconomic status, and difficulty adjusting to changes such as the move to a long-term care facility. Those who are pessimistic, worry, have a low self-esteem, and ineffective responses to stress tend to also be more at risk for depression.

Depression may be complicated by brain disorders associated with the aging process such as Alzheimer’s disease. Depression can also increase a person’s risk of developing infections and increased risk of death following a heart attack. Depression is also more likely to occur in those with stroke, diabetes, cancer, hypothyroidism, and Parkinson's disease. Diet may also play a role in the risk of depression. Deficiencies in folic acid and B-12 may prevent antidepressant medication from working properly.

Medicines can sometimes cause depression symptoms. Some drug classes that have side effects of depression include those used to treat pain, hypertension, hormone replacement, cardiac disease, cancer, Parkinson’s disease, arthritis, and insomnia.

What are the symptoms of depression?

Major depression (the most common type in the elderly) is described as having a depressed mood for at least 2 weeks and at least 5 of the following symptoms: feelings of worthlessness, loss of interest or pleasure in daily activities, change in appetite, change in weight, insomnia or hypersomnia, fatigue, difficulty concentrating and memory loss, abnormal thoughts and excessive guilt, plans to commit suicide or actual suicide attempts, crying or agitated behaviors.

What do I do if I think my loved one is depressed in the nursing home?

Talk to your loved one's physician and nurse. Many physicians and nurses do not pick up on depression because they are so busy treating other medical problems. Your insight will be helpful in preventing the consequences of depression.

How is depression treated in the nursing home?

Treatment includes behavior modification, psychotherapy, medications, and sometimes electroconvulsive treatments.

Electroconvulsive therapy (ECT) has been offered to residents in the nursing home that do not respond to other treatments or who are suicidal. It has been shown to alter the levels of brain neurotransmitters that may cause depression. ECT treatments are generally given every other day for 2-3 weeks (for about 6-10 treatments) at a treatment center and are performed under the direct supervision of a psychiatrist.

Side effects from treatment include muscle aches or a headache after treatment. Some memory loss, temporary, is fairly common with ECT as well. If ECT is used, the nursing home must have a policy and procedure for managing residents who have ECT and a care plan to monitor for side effects and effectiveness of treatment.

Questions you can ask the nursing about how they manage depression:

  • How does the nursing home look for underlying causes of increased depression and anxiety?
  • How is depression treated in the nursing home?
  • How does the nursing home decide that consultation with a psychiatric specialist is needed?

Resources

Lynch, J. S. (1998). Prescribing medications for mood disorders. Advance for Nurse Practitioners, 6(1), 3.

Salerno, M. (1999). Psychosocial Disorders. In V.L. Millonig & S.K. Miller (Eds.). Adult Nurse practitioner certification review guide. (pp. 591-642). Potomac, MD: Health Leadership Associates.

American Psychiatric Association

National Foundation for Depressive Illness

National Institute of Mental Health

Emedicine