Depression in Older Adults: Pervasive or Preventable?

Depression occurs in as much as 15% of older adults, but it is often undiagnosed and untreated. This article explores topics related to depression in older adults including etiology, diagnosis, screening and treatment options, treatment outcomes, interventions, implications for counselors, and areas for further research. Depression, often called "the common cold of mental illness" (Castleman, n.d.), affects 18.8 million Americans, or 9.5% of the population in any given year ("Depression," n.d.). Among older adults, depression is an even larger concern. A recent report from the National Institute of Mental Health called depression in the older adult population "widespread . . . a serious public health concern" (Castleman, n.d., "Aging"). Depression is the most common mental illness among persons over the age of 60. Approximately 150/0 of older adults suffer from significant depression at any given time (Sable, Dunn, & Zisook, 2002). Despite its prevalence, depression is not an inevitable part of the aging process. In this article, I refute the myth that older adults are inevitably depressed, by examining etiology, diagnosis, screening and treatment options, treatment outcomes, need for further research, and implications for counselors. ********** CAUSES OF DEPRESSION Although the American Psychiatric Association's (2000) Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) suggests that symptoms of a major depressive episode may develop over a period of days to weeks, the development period for depression in older adults may be much longer, even years. In a study, Berger, Small, Forsell, Winblad, and Blackman (1998) found that people over the age of 75 who demonstrate depressive symptoms, such as appetite disturbance, psychomotor disturbances, and dysphoria at baseline, are more likely to be diagnosed with depression 3 years later. Furthermore, these patients also demonstrated more severe baseline symptoms than their nondepressed counterparts. This study indicates "major depression has a more chronic nature in very old age" (Berger et al., 1998, P. 1043). Unfortunately, because of its slow development and because most older depressed patients exhibit physical signs of depression rather than overt sadness, the illness often goes undetected. Many of the somatic signs of depression, such as lethargy, sleep impairment, loss of appetite, difficulty concentrating, and pessimism, overlap with symptoms of other illness such as multi-infarct dementia, Parkinson's disease, and Alzheimer's disease (Macready, 1999; Peveler, Carson, & Rodin, 2002). A high level of depression in later life is associated with an increased risk of developing Alzheimer's disease. Consequently, Alzheimer's patients have a high prevalence of depression (Meltzer, Price, Mathis, & Greer, 1999). Taking estrogen may decrease depression in older women suffering from Alzheimer's disease (Carlson, Sherwin, & Chertkow, 2000). In addition to Alzheimer's disease, other serious illnesses, such as cancer, heart attacks, or strokes, may also have a high rate of comorbidity with depression. The primary illness, however, often masks the symptoms of depression. Those who are depressed are less likely to survive. Approximately 20% of heart attack survivors suffer major depression in a given year, compared with 5% of all Americans (Carney & Jaffe, 2002; Parmet, 2002). Accordingly, the rate of depression is particularly high among older medical inpatients, although there is no significant relationship between severity of illness and rate of depression (Magni, 1985). However, the type of disease is associated with depression. Older patients with blood diseases, musculoskeletal diseases, and diseases affecting the central nervous system were most likely to be depressed (Magni, 1985). One explanation is that these disorders tend to lead to disability, which leads to social isolation, a key risk factor for depression (Magni, 1985). …