Depression In Elderly Essay, Research Paper

Mental disorders are becoming more prevalent in today?s society as people add

stress and pressure to their daily lives. The elderly population is not

eliminated as a candidate for a disorder just because they may be retired. In

fact, mental disorders affect 1 in 5 elderly people. One would think that with

disorders being rather prevalent in this age group that there would be an

abundance of treatment programs, but this is not the case. Because the diagnosis

of an individual?s mental state is subjective in nature, many troubled people

go untreated regularly (summer 1998). Depression in the elderly population is a

common occurrence, yet the diagnosis and treatment seem to slip through the

cracks. Depression is an example of a metal condition that may slip through the

cracks when it comes to detection. The health care industry contributes to the

overlooking of depression in the elderly because of the overwhelming desire to

keep costs down. The factors of depression are open for interpretation, which

results in different doctors looking for different things. In addition to that,

elderly people may not exhibit the traditional symptoms of depression either.

Aged individuals may have symptoms of depression that go unnoticed due the fact

that those symptoms are being attributed to a different ailment. ?One half of

all depressed patients seen by general physicians are not identified as

depressed (August 1995).? Also, some of the things people look for in

detecting depression are things that society seems to think are the norm for our

elders (October 1999). In addition, there appear to be a few fundamental

differences between depression in the young and old. Elderly people tend to have

more ideational symptoms, which are related to thoughts, ideas, and guilt.

Elderly depressed individuals are also more likely to have psychotic depressive

and melancholic symptoms such as anorexia and weight loss. Finally, older people

tend to have more anxiety present in their depression than younger patients do

(winter 1996). In the natural order of things, bodies tend to wear down somewhat

and people become higher risk candidates for various health problems. It is the

increase in health problems that allows for some symptoms of depression to be

overlooked. Doctors begin to attribute all problems and ailments to the primary

problem, neglecting the possibility of depression. The prevalence of low blood

pressure is one of those items that do increase as an individual ages. The

correlation of depression with low blood pressure also increases as time passes,

particularly among men. A study by Barrett-Connor and Palinkas indicated ?men

with low blood pressure scored significantly higher on both the emotional and

physical items of a depression test (February 1994).? These same individuals

also scored higher on measures of pessimism, sadness, loss of appetite, weight

loss, and preoccupation with health than did people with normal blood pressure.

Some believe that because low blood pressure can cause fatigue, anyone with

these two symptoms could possibly be diagnosed with depression. This is a

snowball effect where the low blood pressure causes the fatigue, which in turn

causes someone to feel useless, which further develops into other possible

depressed symptoms. An interesting side note to this study was that the low

blood pressure found in the patients was not directly related to any chronic

health condition (February 1994). Low blood pressure is not the only risk factor

for the development of depression. Some other factors include losses dealing

with jobs, status, finances, physical ability, or relocation. Family problems

dealing with divorce, siblings, children, or a death can also send one on a

downward spiral. Changes in the brain such as decreased adaptive capacity,

neurotransmitter and receptor changes, cognitive impairment, and dementia

increase the risk of depression (winter 1996). As more factors enter the

equation and the patient becomes more depressed, the likelihood of a suicide

attempts increases. As previously mentioned, diagnosing depression in the

elderly can be a challenging task due to all of the factors involved. When

considering if an individual is depressed, one must examine the individual?s

background, cognition, medical history, etc. In order to diagnose depression,

there are written and oral inventories of a person?s mind that need to be

performed. Symptoms of severe depression include: diminished interest in usual

activities, significant weight loss or gain, insomnia or hypersomnia,

psychomotor agitation or retardation, fatigue or loss of energy, feelings of

worthlessness or guilt, diminished ability to concentrate, and recurrent

thoughts of death or suicide. Depression does not always have to be severe. To

be diagnosed with mild depression or dysphoria, the mood of the patient would

first need to be depressed for two years. In addition to that, two of the

following characteristics would need to be present: low self-esteem, poor

concentration, difficulty making decisions, overeating or a poor appetite, low

energy level, insomnia or hypersomnia, and feelings of hopelessness (August

1995). Diagnosing depression can be a difficult task due to the human element

involved. A recent study by Jackson and Baldwin tested nurses? skills of

observation in detecting depression in hospital patients. They were asked to

categorize patients as definitely not depressed, probably not depressed,

probably depressed, and definitely depressed. The responses given by the nurses

were checked against written inventories that had been filled out and analyzed.

The results indicated the nurses were not accurate in their assessment until

those labeled as ?probably not depressed? were moved into the ?definitely

depressed? category. This illustrates that the patient may have exhibited

symptoms of depression, but those symptoms were attributed to another health

problem leading to the diagnosis of depression being overlooked (September

1993). Another way to diagnose a patient is by having the patient complete the

GDS, or Geriatric Depression Scale once he or she had been treated for the

primary illness. This is a 30-question survey of things happening to a patient,

both physically and mentally. These results are then analyzed using the

Geriatric Mental Status Schedule (GMSS) on a computer. The GMSS compares

psychiatric symptoms in stage 1 to organic disorders in stage 2. Preferences are

given to organic disorders in stage 2 because it is believed that these are the

primary causes. In GMSS stage 1 the patient must score a severity level of 3

(out of 5) to be classified as syndromal depression. In the experiment conducted

by Jackson and Baldwin 36% of the sample was classified as having syndromal

depression. This sample was made up of elderly medically ill hospital

inpatients. The selection appears to reflect the general population fairly well,

as it is believed that between 9% and 45% of the medically ill elderly

experience depression (September 1993). There are many ways to go about treating

depression in the elderly. According to American Family Physician (April 1996),

?there are 7 guidelines to follow: 1) correct any underlying illness; 2)

avoid, if possible, prescribing medications that may cause or exacerbate

depression; 3) decrease isolation due to sensory deprivation; 4) increase

stimulation; 5) consider psychotherapy; 6) consider psychiatric referral for

severe depression, and 7) consider the use of antidepressants.? Cognitive

therapy has been used successfully to treat depression in young and middle aged

individuals. It is this success that has brought on the growing interest in the

results of cognitive therapy on elderly depressed patients. In addition to the

success, ?the US National Institute of Health consensus conference highlighted

the need for continued development in this area (January 1997).? The types of

psychological treatments used on the elderly are specifically designed for aged

persons. The central idea in cognitive therapy is to take the negative

self-opinion and teach ways to reverse this opinion. Validation and reminiscence

are examples of techniques used to get the patient to reflect on the

accomplishments of his or her lifetime. Hopefully, this will bring back some

pleasant memories of family or other accomplishments. It also allows the patient

to look at the impact he or she has made in the lives of others and provides

feelings of usefulness. These memories and feelings aid in the individual

viewing himself as he once did, with a positive outlook. People often develop

negative opinions, called cognitive distortions based on difficulties adapting

to change. Normal changes in physical ability, memory, living arrangements, etc.

that occur naturally with time can cause an individual to view his life as

worthless. The tendency to blame oneself becomes popular because the person

likely has an unrealistic view of the aging process. Thus, the goal of cognitive

therapy becomes equipping the patient with the ability to alter their internal

biased view of life events (January 1997). Medication, specifically

antidepressants are among the other treatment options for depression in the

elderly. Antidepressants are drugs the patient takes to improve his or her

overall mood. These pills must be taken regularly and require several weeks of

ingestion before any results will be noticeable. According to Dr. Sunderland,

?every primary care physician should have at least two or three medicines they

feel comfortable using (April 1997).? To feel comfortable using a medicine,

one must be informed about side effects, how to begin dosing, when to switch

dosage, and what to look for in blood tests. Many senior citizens take

prescriptions regularly for various ailments. Due to the fact that many senior

citizens take multiple prescriptions daily, the physician must also be familiar

with how the various drugs interact with prescriptions the patient is currently

taking (April 1997). The most commonly used and most successful antidepressants

are tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI’s?).

Tricyclic antidepressants include nortriptyline and desipramine and are

frequently used for depressed patients with insomnia. Their side effects include

hypotension and constipation, which may be too much for the patient to bear.

SSRI?s include fluoxetine (Prozac) and paroxetine (Paxil) and are generally

classified as safer, with fewer side effects. The known side effects are

insomnia, nausea, and mild headache, which may be more bearable to the

individual (April 1996). MAO inhibitors are another type of antidepressant, but

not prescribed as frequently due to the alterations a patient must make to his

or her diet (August 1995). Electroconvulsive therapy (ECT) is the treatment for

depression used when results are needed immediately and is nearly 80% effective.

Only 25% of depressed patients receive this treatment, but it has proved

effective when it has been utilized. ECT sends electric pulses (shock waves)

into the brain, which enhance the patient?s mood as an antidepressant would.

Patients with suicidal tendencies or severe weight problems would be justifiable

in using ECT. ECT is a great solution to short term depression because the

patient feels better quickly and avoids having to take expensive drugs for an

extended period of time. Recent technological advancements allow for treatment

of just one side of the brain if so desired whereas in the past it was the

entire brain or not at all (April 1997). Most experts will agree that the most

effective way to treat depression is a combination of any or all methods. Each

treatment has merits by itself, but those multiply when combined. The most

popular combination of treatments includes using antidepressants in conjunction

with regularly scheduled visits to a professional. This allows for the drugs to

aid in improving the mood between visits, while the visits teach the person how

to cope with any cognitive distortions that may arise. The biggest challenge

when treating depression is convincing the patient to stick with any type of

therapy. Patients become stubborn and quit taking their medication or visiting

the doctor as soon as they begin to feel better. This is a huge mistake because

it will only cause the individual to fall back into the old patterns and

problems. Depression is one of those conditions that can return if proper

preventative measures are not taken. Patients need to understand that depression

can return at any time and certain precautions must be taken. The individual

needs to continue drug treatments in conjunction with doctor visits to have the

highest rate of recovery. A study done by Dr. Reynolds showed that 3 years after

being treated for depression, patients who used drug treatments and continued

regular visits to the doctor only had a 20% relapse rate. Those who did not

continue their medication or doctor visits had a 90% rate of relapse. Dr.

Reynolds states, ?Our results demonstrate the importance of adding just one

counseling secession a month to a medication regimen (March 1999).? It is

important to treat depression as early as possible because once the patient

passes the age of 70 it becomes difficult for any long-term results. Depression

is no different from most other medical problems in that the earlier the problem

is detected the better the chances of a successful recovery. Elderly individuals

have many potential reasons to be depressed ranging from society?s perception

of them to their own self-opinion. The health of a person also begins to decline

as they age which reinforces the depressed state of mind. The elderly deserve

our respect and support through their physical and emotional difficulties

because we would not be around if not for them. The diagnosis and treatment of

depression in the elderly may not be a simple task, but it is one that deserves

more attention and further advancement.

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