Depression Assessment: Older Adults

Depression in older adults is about as common as it is in the general population (12% versus 16%) but is detected and treated at a much lower rate.  Although depression is not a normal response to getting older, there are several life events that occur with aging that can trigger depression such as reductions in physical or mental functioning, life changes with retirement, transitions from independent living to assisted living, and grief over lost loved ones. Depression in older adults, also called “late-life depression” has several negative consequences including worse outcomes for other medical diseases, increased healthcare use, and suicide.  In fact, suicide rates among older adults is nearly twice as high as the general population and is highest for White men over 85 (Hoyert 1999)
 
Considerations for Treatment with Older Adults
Following the general treatment guidelines  for depression is always a good place to start for anyone experiencing depression, including older adults.  If difficulties arise in encouraging a loved one to seek treatment and/or consider treatment options for depression, a logical place to start is to identify barriers to seeking treatment, acknowledge understanding of possible reasons for declining treatment, and problem-solve strategies for overcoming barriers. 
 
The most common form of treatment for depression in older adults is medication. However, many older adults are taking multiple medications (sometimes called “polypharmacy) so it is important to pay attention to the potential for interactions  between medications for depression and medications for other health problems. It is common for antidepressant medications to take more time to start working in older adults (8-12 weeks versus 4-6 weeks for the general population). Psychotherapy is effective for depression in older adults but is used much less frequently.  A specific type of Cognitive-Behavioral Therapy called Problem-Solving Therapy focuses has been shown to be well received and effective for older adults (Kirkham, Choi, & Seitz, 2015). As the name implies, the treatment focuses on identifying specific stressors a person is encountering (e.g. “I am lonely since my spouse died”) and coming up with specific, do-able plans for addressing these stressors (e.g. “I will call 2 friends this week”). For severe depression, a combination of medication and psychotherapy is recommended.
 
Identification treatment of depression in older adults can be complex. As people age, it is common to have more medical illness and medications for these illnesses.  Both the symptoms of the illnesses and the side effects from medications can look very similar to symptoms of depression (fatigue, appetite loss, sleep difficulties, lack of sexual interest, memory complaints).  Difficulties with communication, somatic symptoms, and hopelessness also tend to get worse with age, which can interfere with effective treatment.
 
Sources

• Unützer J. Clinical practice. Late-life depression. N Engl J Med 2007; 357:2269.
• Hoyert, DL, Kochanek, KD, Murphy, SL. Deaths: Final data for 1997. National Vital Statistics Reports 1999: 47:1.)
• Areán PA, Cook BL.Psychotherapy and combined psychotherapy/pharmacotherapy for late life depression.Biol Psychiatry. 2002;52(3):293.
• Kirkham, J. G., Choi, N., & Seitz, D. P. (2015). Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults. Int J Geriatr Psychiatry. doi:10.1002/gps.4358