The term “depression” has been variably used to describe either a symptom, a syndrome, or a disease. In the present consensus statement, depression is used in the broad sense to describe a syndrome that includes a constellation of physiological, affective, and cognitive manifestations. As listed in the current American Psychiatric Association Diagnostic and Statistical Manual (DSM- IIIR), criteria for the diagnosis of depression include:
(1) changes in appetite and weight; (2) disturbed sleep; (3) motor agitation or retardation; (4) fatigue and loss of energy; (5) depressed or irritable mood; (6) loss of interest or pleasure in usual activities; (7) feelings of worthlessness, self-reproach, excessive guilt; (8) suicidal thinking or attempts; and (9) difficulty with thinking or concentration. Depression may range in severity from mild symptoms to more severe forms that include delusional thinking, excessive somatic concern, and suicidal ideation, over longer periods of time. The DSM-IIIR requires the presence of at least five of the symptoms listed above for a diagnosis of major depressive episode. Concurrent medical conditions are frequently present in elderly persons and should not preclude a diagnosis of depression.
The recognition of depression may be more difficult in late compared with early life. In the elderly age group, both clinicians and patients may incorrectly attribute depressive symptoms to the aging process. They may not fully appreciate the degree of impairment because of lower functional expectations in the post-retirement years. The particular constellation of symptoms may differ because elderly persons may more readily report somatic symptoms than depressed mood. Because both the patient and the evaluating clinician are often more concerned about concurrent medical conditions, depressive symptoms may be overlooke. Finally, the concomitant presence of dementia may compromise accurate recognition and reporting of symptoms. As a result, depression is often underdiagnosed in elderly people, despite a high frequency of potentially treatable depressive symptoms.
Depression in late life frequently coexists with multiple chronic diseases and disabilities, for example, cancer, cardiovascular disease, neurological disorders, various metabolic disturbances, arthritis, and sensory loss. These conditions create psychosocial concerns, medical and physiologic burdens, and functional disabilities that may directly contribute to the pathogenesis of depressive symptoms as well as complicate treatment. However, current data indicate that depressive symptoms may respond to treatment in many of these patients.
Depression in late life occurs in the context of numerous social, developmental, and biological diversities. Advancing age is accompanied by loss of important social support systems due to death of spouse or siblings, retirement, or relocation of residence. At the biologic level, there is variability in the regulation of homeostasis, organ system reserve, immunologic responsiveness, and body composition. These sources of heterogeneity have major implications for risk of illness, diagnosis, and treatment. For example, levels of antidepressant drugs and toxic metabolites may be disproportionately increased in the “old-old,” making this subgroup particularly vulnerable to adverse side effects.
Following are the ways to get rid of late life depression:
- Partial or complete remission of the broad range of symptoms associated with depression.
- Amelioration of pain and suffering associated with physical illnesses.
- Enhancement of general mental, physical, and social functioning and personal well-being.
- Minimization of cognitive disability, a particular fear in the elderly.
Tags: change physical behaviours Depression depression late life
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