Depression in Special Circumstances: The Elderly

Getting older has its rewards but there is no question that losses are more likely to occur as people age. With these losses comes sadness of course, a prelude for some people to depression. Compounding the risk of depression in the elderly are biological changes that happen to us all.

As we age, the levels of a certain enzyme in the brain, monoamine oxidase, increase. This enzyme normally breaks down various brain chemicals including serotonin and norepinephrine, and low levels of these brain chemicals – which occur as enzyme levels increase – make depression more likely. Certain medical disorders can contribute to a depressed mood as well. Alzheimer’s and Parkinson’s disease are both associated with depression, as are many hormonal disorders, congestive heart failure, anemia and even infectious diseases.

Depression following stroke – a not uncommon event in the elderly – affects up to 30% of stroke victims. A number of drugs used to treat common medical conditions (cancer and heart conditions among them) can cause depression in some people as well. If an elderly person needs to take corticosteroids for their rheumatoid arthritis, they, too, may be more prone to either depression or anxiety. As well, if people get ill, they have to adjust to their ill health and this can often be very difficult.

A man who used to take pride in being fit and virile can’t help but feel the loss of his “self-hood” if some serious medical event makes it impossible for him to be active – physically or sexually. A woman who has had a heart attack may feel chronically anxious about having a second event, as would any woman about a new lump in her breast if she’s been treated for breast cancer. All these factors together make the elderly highly vulnerable to depression and anxiety.

The elderly can also develop phobias (the most common phobia in the elderly is fear of falling) and refuse to take advantage of their potential mobility – a fear that can increase their isolation and potential depression as well. Being placed in a chronic care facility where people are being told what to do, or where they have to share a room with others and listen to disturbing noises at night, can activate posttraumatic stress disorder in an elderly person who may have lived through the Holocaust, for example.

Complicating the picture in the elderly is the way most of them experience depressive symptoms. Possibly because elderly people are not comfortable discussing their feelings, many of them will complain about bowel disturbances and other physical problems when depressed, and not how blue they may feel.

Symptoms of depression in the elderly, such as irritability, memory loss, disorientation and incontinence may be misinterpreted as signs of dementia. This makes it very hard for family members and even physicians to recognize depression in an elderly person.

Although an elderly person can have all of the classic symptoms of a major depressive disorder (see Depression: Signs and Symptoms), they may hide their feelings or be unaware they are depressed and the diagnosis may be missed.

How to tell if you are depressed – For elderly people only

A simple checklist has been specially developed to detect depression in the elderly. Choose the best answer to describe how you have felt over the past week. Answers indicating depression are in the bolder type. Each answer counts as one. A score between 5 and 9 indicates a strong possibility of depression, while a score of 10 is almost always a sign of depression.

Geriatric Depression Scale

  1. Are you basically satisfied with your life? Yes No
  2. Have you dropped many of your activities and interests? Yes No
  3. Do you feel that your life is empty? Yes No
  4. Do you often get bored? Yes No
  5. Are you in good spirits most of the time? Yes No
  6. Are you afraid that something bad is going to happen to you? Yes No
  7. Do you feel happy most of the time? Yes No
  8. Do you often feel helpless? Yes No
  9. Do you prefer to stay at home rather than going out and doing new things? Yes No
  10. Do you feel you have more problems with memory than others? Yes No
  11. Do you feel it is wonderful to be alive now? Yes No
  12. Do you feel pretty worthless the way you are now? Yes No
  13. Do you feel full of energy? Yes No
  14. Do you feel that your situation is hopeless? Yes No
  15. Do you think most people are better off than you are? Yes No

Geriatric depression scale from Yesavage JA. Depression in the elderly: How to recognize masked symptoms and choose appropriate therapy. Postgrad Med 1992; 91(1):256