Test Your Knowledge

Depression is a common medical condition characterized by many physical and psychological symptoms, including profound sadness, loss of interest or pleasure in activities normally enjoyed (anhedonia) and other symptoms that impair a person's ability to function.

Depression is a growing health issue for older adults. The actual percentage of adults over 65 who meet the diagnostic criteria is low when compared to the population as a whole. However, about 5.8 percent of Americans 65 or older have some form of diagnosable depression (roughly two million out of nearly 34 million), according to the National Institute of Mental Health (NIMH).

The NIMH also estimates that an additional five million have serious symptoms related to depression. Those 65 or older comprise 20 percent of all people who commit suicide. Among white males 85 and older, suicide is nearly six times higher as compared to the national average.

Depression is frequently undiagnosed and untreated in older adults for a number of reasons:

• Depression is often attributed to other medical conditions, such as heart disease, stroke, Parkinson’s disease and cancer. Patients and their families often share this belief. In addition, a physician’s attention is often focused on treating these physical conditions.
  
  
• Depression may be attributed to the passing of loved ones. Grief and bereavement are natural feelings following the death of a spouse, relatives or close friends. Depression is not.
  
  
• Older patients may be more likely to rely on their primary care physicians, who are not mental health professionals, than younger patients. According to the NIMH, less than 3 percent of people aged 65 and older were treated by mental health professionals.
  
  
• Not all primary care physicians have the training to distinguish between the signs of aging and depression. According to the NIMH, primary care physicians accurately diagnosed less than half of patients who were depressed.

The issue is further complicated by generational attitudes. Many older adults view depression as a character flaw rather than a genuine disorder. These attitudes frequently deter older adults from seeking professional help.

Studies show that older adults in general tend to know less about depression than the general public as a whole. According to the National Mental Health Association (NMHA), about 68 percent of adults over the age of 65 years know little or close to nothing about depression. Around 58 percent of these individuals think that it is normal to get depressed with advancing age, NMHA reports, and only 38 percent of adults in this age group consider depression a genuine health problem.

Cognitive disorders such as Alzheimer’s disease can mask symptoms of depression. Research indicates that the combination of Alzheimer’s and depression often leads to more advanced cognitive impairment than Alzheimer’s alone. However, depression may be difficult to diagnose in these patients. Alzheimer’s patients often have difficulty describing how they are feeling (e.g., sad, hopeless, helpless, worthless). Because of this, physicians must rely on other signs and nonverbal expressions, including refusal to eat, crying spells, facial expressions, unexplained agitation or hostility and increased confusion.

Depression is closely associated with disability and dependence on caregiver assistance. It causes a great deal of distress for both patients and their caregivers. Depression is also associated with increased healthcare costs. Older patients with symptoms of depression have about 50 percent higher healthcare costs than patients of similar age without such symptoms, according to the NMHA.