Depression in older adults: how do the symptoms differ from adult depression?

Author/s
Janitha L. Jayasinghe, Nadeem Mazi-Kotwal
Citation
Issue 5 Winter 2018
CEPiP.2018.1.181-189
Abstract

Depression is a common mental illness in older adults and with the projected increase in population of older adults, depression in older adults is likely to result in greater demand on mental and physical health care services and also increased healthcare costs. Depression in older adults is underreported, underdiagnosed and undertreated and is associated with increased disability, increased mortality and poorer recovery from physical illness. The presentation of depression in older adults is often significantly different from younger adults and presents a diagnostic challenge to clinicians. This article provides an overview of depression in older adults and highlights the salient features in its presentation and management.

Cite as: Cutting Edge Psychiatry in Practice 2018, 5(1):181-189; https://doi.org/10.65031/cysv8915

References

  1. Manthorpe J, Iliffe S. Suicide in later life: public health and practitioner perspectives. International Journal of Geriatric Psychiatry. 2010 Dec;25(12):1230-8. https://doi.org/10.1002/gps.2473
  2. Demography: future trends [Internet]. The King's Fund. [cited 31 December 2018]. Available from: http://www. kingsfund.org.uk/time-to-think-differently/trends/demography/ageing-population          
  3. Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annual Review of Clinical Psychology. 2009 Apr 27;5:363-89. https://doi.org/10.1146/annurev.clinpsy.032408.153621
  4. Pocklington C. Depression in older adults. British Journal of Medical Practitioners. 2017 Mar;10(1).  
  5. Rapp MA, Dahlman K, Sano M, Grossman HT, Haroutunian V, Gorman JM. Neuropsychological differences between late-onset and recurrent geriatric major depression. American Journal of Psychiatry. 2005 Apr 1;162(4):691-8. https://doi.org/10.1176/appi.ajp.162.4.691
  6. McDougall FA, Kvaal K, Matthews FE, Paykel E, Jones PB, Dewey ME, Brayne C. Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychological Medicine. 2007 Dec;37(12):1787-95. https://doi.org/10.1017/s0033291707000372
  7. Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, Weyerer S, König HH, Riedel-Heller SG. Age-and gender-specific prevalence of depression in latest-life: systematic review and meta-analysis. Journal of Affective Disorders. 2012 Feb 1;136(3):212-21. https://doi.org/10.1016/j.jad.2010.11.033
  8. Thomas AJ, O’Brien JT. Mood disorders in the elderly. Psychiatry. 2009 Feb 1;8(2):56-60.  
  9. Blazer DG. Depression in late life: review and commentary. Focus. 2009 Jan;7(1):118-36. 
  10. Gellis Z, Kenaley B, McCracken S. Depressive Disorders in Older Adults [Internet]. Chicago: Council on Social Work Education; 2014 [cited 31 December 2018]. Available from: https://www.cswe.org/getattachment/Centers- Initiatives/Gero-Ed-Center/Initiatives/Past-Programs/MAC-Project/Resource-Reviews/Mental- Health/2014Revision_MH_Ch3_DepressiveDisorders.pdf.aspx           
  11. Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica. 2006 May;113(5):372-87. https://doi.org/10.1111/j.1600-0447.2006.00770.x
  12. Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, Catani M, Senin U, Cherubini A. Validation of the five‐item geriatric depression scale in elderly subjects in three different settings. Journal of the American Geriatrics Society. 2003 May;51(5):694-8. https://doi.org/10.1034/j.1600-0579.2003.00216.x
  13. Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. Journal of Affective Disorders. 2011 Mar 1;129(1-3):126-42. https://doi.org/10.1016/j.jad.2010.09.015
  14. Rogers D, Pies R. General medical drugs associated with depression. Psychiatry (Edgmont). 2008 Dec;5(12):28. 
  15. Sneed JR, Rindskopf D, Steffens DC, Krishnan KR, Roose SP. The vascular depression subtype: evidence of internal validity. Biological Psychiatry. 2008 Sep 15;64(6):491-7. https://doi.org/10.1016/j.biopsych.2008.03.032
  16. Sneed JR, Culang-Reinlieb ME, Brickman AM, Gunning-Dixon FM, Johnert L, Garcon E, Roose SP. MRI signal hyperintensities and failure to remit following antidepressant treatment. Journal of Affective Disorders. 2011 Dec 1;135(1-3):315-20. https://doi.org/10.1016/j.jad.2011.06.052
  17. Baldwin RC. Poor prognosis of depression in elderly people: causes and actions. Annals of Medicine. 2000 Jan 1;32(4):252-6. https://doi.org/10.3109/07853890009011769
  18. Evans M, Mottram P. Diagnosis of depression in elderly patients. Advances in Psychiatric Treatment. 2000 Jan;6(1):49-56. https://doi.org/10.1192/apt.6.1.49
  19. Mackenzie CS, Gekoski WL, Knox VJ. Age, gender, and the underutilization of mental health services: the influence of help-seeking attitudes. Aging and Mental Health. 2006 Nov 1;10(6):574-82. https://doi.org/10.1080/13607860600641200
  20. Oliver MI, Pearson N, Coe N, Gunnell D. Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. The British Journal of Psychiatry. 2005 Apr;186(4):297-301. https://doi.org/10.1192/bjp.186.4.297
  21. Conradsson M, Rosendahl E, Littbrand H, Gustafson Y, Olofsson B, Lövheim H. Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment. Aging & Mental Health. 2013 Jul 1;17(5):638-45. https://doi.org/10.1080/13607863.2012.758231
  22. Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Archives of General Psychiatry. 2006 May 1;63(5):530-8. https://doi.org/10.1001/archpsyc.63.5.530
  23. Jorm AF. History of depression as a risk factor for dementia: an updated review. Australian & New Zealand Journal of Psychiatry. 2001 Dec;35(6):776-81. https://doi.org/10.1046/j.1440-1614.2001.00967.x
  24. Tsuno N, Homma A. What is the association between depression and Alzheimer’s disease? Expert Review of Neurotherapeutics. 2009 Nov 1;9(11):1667-76. https://doi.org/10.1586/ern.09.106
  25. Sözeri-Varma G. Depression in the elderly: clinical features and risk factors. Aging and Disease. 2012 Dec;3(6):465.             
  26. Rapp MA, Dahlman K, Sano M, Grossman HT, Haroutunian V, Gorman JM. Neuropsychological differences between late-onset and recurrent geriatric major depression. American Journal of Psychiatry. 2005 Apr 1;162(4):691-8. https://doi.org/10.1176/appi.ajp.162.4.691
  27. Arean PA, Ayalon L. Assessment and treatment of depressed older adults in primary care. Clinical Psychology: Science and Practice. 2005 Sep;12(3):321-35. https://doi.org/10.1093/clipsy/bpi034
  28. Alexopoulos GS. Depression in the elderly. The Lancet. 2005 Jun 4;365(9475):1961-70.    
  29. Evans M. Detection and management of depression in the elderly physically ill patient. Human Psychopharmacology: Clinical and Experimental. 1995 Nov;10(S4):S235-41. https://doi.org/10.1002/hup.470101007
  30. Mitchell AJ, Rao S, Vaze A. Do primary care physicians have particular difficulty identifying late-life depression? A meta-analysis stratified by age. Psychotherapy and Psychosomatics. 2010;79(5):285-94. https://doi.org/10.1159/000318295
  31. Kang H, Zhao F, You L, Giorgetta C. Pseudo-dementia: a neuropsychological review. Annals of Indian Academy of Neurology. 2014 Apr;17(2):147. https://doi.org/10.4103/0972-2327.132613
  32. Fischer P. The spectrum of depressive pseudo-dementia. In: New Trends in the Diagnosis and Therapy of Non- Alzheimer’s Dementia 1996 (pp. 193-203). Springer, Vienna. https://doi.org/10.1007/978-3-7091-6892-9_13
  33. Butters MA, Bhalla RK, Mulsant BH, Mazumdar S, Houck PR, Begley AE, Dew MA, Pollock BG, Nebes RD, Becker JT, Reynolds III CF. Executive functioning, illness course, and relapse/recurrence in continuation and maintenance treatment of late-life depression: is there a relationship?. The American Journal of Geriatric Psychiatry. 2004 Jul 1;12(4):387-94. https://doi.org/10.1097/00019442-200407000-00006
  34. Alexopoulos GS, Bruce ML, Silbersweig D, Kalayam B, Stern E. Vascular depression: a new view of late-onset depression. Dialogues in Clinical Neuroscience. 1999 Sep;1(2):68. https://doi.org/10.31887/dcns.1999.1.2/galexopoulos
  35. Taylor WD, Aizenstein HJ, Alexopoulos GS. The vascular depression hypothesis: mechanisms linking vascular disease with depression. Molecular Psychiatry. 2013 Sep;18(9):963. https://doi.org/10.1038/mp.2013.20
  36. Lockwood KA, Alexopoulos GS, Kakuma T, Van Gorp WG. Subtypes of cognitive impairment in depressed older adults. The American Journal of Geriatric Psychiatry. 2000 Jun 1;8(3):201-8. https://doi.org/10.1097/00019442-200008000-00004
  37. Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. BioMed Research International. 2013. https://doi.org/10.1155/2013/158746
  38. Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, Zmuda MD, Bhalla R, Meltzer CC, Pollock BG, Reynolds CF. The nature and determinants of neuropsychological functioning in late-life depression. Archives of General Psychiatry. 2004 Jun 1;61(6):587-95. https://doi.org/10.1001/archpsyc.61.6.587
  39. Polenick CA, Flora SR. Behavioral activation for depression in older adults: Theoretical and practical considerations. The Behavior Analyst. 2013 Apr 1;36(1):35-55. https://doi.org/10.1007/bf03392291
  40. Shahpesandy H. Different manifestation of depressive disorder in the elderly. Neuroendocrinology Letters. 2005 Dec 1;26(6):691-5.   
  41. El-Gabalawy R, Mackenzie CS, Thibodeau MA, Asmundson GJ, Sareen J. Health anxiety disorders in older adults: conceptualizing complex conditions in late life. Clinical Psychology Review. 2013 Dec 1;33(8):1096-105. https://doi.org/10.1016/j.cpr.2013.08.010
  42. Friedman B, Conwell Y, Delavan RR, Wamsley BR, Eggert GM. Depression and suicidal behaviors in Medicare primary care patients under age 65. Journal of General Internal Medicine. 2005 May 1;20(5):397-403. https://doi.org/10.1111/j.1525-1497.2005.40244.x
  43. Birrer RB, Vemuri SP. Depression in Later Life: A Diagnostic and Therapeutic Challenge. American Family Physician. 2004 May 15;69(10).               
  44. Crabb R, Hunsley J. Utilization of mental health care services among older adults with depression. Journal of Clinical Psychology. 2006 Mar;62(3):299-312. https://doi.org/10.1002/jclp.20231
  45. Speer DC, Schneider MG. Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. Clinical Psychology: Science and Practice. 2003 Mar;10(1):85-101. https://doi.org/10.1093/clipsy/10.1.85
  46. Alexopoulos GS, Kiosses DN, Heo M, Murphy CF, Shanmugham B, Gunning-Dixon F. Executive dysfunction and the course of geriatric depression. Biological Psychiatry. 2005 Aug 1;58(3):204-10. https://doi.org/10.1016/j.biopsych.2005.04.024
  47. Depression in adults: recognition and management: Clinical Guideline CG90 [Internet]. Nice.org.uk. 2018 [cited 31 December 2018]. Available from: https://www.nice.org.uk/guidance/cg90
  48. Cuijpers P, van Straten A, Smit F, Andersson G. Is psychotherapy for depression equally effective in younger and older adults? A meta-regression analysis. International Psychogeriatrics. 2009 Feb;21(1):16-24. https://doi.org/10.1017/s1041610208008089
  49. Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta‐analysis. Depression and Anxiety. 2009 Mar;26(3):279-88. https://doi.org/10.1002/da.20519
  50. Mottram PG, Wilson K, Strobl JJ. Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews. 2006(1). https://doi.org/10.1002/14651858.cd003491
  51. Nelson JC, Delucchi K, Schneider LS. Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence. The American Journal of Geriatric Psychiatry. 2008 Jul 1;16(7):558-67. https://doi.org/10.1097/jgp.0b013e3181693288
  52. Kok RM, Heeren TJ, Nolen WA. Continuing treatment of depression in the elderly: a systematic review and meta-analysis of double-blinded randomized controlled trials with antidepressants. The American Journal of Geriatric Psychiatry. 2011 Mar 1;19(3):249-55. https://doi.org/10.1097/jgp.0b013e3181ec8085
  53. Rodda J, Walker Z, Carter J. Depression in older adults. BMJ. 2011 Sep 28;343:d5219. https://doi.org/10.1136/bmj.d5219
  54. Baldwin RC, Jolley DJ. The prognosis of depression in old age. The British Journal of Psychiatry. 1986 Nov;149(5):574-83. https://doi.org/10.1192/bjp.149.5.574
  55. Post F. The management and nature of depressive illnesses in late life: a follow-through study. The British Journal of Psychiatry. 1972 Oct;121(563):393-404. https://doi.org/10.1192/bjp.121.4.393
  56. Murphy E. The prognosis of depression in old age. The British Journal of Psychiatry. 1983 Feb;142(2):111-9.      
  57. Vilalta‐Franch J, Planas‐Pujol X, López‐Pousa S, Llinàs‐Reglà J, Merino‐Aguado J, Garre‐Olmo J. Depression subtypes and 5‐years risk of mortality in aged 70 years: a population‐based cohort study. International Journal of Geriatric Psychiatry. 2012 Jan;27(1):67-75. https://doi.org/10.1002/gps.2691
  58. Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. American Journal of Psychiatry. 2005 Sep 1;162(9):1588-601. https://doi.org/10.1176/appi.ajp.162.9.1588
  59. Licht-Strunk E, Van Marwijk HW, Hoekstra TB, Twisk JW, De Haan M, Beekman AT. Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up. BMJ. 2009 Feb 2;338:a3079. https://doi.org/10.1136/bmj.a3079
  60. Azar AR, Chopra MP, Cho LY, Coakley E, Rudolph JL. Remission in major depression: results from a geriatric primary care population. International Journal of Geriatric Psychiatry. 2011 Jan;26(1):48-55. https://doi.org/10.1002/gps.2485
  61. Sawyer P, Williams BR. Counseling Older Adults at Risk of Suicide: Recognizing Barriers, Reviewing Strategies, and Exploring Opportunities for Intervention. Alabama Counseling Association Journal. 2012;38(2):80-103.