GERIATRIC DEPRESSION

By Richard J. Capiola, MD

Everybody hurts. Everyone feels sad sometimes. Everyone experiences moments or even days of feeling “blue”. However, if these feelings persist and affect a person’s ability to carry out normal day to day activities, it is time to look at the very common mental health issue called depression.

According to the Mayo Clinic, depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It can also be called major depressive disorder or clinical depression. It affects how a person feels, thinks, and acts. It causes problems both emotionally and physically. A person with depression may even get to the point of believing that life is no longer worth living. It can be very dangerous when left untreated.

Depression is especially common in older adults. In fact, it is the most common mental health issue faced by senior adults. And though it affects 15% of people over the age of 65, it should not be considered a “normal” part of aging.

WHAT IS GERIATRIC DEPRESSION?
Geriatric depression is a mood disorder in older adults that involves a persistent loss of interest and feelings of sadness. According to the World Health Organization (WHO), while most older adults have good mental health, many are at risk of developing mental health conditions such as depression. The Centers for Disease Control estimate that 7 million adults over the age of 65 experience depression each year in the US.

Recognizing depression in older adults can be challenging. Many have difficulty communicating what they are experiencing and many more “don’t believe in” depression. The world in which they grew up was different than ours today in that people didn’t talk about their feelings. Anyone getting help for mental disorders like depression, were labeled as “crazy”. Add to that the fact that there is no concrete test for depression (no blood test or physical test) and depression in older adults can go undiagnosed and, therefore, untreated.

SIGNS AND RISK FACTORS OF GERIATRIC DEPRESSION
When left untreated, depression in older adults can cause physical illnesses to worsen. It can lead to premature death and even suicide. That is why recognizing the symptoms is so very important.

Symptoms may include:
• Persistent feeling of tiredness
• Too much or too little sleep
• A grumpy or irritable attitude
• Difficulty thinking, concentrating, or making decisions
• Difficulty paying attention
• Lack of interest in activities once enjoyed
• Noticeably slower movement
• Crying spells
• A change in weight or appetite
• Digestive issues
• Feeling guilty, hopeless, or worthless without cause
• Withdrawal from family and friends
• Aches and pains
• Suicidal ideation

Risk factors associated with geriatric depression:
• Extended periods of isolation
• A decline in independence and mobility
• Struggling with the transition into retirement
• Financial difficulties
• Substance abuse
• Widowhood or divorce
• Grief following the deaths of friends and loved ones
• Chronic medical conditions
• A history of depression
• Grappling with their own mortality

Diagnosis of geriatric depression
If an older adult has signs and symptoms of depression lasting for 2 weeks or more, a doctor may diagnose geriatric depression. However, before coming up with a diagnosis, a doctor should consider the person’s medical history and use a geriatric depression scale (GDS) when asking about symptoms to understand how long they have been present.

The GDS is a tool developed in the early 1980s by J.A. Yesavage. The GDS is a self-report instrument that uses a “yes/no” format. It was originally developed as a 30-item instrument. Since this version proved both time-consuming and difficult for some patients to complete, a 15-item version was developed. These 15 items were chosen because of their high correlation with depressive symptoms in previous validation studies.

The GDS differs from depression screening instruments used in younger populations because some somatic symptoms (such as weight loss, pessimism about the future, and sleep disturbances) can be related to aging itself. For this reason, the GDS focuses specifically on psychiatric rather than somatic symptoms.

Treating geriatric depression
Mild forms of depression can be treated with certain lifestyle change, like finding a new hobby, becoming more physically active, eating well, and spending more time with others. However, if someone has a high score on the Geriatric Depression Scale, it could indicate that they have severe depression, and more advanced treatments should be considered. This may include prescription medication (antidepressants) or psychotherapy (seeing a therapist).

Dr. Richard J. Capiola is a psychiatrist in Naples, Florida and is affiliated with Willough at Naples Hospital. He received his medical degree from Tulane University School of Medicine and has been in practice for more than 20 years. Call Dr. Capiola today at 239-649-7494.