The Depression in older people Presents a high prevalence, impacting negatively on the quality of life of this population group.
It is important to know and understand it, to know its possible etiology, risk factors and its prognosis in order to be able to influence and intervene on it and Alleviate its negative effects on people who suffer from it.
What is depression in older adults?
The American Society of Psychiatry Describes depression as "A mental illness in which the person experiences a deep sadness and diminishing his interest for almost all activities."
Depression in older people refers to the group of mood disorders and its diagnostic criteria are within the Manual of Diagnosis and Statistician of the American Psychiatric Association , Now in its fifth review (DSM-5).
The criteria for the diagnosis of a Major depressive episode Are the presence of symptoms such as:
- A depressed mood.
- Anhedonia .
- Loss or weight gain.
- Insomnia or Hypersomnia .
- Psychomotor agitation or slowing.
- Fatigue or loss of energy.
- Feelings of guilt or worthlessness.
- Decreased concentration.
- Indecision.
- Recurring thoughts of death.
At least 5 of the above mentioned symptoms must be met in a period of at least two weeks, with a change from the activity previous.
The most significant symptoms and a necessary condition to diagnose a depressive episode are depressed mood or loss Of interest or loss of experiencing pleasure ( Anhedonia ).
In addition, the symptoms should cause a detriment in the activity and sociability of the patient.
Why do we talk about depression in the elderly and the elderly?
The presence of depressive disorder in the elderly is a public health problem worldwide, as Age group and decreases the quality of life Of this population.
The criteria for depression (according to DSM-5 referred to above) do not differ according to the age group, so that the syndrome Depressive disorder is fundamentally similar in young, elderly and elderly people.
However, there are some variations or characteristics typical of these age groups.
For example, elderly people with depression have less depressive affect than people with depression in other age groups.
It is usually more severe in older adults than in the elderly, and in this latter age group it tends to have more melancholy characteristics.
Older people with depression have a malfunction, even worse than those with chronic diabetes , the arthritis Or lung disease.
Depression increases the perceived negative health of these patients and makes them use health services more often (two to three Times more), so that the health cost increases.
However, less than 20% of all cases are diagnosed and treated and even those who do receive treatment for depression, the efficacy is limited.
Depression is, along with dementia , The most common mental illness in the elderly.
The impact it has on this age group is becoming more noticeable and although serious, in many cases goes unnoticed.
It is responsible not only for personal and family suffering but also for complications and other medical problems.
Characteristics of depression in the elderly and the elderly
Older people with depression often show more anxiety And greater somatic complaints than those young people who also suffer from depression. Nevertheless, Show less sad mood.
Elderly patients with depression often perceive, compared to younger groups, that their depressive symptoms are normal and are less likely to Be sad
The elderly usually present more insomnia onset and early awakening, more loss of appetite, more Psychotic symptoms within depression , is it so Less irritable and have less daytime sleepiness than younger depression patients.
They also show more complaints Hypochondriacs . When they are disproportionate to the medical condition or there is no aetiology explaining it, they are more Common in elderly patients and are usually observed in about 65% of the cases, being significant at this age.
It should be borne in mind that although in depression the most important symptom is sadness, the older person often expresses it in the form of apathy , Indifference or boredom, without the State of mind If you live as sad.
The loss of enthusiasm and lack of interest in activities that were previously liked and interested are frequent. It is usually an early symptom of depression in this stage.
Many times the patient feels insecure, is slow thinking and undervalued. They are often more interested in the evolution of their physical symptoms than in sadness or melancholy.
Factors that can mask depression in older people
There are certain factors that can hide depression in the more advanced age groups such as:
Symptoms that are characteristic of a depressive episode such as anhedonia, asthenia , Fatigue or loss of energy, lack of concentration , Decreased appetite, Sleep or psychomotor retardation are attributed to normative aging.
Many patients do not recognize that they are depressed.
They present hypochondriacal symptoms such as cardiovascular, urinary or gastrointestinal problems that often occur together with an illness Somatic.
- Anxiety may mask a depressive condition, so that the elderly person is treated with anxiety disorders with the risk of being chronic.
- Depressive mood goes unnoticed and is sometimes interpreted as Affective flattening Like serenity of this age.
- Somatic complaints, which are often the beginning of the illness, along with denial of depressive feelings and lack of sadness.
Epidemiology
The prevalence of depression varies according to the instrument used (interview or questionnaires, for example) or the population group studied (Hospitalized, in community, institutionalized).
The epidemiology of depression in the elderly group could be noted at about 7%.
However, we can include an interval between 15-30% if we take into account also those cases that, without fulfilling diagnostic criteria, present Clinically relevant depressive symptomatology.
If we take into account the area in which they fit, the figures vary. In those who are in institutions the prevalence is around the 42%, in hospitalized patients between 5.9% and 44.5%.
Although the frequency seems to be the same across the different age groups, women appear to be more affected in the gender.
In any case, and varying the figures and despite the variability in the methodology used, there is agreement on the existence of an underdiagnosis and Subtreatment.
Etiology and risk factors
We find different risk factors for developing depression in these last stages of life, such as:
- Grieving for the loss of loved ones
- Retirement
- Loss of socioeconomic statues
- Sleep disorders
- Lack of functionality or disability
- Female gender
- Dementia
- Chronic diseases
- Have had an episode throughout the life of depression
- Pain
- Cerebrovascular disease
- Social support deficit
- Negative life events
- Rejection of the family
- Perceived inadequate care
It should also be noted that suicide is greater in the elderly than in younger people (5-10% higher) and it is a risk factor for the disorders Affective-emotional as depression.
Suicide (which in high life, about 85% is male) is characterized by previous threats, more lethal methods than in later stages young boys.
Other risk factors are associated with:
- Being widowed or divorced
- Living alone
- Substance abuse
- Stressful life events
Regarding the etiology, it should be noted that the etiopathogenic factors are the same as those that influence the mood disorders of Other age groups: neurochemical, genetic and psychosocial.
However, in this age group the factors that precipitate it psychosocial and somatic are more important than in other population groups.
Prognosis and course of depression in the elderly and the elderly
We found that the prognosis is generally poor, given that it is common for relapses to occur and there is greater overall mortality than in the elderly Different.
In both the elderly and the elderly, remission rates, response to treatment with psychotropic drugs and response to therapy Electroconvulsive are similar.
However, the risk of relapse is greater in the elderly, especially if they have already had a depressive episode earlier in the early stages.
Some studies have shown that when there is an associated medical illness, the time for depression to go may be greater. In this way, the Pharmacological treatments in these cases should be longer.
There is worse prognosis when there is cognitive deterioration, the episode is more serious, there is associated disability or comorbidity with other problems.
Thus, the presence of depression increases mortality due to different causes in the elderly group.
In some patients a complete recovery may not be achieved, so they end up maintaining some depressive symptoms without complying with the diagnosis.
In these cases, the risk of relapse is high and the risk of suicide increases. It is necessary to continue the treatment so that the recovery is Complete and return symptoms.
Evaluation and treatment guidelines
To correctly assess the patient with suspected mood disorder, a clinical interview and physical examination should be developed. The The most useful tool is the interview.
As we have already mentioned throughout the article, since elderly patients with depression may perceive themselves as less sad, it is necessary to inquire Also about anxiety, hopelessness, memory problems, anhedonia or personal hygiene.
The interview should be done with language adapted to the patient, simple, understood with empathy And respect for the patient.
You should inquire about the symptoms, how your onset was progressing, the triggers, the history and the medications used.
It is appropriate to use some depression scale adapted to the age group. For example, for the elderly group you can use Yesavage or Geriatric Depression Scale.
Also, cognitive function should be explored to exclude the presence of dementia, since it may be confused with a depressive episode in These vital stages.
The treatment must be multidimensional, and take into account the context in which it lives.
For the pharmacological treatment of these patients it is required, as in the majority of the intervention in psychiatric disorders, the individualization Of each patient, considering other comorbidities or medical conditions that are associated and evaluating the negative effects or interactions that may occur Give up
The main objective of the treatment is to increase the quality of life, that its vital functioning is more optimal, that the symptoms refer and there is no more Relapses.
We found several methods to treat depression: pharmacotherapy, psychotherapy and electroconvulsive therapy.
When depression is between moderate and severe, it is necessary to introduce psychotropic drugs, preferably accompanied by psychotherapy.
Phases in the treatment of depression
We find different phases within the treatment of depression:
A) Acute phase: Remission of symptoms through psychotherapy and / or psychotropic drugs. We must take into account that psychotropic drugs take 2-3 weeks to start Have an effect and generally the maximum reduction of symptoms occurs between 8-12 weeks.
B) Continuation phase: Improvement in depression has been achieved but treatment is continued for 4-9 months to avoid relapse.
C) Maintenance phase: Is continued indefinitely with the antidepressant in case the depressive episode is recurrent.
Psychotherapy is important for patient management, and the psychological streams with the most evidence are therapy Cognitive-behavioral, cognitive therapy, problem solving and interpersonal therapy.
It may be especially useful when there are psychosocial factors that have been identified in the origin or maintenance of depression or when the drugs Are poorly tolerated or do not show efficacy.
Also, when depression is mild it could be dealt with only with psychotherapy.
Through this, the patient can improve their relationships, Increase your self-esteem And self-confidence and help you better manage your emotions with Negative valence.
Electroconvulsive therapy is an indicated option for depression with psychotic symptoms, for those at risk of suicide or pictures Refractory to treatment with psychotropic drugs.
It is also suitable for those cases in which depression is accompanied by malnutrition or a deficit in food intake.
It is also necessary to include correct information about the disease, to intervene in the social field (day centers, to maintain an active life, Favoring social relations).
It must be taken into account that, despite the severity, depression in the elderly may have a better prognosis than other diseases, since their character, If adequate treatment is offered, it is reversible.
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