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Recognizing Depression in the Older Adult

According to the American Community Survey, adults over 60 account for almost 25%1 of the US population. Growing older is a rewarding experience, but it also comes with challenges, such as health issues and age-related disabilities and the loss of family members and friends. Reduced income and the loss of a sense of purpose are also significant problems older adults may face.      

Depression is a real problem for many senior citizens, and it can have devastating consequences in their golden years. According to the Centers for Disease Control and Prevention (CDC), approximately 7 million senior citizens over 65 suffer from depression each year.2 The CDC has also found that people aged 65 or older accounted for 16% of suicide deaths2.

As the population of older adults in the US increases, the statistics on depression in older adults may rise as well. Recognizing depression and mental health challenges in the older adult is a critical responsibility of nurses who care for the adult population.

Identifying Depression

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) has identified episodic depression, also known as major depressive disorder, and chronic depression, also called dysthymic disorder, as two of the most common forms of depression3.

Major Depressive Disorder

According to the DSM-IV-TR, the following findings may be associated with major depressive disorder:

  • Agitation, slowing down, and other psychomotor changes
  • An inexplicable sense of guilt or worthlessness
  • Fatigue
  • Feelings of hopelessness, demotivation, and sadness
  • Insomnia and other sleep disturbances
  • Poor decision-making ability or concentration
  • Recurring suicidal ideation, thoughts of dying, or suicide attempts
  • Significant weight loss with appetite changes

Not all symptoms must be present to be diagnosed with major depressive disorder. However, a loss of interest or pleasure in everyday activities and the feeling of sadness and hopelessness are prevalent.

Chronic Depression

According to the DSM-IV-TR, the following findings may be associated with chronic depression:

  • Boredom and irritability
  • Deteriorating cognitive functions
  • Fatigue
  • Lack of appetite or overeating
  • Sadness
  • Self-esteem issues
  • Sleep disturbances

Chronic depression is increasingly prevalent in older adults. It may manifest primarily as somatic complaints, such as an increased focus on physical symptoms like fatigue, pain, and weakness, which when prolonged, can cause major distress.

The risk of depression in older adults also increases with the amount of prescription and non-prescription medications they take. Despite accounting for approximately 25% of the adult population, adults over 65 report taking four or more prescription drugs compared to those younger than them.4

Why is Depression Often Missed?

Depression in seniors often goes undetected or unreported, highlighting the need for nurses and caregivers to be better able to recognize depression in older adults. Because of their frequent interactions, nurses caring for seniors are better positioned to identify the symptoms of depression. The following are reasons depression is often missed in the elderlyolder adult:

  • Depression symptoms in seniors may differ from those found in younger adults. Most seniors do not report symptoms aligning with the DSM-IV-TR criteria. However, they may report somatic complaints, implying the presence of depression.
  • Many older adults assume decreased pleasure and sadness are a part of aging.
  • Older adults are less likely to identify such problems, often dismissive of the possibility. Many of the seniors today come from a generation that stigmatized mental health issues.
  • Depression may develop simultaneously with other serious physical problems, including cardiovascular issues, diabetes, cancer, Parkinson’s disease, and infections. The prevalence of other health issues may make it challenging to diagnose depression. It can be dangerous for them because depression may worsen outcomes for the seniors suffering from these conditions alongside mental health issues.
  • Cultural factors may impact a person’s ability to accept that they are facing mental health challenges and diminish their willingness to seek adequate care and treatment.

The Geriatric Depression Scale

Nurses working closely with older adults, particularly in nursing homes for seniors and other long-term care facilities that house seniors, must understand how to assess older adults to detect depression. Nurses can use several possible tools for this purpose. The Geriatric Depression Scale (GDS) is one such tool that can help nurses recognize depression in the older adult.

The short-form GDS is a brief 15-item questionnaire that asks questions about a person’s feelings over the previous week.5The Geriatric Depression Scale is an extensively used tool that screens for depression in the elderly. However, conducting a GDS should not replace a thorough diagnostic interview by a qualified mental health professional. You can use the tool to get a preliminary idea of whether the intervention of a mental health expert may be necessary.

As nurses increasingly encounter older adults suffering from depression, an enhanced ability to recognize depression can help nurses make more timely decisions for comprehensive evaluations and referrals to expert healthcare professionals.

Final Thoughts

Today, depression is primarily assessed and treated in primary care and general medical settings. Nurses must understand how to identify the symptoms of depression in older adults and learn how to screen for depression.

Pursuing nursing continuing education courses focused on such aspects can be critical to improving your role in providing better care for seniors. Besides helping you with recertification, it can help you expand your skills and gain knowledge vital to your career progress. You now have easier access to continuing education courses through online CEUs like those offered at Fast CE For Less at https://fastceforless.com/ce-courses-for-nursing/.

References:

https://www.census.gov/newsroom/stories/older-americans-month.html

https://www.cdc.gov/aging/pdf/cib_mental_health.pdf

https://www.ncbi.nlm.nih.gov/books/NBK572966/

https://www.kff.org/health-reform/issue-brief/data-note-prescription-drugs-and-older-adults/#:~:text=Older%20adults%20are%20also%20more%20likely%20than%20their%20younger%20counterparts%20to%20be%20taking%20multiple%20prescription%20medications

https://pubmed.ncbi.nlm.nih.gov/31470180/

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