Depression in Older Adults
Although the likelihood of depression in adults over 65 is lower than in younger adults, its occurrence in older adults may be more severe. Seniors at risk for depression are often underserved by the mental health profession and have the highest rates of suicide in the US.
Clinically significant depressive symptoms are present in approximately 15% of older adults living alone or with a caregiver. Rates of depression are higher in older women than in older men, as well as medical outpatients, medical inpatients, and residents of long-term care facilities. Depression risk is also greatest in patients facing the transition from their home or a caregiver or relocating to congregate living. Most older adults struggling with depression are also managing other chronic conditions, medications and physical decline that contribute to depression. However, many seniors are resistant to treatment because they don't want to burden their families, or equate depression with weakness or even death.
Common symptoms of depression can affect every aspect of a patient’s life, including loss of energy, appetite, sleep, and faded interest in work, hobbies, and relationships. Other symptoms include:
- Sadness or feelings of despair
- Unexplained or aggravated aches and pains
- Weight loss or loss of appetite
- Feelings of hopelessness or helplessness
- Loss of self-worth (worries about being a burden, feelings of worthlessness or self-loathing)
- Slowed movement and speech
- Increased use of alcohol or other drugs
- Fixation on death; thoughts of suicide
- Memory problems, slowed movement and speech
- Neglecting personal care (skipping meals, forgetting meds, neglecting personal hygiene)
Chronic Care Managers (CCM) can help patients at risk for depression by monitoring for the disease and any associated chronic comorbidities. This may include conditions such as Parkinson’s disease, stroke, congestive heart failure, cancer, thyroid disorders, diabetes or dementia and Alzheimer’s disease. Care Managers can educate patients on signs and symptoms such as abrupt changes in mood and behavior or level of concentration and communication or interaction with others.
Medications that can trigger or worsen depression include:
- Blood pressure medication (clonidine)
- Beta-blockers (e.g. Lopressor, Inderal)
- Heart drugs containing reserpine
- Steroids (e.g. cortisone and prednisone)
- High-cholesterol drugs (e.g. Lipitor, Mevacor, Zocor)
- Painkillers and arthritis drugs
- Estrogens (e.g. Premarin, Prempro)
- Sleeping pills
- Tranquilizers (e.g. Valium, Xanax, Halcion)
- Calcium-channel blockers
- Medication for Parkinson’s disease
- Ulcer medication (e.g. Zantac, Tagamet)
The transition between extended hospitalization and discharge home to family or a caregiver, or even alone to home-care increases the risk for functional decline, depression, and anxiety. Transitional Care Managers (TCM) can help plan for such transitions including assessing for medications that may exacerbate the effects of depression.
Unfortunately, all too many providers and older adults at risk for depression fail to recognize the symptoms and signs early enough to begin the right treatments and offer the best support. CCM and TCM Care Managers aim to identify and understand the underlying causes and risks associated with depression in older adults. Care Managers can help providers and patients take the right steps toward mental and emotional health.
About the Author
Joseph F. West, ScD, is a population health and data analytics leader with over 10 years of research and enterprise consulting experience. He is a recognized leader in the development of outcomes-based healthcare. Joseph has served as Chief Population Health Officer, Senior Epidemiologist, Program Director, and Adjunct Assistant Professor. As a consultant and content creator, his current work focuses on population health management (PHM), health information technology (HIT), care coordination innovation, and healthcare risk management.