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Depression in Older People - Common and Often Missed
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Depression in older people often goes undiagnosed. The patients don’t often bring it up, maybe because of a perceived social stigma, and doctors may miss it. Some may even consider it a normal part of aging. It isn’t.
The general older population actually has a lower rate of depression compared with people at mid life. However, rates of depression are higher for older adults with medical illnesses such as heart disease, chronic pain and insomnia. Other risk factors include being female, socially isolated, or a widow or divorcee.
Being depressed can be dangerous. One study of depression in people who’d had heart attacks showed that being depressed made you four times more likely to die.
I once had a woman admitted to hospice who seemed to be near death. She slept 20 hours a day and didn’t eat. Her family assumed that she’d be gone within a month. But what was wrong with her? She didn’t have cancer or heart disease, so why did she sleep all day and refuse food? We thought she might be depressed so we started her on an anti-depressant. It was a miracle. Within 3 weeks she was up and about and lunching with her friends.
Depression tends to hang with other illnesses like anxiety and, sometimes, even psychosis. If you only treat the anxiety or psychosis, but neglect the depression the patient just won't get better. This is a common mistake made with elderly people; I saw it just this week. Using Xanax or Ativan to treat nervousness in an elderly patient who has an anxious depression creates a person who is dependent on anxiety medicines but doesn’t feel all that much better.
Some people who are depressed self-medicate with alcohol, pain pills or sleeping medicines. This phenomenon is easily missed by busy primary care doctors, but can be tragic if it leads to a broken hip, a household accident, or memory deficits. Actually confusion in older people can actually be caused by depression. It is often worth a trial of antidepressants when dementia first appears.
“Sure, Grandpa gets a little cranky and blue sometimes, but he’d never do anything stupid”, you might think. Wrong. Elderly people account for 13% of the US population, but make up nearly 24% of completed suicides. Older men are the most at risk with a rate of 29 per 100,000 people.
A simple 2 question screening test can be used to help diagnose depression. The questions are:
1. During the past month, have you been bothered by feeling down, depressed or hopeless?
2. During the past month, have you been bothered by little interest or pleasure in doing things?
Anyone who answers yes to both of these questions is likely to be suffering from depression.
Does this sound like anyone you know?
Be well,
Dr. C
www.insightmedicalconsultants.com
(photo courtesy of elderlycareservices.org)
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