Berks County Medical Society Medical Record Summer 2019 - 40
M e d i c a l r e c o r d f e at u r e
Shedding Light on the
Presentation of Late-Life
Depression
by Sheveen Greene-Adenaike, MSN AGNP-BC
A
ccording to the World Health Organization,
depression is the leading cause of world disease
burden. It is a particularly growing public health
concern among community-dwelling older adults,
as 1 in 4 suffer with depressive symptoms. Subsequently, this
leads to poor health outcomes, decline in physical, cognitive
and social functioning. There is also an increase in health care
costs, complications of other chronic medical illnesses and
the incidence of suicide. Older adults have the highest rates of
suicide of any age group. With the number of Americans age
65 and over projected to increase from 46 to 88 million by the
year 2050 (Vincent, 2010), we can understand the need to be
proactive in addressing this growing public health concern.
Despite its increasing prevalence, related negative outcomes,
and documented good treatment response, depression in older
adults remains highly under-recognized, misdiagnosed and
consequently undertreated.
Contrary to widespread belief among many providers,
depression is not a normal part of aging and should not be
dismissed as such. In doing so, we miss important opportunities
to initiate treatment for what is a notably treatable health
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condition. A study in the Journal of the American Geriatrics
Society (Li et al., 2007) found that primary care physicians
spend very little time discussing mental health with their older
patients. This is problematic because primary care providers are
strategically positioned to assess, diagnose and treat depression
on a population level as they are usually the first contact for any
new health issue or need.
Geriatric patients can present diagnostic challenges as
clinical presentations may be varied and symptoms may not be
readily evident (Ritchie, 2014). Recognizing some of the major
risk factors for depression in the elderly can aid in making the
diagnosis. Some of these include female gender, past history of
depression, sleep disturbances, disability and bereavement (Fiske,
2009). Understanding the nuances of diagnosing and treating
older adults will result in more positive clinical outcomes.
In younger adults, depression is often discernible by
depressed mood and loss of interest (Balsis, 2008). In contrast,
older adults may not report feeling sad at all but present with
increased anger and irritability (Ellison et. al, 2012). Another
marked difference is that unlike their younger counterparts,
older patients report feelings of hopelessness and thoughts of
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Berks County Medical Society Medical Record Summer 2019
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