By Sylvia Foley, AJN senior editor
‘Mourning Old Man’ by Vincent Van Gogh
“It is a misconception that depression is a normal, inevitable part of aging; it is not,” writes author Cynthia Cahoon in this month’s CE, “Depression in Older Adults.” Depression affects an estimated 15% to 19% of Americans ages 65 and older living in a variety of settings, yet it often goes unrecognized and untreated. Granted, recognition can be challenging, in part because many symptoms of depression are also common to other illnesses seen in older adults. As Cahoon points out, though, there is also “abundant evidence that depression in older adults is treatable, perhaps in as high as 65% to 75% of cases.”
The article provides an overview of depression in older adults and outlines its pathophysiology and disease types. Known risk factors for this population include the following:
- chronic medical conditions
- polypharmacy
- multiple losses
- functional decline (physical, cognitive, or both)
- personal or family history of depression
- social isolation
- substance abuse or dependence
According to Cahoon, a majority of adults with depression will present for treatment of physical conditions, rather than for a mood disorder. So it’s important to assess each patient’s mood, regardless of presenting symptoms. Several brief, validated screening tools exist, and busy nurses have several options. One tool, the Whooley Depression Screen, takes less than five minutes to administer and asks just two questions:
1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
2. During the past month, have you often been bothered by little interest or pleasure in doing things?
Cahoon goes on to describe several treatment modalities, which include psychosocial interventions, psychotherapy, and psychopharmacology. She also covers nursing implications in detail. To learn more, read the article, which is free online. And if you’ve cared for older adults with depression, we’d love to hear about your experiences.
Ego integrity verses despair is the final stage of Erik Erickson’s model of psychosocial development. As Erik exemplifies in his model, most individuals come to a point in life where he or she is faced with feelings of either satisfaction and success, or regret and disappointment. Feelings of regret may sometimes progress to depression, but that is not always the case. Regret alone may sometimes be a positive influence. In example, someone who regrets that they did not travel enough may then be motivated to take a trip around the world. The influences surrounding individuals as mentioned above may negatively reflect onto a person’s wellbeing. Early detection of warning signs and recognition of potential risk factors are key methods in primarily preventing depression.