Approaches to the Management of Depression in Old Age

Abstract

Depression in old age is common, underdiagnosed and under-treated. It has a high rate of recurrence and is associated with significantly increased mortality. Its mismanagement stems in large part from the misconceptions that it is an inevitable condition, that old people are too inflexible to change, and that treatment is unacceptably hazardous. There is considerable potential for prevention, improved detection and appropriate treatment. In addition, it is increasingly clear that treatment can improve prognosis. Prevention requires education, and a political agenda to address aetiological factors such as poverty, loneliness, institutionalisation and poor physical health. Treatment with antidepressant drugs and/or psychological techniques is effective. Newer drugs may well be superior in safety and real-life tolerability but require better evaluation in representative samples, against placebo and incorporating cost-benefit and quality-of-life measures. Prophylaxis with antidepressants, electroconvulsive therapy and psychotherapy groups has been shown to be effective. The prophylactic efficacy of newer antidepressants has yet to be properly evaluated.

Racial Differences in Gait Velocity in an Urban Elderly Cohort

“…Depression was assessed using the Geriatric Depression Scale (GDS) and cognition using the Blessed Information–Memory–Concentration test (BIMC) . The GDS was dichotomized at 6 points, with those scoring 6 or more classified as probably depressed . The BIMC was dichotomized at a score of 8, with a score of 8 or more considered indicative of cognitive impairment …”

Loneliness: an epidemic in modern society

“…Much of the literature, when looking at the characterological causes of loneliness, concentrates on relating loneliness to other rather negative concepts, for example self-esteem. Loneliness is found to be negatively related to the following concepts: (a) self-esteem (Loucks 1980, Ouellet & Joshi 1986, Booth 1987, Sears et al 1991, Jackson & Cochran 1991, Haines et al 1993, Kraus et al 1993), (b) depression (Roscoe & Skomski 1989, McWhirter 1990, Katona 1994), (c) shyness (Kalliopushka 1986, Carr & Schellenbach 1993, Kraus et al 1993), (d) anxiety (Ryan & Patterson 1987, Roscoe & Skomski 1989, McWhirter 1990, Sears et al 1991, Kraus et al 1993, (e) anger and tension (Loucks 1980), (f) greater neurotiscism and lower extroversion (Kraus et al 1993), (g) less assertion and more self-consciousness (Sears et al 1991), (h) self-blame and self-devaluation (Jackson & Cochran 1991), and ®nally (j) lower educational levels (Baum 1982). Unfortunately, with such a complex concept, it is impossible to say whether the correlational concepts cause the loneliness, or are an effect of it.…”

Best Practices in Care Management for Asian American Elders: The Case of Alzheimer’s Disease

“…Care managers could explore cognitive behavioral therapy (CBT) approaches (Teri & Gallagher-Thompson, 1991) combined with medication such as tricyclic antidepressants (Katona, 1994) clozapine (Nacasch, Dohlberg, Hirschmann, Dannon, & Grunhaus, 1998) or selective serotonin reuptake inhibitors (SSRIs) as serotonin neurotransmitter loss is associated with both age-related cognitive and mood disorders (Cohn, Shrivastava, & Mendels, 1990;Meltzer, Smith, DeKosky, Pollock, & Mathis, 1998).…”