Late Life Depression
Late-life depression different?
Late-onset depression or late-life depression is characterised by a person over the age of 60 experiencing a first episode depression. As opposed to early-onset depression, late-life depression is characterised by less emotional symptoms and more cognitive (thinking) and physical symptom and loss of interest. For example, they may be less likely to report feeling sad but describe not wanting to do anything and feeling slowed in their thinking. Often there is an increased likelihood that a medical illness may also be present and there is usually no previous history of depression or family history. It is essential for a person with these symptoms and characteristics to undergo with depression treatment. The symptoms of late-life depression can include:
- Slower cognitive processing speed
- Decision making and memory problems (e.g. feeling slowed in thinking)
- higher rates of fatigue
- Increased irritability (described as being short-tempered)
- Psychomotor retardation
How common is it?
The prevalence of late life depression is estimated among people 65 years of age to be 15%. Patients with neurodegenerative disorders also run a higher risk for being depressed. Diagnosis of depression increases an older adult’s risk of disability by 67-73% over 6 years follow up, causes twice the functional impairment compared to those without MDD, increases the risk of mortality in patients with heart disease, and is associated with high rates of completed suicide in individuals over 65.
Why is depression often not recognised in older people?
- Many older people don’t visit their GP as feeling down is not a physical illness and therefore they seldom mention depression
- Some people have difficulty putting troubled feelings into words.
- People born in the early part of the 20th century endured world wars and economic depression and learned to ‘keep their chin up’ and carry on, without complaining.
- They may be frightened of talking to a doctor about their mental health as they may have fears about being put in a “mental hospital”
- Many people, including some GPs, seem to think depression is an inevitable part of ageing.
The signs of depression and grief can be similar, although people who have experienced both talk about the ‘sadness’ of grief compared with the ‘numbness’ of major depression. Grieving is a natural process which tales time to lessens or resolve. Depressive symptoms are an expected reaction to loss, but pervasive symptoms lasting more than two months may signify a depressive disorder.
Depression vs Dementia?
Major depression and dementia often co-occur and differential diagnosis is often challenging. Depression can be both an early or midlife risk factor for dementia and an early sign of emerging dementia, with both dementia and depression resulting from the same neurological changes. Conversely, dementia may be a risk factor for depression due to psychological reaction to the cognitive and behavioral changes accompanying dementia. The following table can provide some indication of the differences, however only a comprehensive psychological and medical assessment will be able to clarify the issue.
Difference between Depression vs Dementia
|Normal most of the time. Unhappiness is reactive to life situation.
|Quick onset, sad most of the day, very day.
|Gradual loss of interest over years not weeks. Not accompanied by sadness.
|Loss of interest over a period of weeks. Accompanied by sadness.
|Gradual disruption of the sleep-wake cycle over months/years due to brain changes of dementia.
|Quick changes in sleep over a few weeks (increase or decrease).
|Normal energy level, but reduced activity due to poor initiation related to fatigue. Executive.
|Subacute decrease in energy and increased complaints of fatigue.
|Concentration and thinking
|Concentration is normal in early dementia, but impaired in late dementia. Thinking ability declines throughout the course of dementia.
|Sudden loss of concentration and focus.
Often indecisive and concerned about making mistakes
Source: Modified version of table cited in The Canadian Review of Alzheimer’s Disease and Other Dementias, September 2009, pages 17-21. Copyright STA Communications.
Causes and risk factors for late-life depression
Genetic: People who have a first-degree relative with depression are at higher risk for developing the disorder themselves, suggesting a definite genetic link to late-onset depression. Older adults who have relatives with depression are at higher risk than those without a similar family history to develop depression.
Physical: Late-onset depression may be triggered by physical illnesses such as cancer, heart disease, and arthritis. In addition, imbalances of the neurotransmitters in the brain, such as serotonin and dopamine, may lead to the development of late life depression.
Environmental: The stresses associated with older adulthood may trigger late-onset depression in certain older adults.
- Delayed, complicated grief
- Social isolation
- Financial concerns and struggles
- Using many medications to treat physical problems
Research has also shown that depressed older adults are more disabled than their non-depressed peers, and that they tend to recover more poorly from medical illnesses such as stroke or hip fracture. Depression is one of the more treatable conditions in older adults yet can severely impact on quality as well as length of life.
Most people with depression benefit from one or a combination of the following lifestyle changes and social support, psychological or ‘talking’ therapies and medical treatments. Mindfulness-based CBT has also been found to be effective in the treatment of depression and involves the acceptance of unwanted thoughts in a non-judgemental manner to increase the mood difficulties. Social support is perhaps the most important factor. Research allowing for the effects of age, sex or depressive symptoms still found social support was highly likely to lead to positive treatment outcomes for late life depression. Between 40 and 60 per cent of people showing sustained recovery with standard treatment. Another 15 – 20 per cent of cases may relapse, while the remainder do not recover as well following treatment. Unfortunately, older adults often do not receive treatment for their depression. This may be due to several factors, including a) older adults not mentioning depressive symptoms to their GP, or not recognising the signs of depression in themselves, and b) the GP or other health professional not recognising the depressive symptoms, often because they are mistaken for simply the results of illness or the side-effects of medications.