Late Life Depression in Older Adults

Late Life Depression in Older Adults
Salma Abrahim, Dr. Austin Mardon 

Introduction 
The number of aged individuals in our population is consistently increasing, and the rate of problems that the geriatric population experiences is also increasing at an alarming rate (Parkar, 2015). There is a great body of literature identifying the rise in mortality and hospitalization because of mental disorders that manifest in the elderly. Aged individuals often live in nursing homes and are disconnected from the outside world, with their main social interaction being other alienated older people (Parkar, 2015). Older people experience several common psychiatric disorders at an increased rate, including anxiety and depression (Parkar, 2015). 

Late-life Depression 
Late-life depression (LLD) is known as a depressive mental disorder that occurs in individuals over the age of 60 (Blackburn et a., 2017). It is the most common mental health issue in older adults, and it can lead to significant negative outcomes (Blackburn et a., 2017). Functional impairment from late-life depression can be exhaustive for primary caregivers and lead to placing the individual into a care facility. The decreased motivation can interfere with treating other health-related problems such as cognitive disorders, or Parkinson’s disease (Blackburn et a., 2017). 
LLD is associated with suicide, and older men are a high-risk group compared to older women (Blackburn et a., 2017). In addition, older individuals use more lethal suicide methods, with data showing that 26% of victims over the age of 60 died by firearm, compared to a rate of 12% for individuals between 15 to 39 (Blackburn et a., 2017). 
Detecting and diagnosing LLD is more effective when risk factors are taken into account, which include any physical illnesses that are debilitating, sleep difficulties and problematic substance use that interferes with one’s daily life (Blackburn et a., 2017). For psychosocial risk factors, female gender, being divorced or widowed, lacking social company and support and needing to provide caregiving services to others with severe illness increases the chance of having LLD (Blackburn et a., 2017). 
There are several help-seeking behaviors that are suggestive of LLD. They include constant fatigue, headaches, lack of sleep, unexplainable weight loss and consistent complaints of pain (Blackburn et a., 2017). In the hospital, after a patient has undergone a significant health event such as a myocardial infarction, hip fracture or artery bypass graft surgery, LLD should be considered as several help seeking behaviors can present themselves after the event (Blackburn et a., 2017). In a long term care setting, LLD can be considered when members have social withdrawal, have a decreased motivation to thrive, increased agitation and apathy to others (Blackburn et a., 2017). 
The diagnosis of LLD can be made though the DSM-5 criteria, but there can be challenges in the process. A criterion in the DSM-5, written as “markedly diminished interest or pleasure” can overlap with other neurological illness diagnoses (Blackburn et a., 2017). Weight loss and decreased appetite can be caused by other physical or neurological disorders, while sleep disturbance can be a result of chronic pain or substance use (Blackburn et a., 2017). It is imperative that diagnosticians perform a full evaluation of the patient to conclude an accurate diagnosis. 

Conclusion 
Clinical depression can have a significant effect on older adults. Predisposing risk factors, and environmental factors can have an impact on severity and the evolution of the illness. Detecting and diagnosing late life depression should be done at the earliest possible moment for most effective disease management and treatment. Patients with depression should always be referred to the various mental health services whenever available. 

References 
Blackburn P, Wilkins-Ho M, Wiese B (2017). Depression in older adults: Diagnosis and management. BC Med; 59: 171-177. 
Parkar S. R. (2015). Elderly mental health: needs. Mens sana monographs, 13(1), 91–99. https://doi.org/10.4103/0973-1229.153311