Practitioners guide for working with older adults with depression. Most people who experience depression need treatment to get better. Causes of depression in older adults as we grow older, we often face significant life changes that can increase the risk for depression. Depression in older adults canadian coalition for seniors mental. Latelife depression lld is defined as a depressive disorder occurring in a patient older than 60 years, although the onset and definition of cutoff may vary. Latelife depression lld is defined as a depressive disorder occurring in a patient older than 60 years, although the onset and definition of. To assess selected adverse events of antidepressants in the treatment of major depressive disorder mdd in adults 65 years old or older. Because many people think that depression is a normal part of aging. May 23, 2017 major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. The causes of depression in older people are more diverse than in younger adults and, as the number of older people is steadily increasing, it is important to study the effects of treatments specifically in older adults. Selecting ebps for treatment of depression 2 selecting ebps what are evidencebased practices ebps for depression in older adults.
In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems. Treatment of depression and anxiety in the geriatric patient. Most people in this stage of life with depres sion have been experiencing. It negatively affects functioning, health outcomes, quality of life, and health care costs. This kit offers information about an array of evidencebased practices for treatment and services to improve outcomes for older adults experiencing depression, including dysthymia. Cooccurring anxiety can complicate the course and treatment of depression 3. This document was prepared for the substance abuse and mental health services.
People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does affect some groups more than others. Depression is one of the leading causes of worldwide disability. Sep 28, 2011 older adults with depression are at increased risk of suicide and are more likely than younger adults to complete suicide. Once diagnosed, 80 percent of clinically depressed individuals can be effectively treated by medication, psychotherapy, electroconvulsive therapy ect or any combination of the three. The original scale consisted of 30 questions but was considered too time consuming by some patients and. Chronically ill medicare beneficiaries with accompanying depression have significantly higher. Over six million americans 65 and older are affected by late life depression, but only 10% ever receive treatment. Worse prognosis in older adults correlates with advancing age, physical comorbidities and functional impairment 70.
Depression is common when youre over age 65, but it can be harder to spot. Effectiveness of physical exercise in the treatment of. Depression is associated with cognitive impairment and an increased risk of dementia. Due to the many health challenges older adults face. A selective serotonin reuptake inhibitor should be the first line pharmacological treatment for depression for most older adults. The vast majority of older adults who commit suicide have had contact with a health professional within the preceding month 9.
Depression is a common problem among older adults, but it is not a normal part of aging. Please contact bestpractice decision support for further information. Depression is one of the most common mental health problems in older adults. Depression and older adults national institute on aging. Switching medications may be preferable in frail older adults to avoid the polypharmacy that results from augmentation. It also provides you with a brief summary stating why implementation of evidencebased.
Depression in older adults is associated with a slower rate of recovery 9, worse clinical outcomes compared to younger adults 3 and is associated with higher relapse rates 68. Comparative effectiveness of social problemsolving. Depression is a true and treatable medical condition, not a normal part of aging. Without treatment, episodes may last a few months to several years. Relapse and recurrence of a depressive episode is common after acute antidepressant treatment. Remission depression scale score below a threshold that demonstrates relative absence of symptomsdepressed mood goal of treatment continuation therapy relapse remission greater than 6 months recovery maintenance therapy recurrence wilkinson p and izmeth z. Offsetting the increasing prevalence of certain risk factors in late life are agerelated increases in psychological resilience. Although the difficult behaviors associated with depression may be less frustrating to staff than those associated with dementia, older adults with depression may present a number of challenges to staff providing patient. Depression is the leading cause of suicide in older adults 29,71. This module is freely available to all new zealand general practices.
The principles for the assessment and management of depression in older adults are the same as for all adults. The structural brain changes associated with depression in older. Adverse effects of pharmacological treatments of major. Depression is the prototype of mood disorders in older adults, however. Fortunately, the treatment prognosis for depression is good. Cognitive impairment can be a risk factor and a symptom of depression 4. It is not a normal part of aging, a sign of weakness, or a character flaw. Depression in older persons fact sheet national council on. Treatments commonly used are antidepressant drugs and psychological. Many older adults with depression need treatment to feel better. In the majority of older adults, longterm antidepressant treatment may be necessary to maintain the antidepressant response, and prevent some of these negative outcomes. Ect can be safe and highly effective for severe, treatmentresistant depression, as well as a variety of other serious mental disorders. This booklet provides information about demographic trends, definitions and risk factors for depression, prevalence of depression, and the impact and cost of depression.
Support for the effectiveness of rt as a treatment for depression in older people has been found in several studies goldwasser et al. The treatment of depression in older adults samhsa publications. However, the prevalence of subsyndromal depression is higher and may reach up to 40 % of communitydwelling elderly subjects 2, 3. Depression is the most common mental health problem in older adults. Pdf treatment of depression in older adults ricardo. Despite ects efficacy and safety record in older adults, many misconceptions still persist among both patients and health care professionals.
In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major. Antidepressants are effective in older adults, but response rates may be lower for those 55 and over. Major depression occurs in 2% of adults aged 55 years or older, and its prevalence rises with increasing age. Treatment of depression and suicide in older adults. Although common, it is not a normal consequence of aging. Should the hypothesis prove to be true, engaging in physical exercise could be regarded as a novel therapeutic resource in primary care for treating depression in older adults, and be incorporated into clinical practice guidelines along with the currently recommended pharmacological or psychotherapeutic treatments. Jan 14, 2019 should the hypothesis prove to be true, engaging in physical exercise could be regarded as a novel therapeutic resource in primary care for treating depression in older adults, and be incorporated into clinical practice guidelines along with the currently recommended pharmacological or psychotherapeutic treatments. Older people tend to underreport depressive symptoms and may not acknowledge being sad, down or depressed. Comparative effectiveness of social problemsolving therapy.
The changes that often come in later liferetirement, the death of loved ones, increased isolation, medical problemscan lead to depression. Discuss interventions that promote mental health for residents. Thus, in the present study, the comparative efficacy of two psychotherapies for the treatment of depression in older adults was examined. Center for mental health services, substance abuse and mental health services administration, u. Depression presents with the same symptoms in older adults as it does in younger populations.
The evidence based practice guideline for the identification of common mental disorders and management of. Causes and diagnosis of depression in elderly people. Pdf treatment of depression and suicide in older adults. Illness and disability, chronic or severe pain, cognitive decline, damage to your body image due to surgery or sickness can all be contributors to depression. Center for mental health services, substance abuse and mental. However older adults are at an increased risk for experiencing depression. Assessing depression in older primarycare patients according to the u. There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. Further assessment the geriatric depression scale was developed as a screening and assessment tool for depression in older adults. It considers planning, implementation, and maintenance.
After diagnosis, regular followup and active medication management are crucial to maximize treatment and remission. Depression in older adults can reduce quality of life, and it increases risk of suicide. It is a medical condition that interferes with daily life and normal functioning. Depression in later life is an illness that can be treated. Ect may cause side effects, such as confusion and memory loss. Apas clinical practice guideline recommends three psychotherapy interventions as well as a secondgeneration antidepressant selectiveserotonin reuptake inhibitors ssris, selectivenorepinephrine reuptake inhibitors snris or norepinephrinedopamine reuptake inhibitors ndris for the treatment of depression in older adults. Thus, in the present study, the comparative efficacy of two psychotherapies for the treatment of depression in. Treatments commonly used are antidepressant drugs and psychological treatments talking treatments. Depression is a common problem among older adults, but it is.
In addition, 10% to 15% of older adults have clinically significant depressive symptoms, even in the absence of major depression. Even after successful treatment, it frequently recurs. Depression in older adults british journal of medical. This brochure describes the signs, symptoms, and treatment options for depression in older adults. Treatment of depression in older adults evidencebased practices ebp kit substance abuse and mental health services administration. Approximately 15% to 20% of adults 65 years and older have depression. Older adults are less likely to talk about feeling depressed with their health care providers. In the primarycare setting, proper detection of any. Untreated depression can lead to unnecessary suffering, poor health outcomes, high health care costs, and suicide. Older adults and depression pdf, 416 kb depression is not a normal part of aging. Depression, clinical practice guideline, best practices.
This resulted in some overlap between the general adult and older adult populations that the panel was not able to separate out due to the way the data was analyzed. Feb 01, 2020 approximately 15% to 20% of adults 65 years and older have depression. Continuation and maintenance treatment for depression in older people. A study investigating healthrelated quality of life in adults with diabetes found that 31% had depressive symptomsand that by far the most significant negative. Depression is not just having the blues or the emotions we feel when grieving the loss of a. Importance depression in older adults is a common psychiatric disorder affecting their healthrelated quality of life. Depression is a significant health problem for people of all ages, but is particularly troublesome among older adults.
Effective treatments can reduce the severity of depression in up to 80 percent of older adults. Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030. Most clinicians will encounter older patients with. Depressive disorders are common and disabling in the elderly. Read on to learn about symptoms to watch for and treatment options. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. The impact of clinical depression in older adults can be significant, and choosing effective psychotherapeutic and pharmacological management options can be challenging. Pdf effectiveness of treatment for depression in older people. In part, its because it often shows up differently when youre older. Treatment of depression and suicide in older adults request pdf. Cdc promotes public health approach to address depression.
It may be overlooked because for some older adults who have depression, sadness is not their main symptom. Treatment of depression in older adults evidencebased. They may have other, less obvious symptoms of depression. Longterm treatment for depression in older people cochrane. Depression is the most frequent mental disorder in older people, often causing emotional distress and reduced quality of life. Older adults may take up to 1012 weeks to respond to treatment. In a recent work, byers and colleagues found that the prevalence of major depression and dysthymia in older adults was 4 % and 0.