Abstract
This research paper sought to explain the issue of depression in the elderly population in the modern context and to give the grounds that multifactorial depression is primarily a psychological issue. The analysis included a brief summary of the concept of depression among senior citizens as seen by the World Health Organization and researchers. Moreover, the major theoretical perspective to clarify the onset of depression was based on the necessity to consider the risk factors in terms of psychological, biological, social, cultural, economic and family. The observations allowed centering on the major risks of depression in older adults as it relates to negative life events and marital disruption. All the data explored in this study extended the extant research literature on depression in the elderly, with a focus on relevant intervention to eliminate depressive symptoms of the elderly population. The results of this research paper emphasized a psychological nature of depression typical of the aging process and the most widespread mental health problem supported by the patients’ complaints about increasing depressive symptoms.
Keywords
Depression in the Elderly
Introduction
Aging of the population relates to a phenomenon applicable to all countries in the world. Progressive aging makes a topic germane to psychological and health spheres. The key reason for aging in the first half of the twentieth century embraced a decrease in perinatal and infant mortality due to improved treatment of infectious diseases, enhanced nutrition and better prenatal and postnatal care. As regards the second half, the main reason was associated with a decline in mortality from different chronic diseases (Dhungana et al. 53). These reasons establish a shift in understanding the age structure and concept of older adults. In the elderly population women dominate as “they live on average six years longer than men” (Koch et al. 5575)
Depression is prominent among the mental illnesses that affect the elderly, therefore it can often “go unnoticed or can be characterized as a manifestation of their own age” (Koch et al. 5575). Gameiro et al. support the view by emphasizing that “prevalence of late onset depression increases with age” (32). It is a serious issue, since depression depicts one of the most prevalent psychiatric conditions in later life (Gameiro et al. 32, Dhungana et al. 56). Also, depression as a psychiatric disorder functions as a leading cause of human suffering, disability and severe stress. Thus, senior citizens suffer deterioration of quality of life, which is not a natural consequence of aging (Kitsumban et al. 1, Koch et al 5575). The multifactorial depression in the elderly poses a serious psychological issue, which can be mitigated by addressing timely specific interventions.
The Concept of Depression in the Elderly
The World Health Organization defines senior citizens as people 60 years and above (Dhungana et al. 54). The aging process relates to physical, cognitive, psychological and emotional changes. Specifically, the elderly are characterized by having biological heterogeneity, more physical and cognitive comorbidity and a higher risk of major side effects of medications. In addition, older adults possess such socioeconomic stressors as retirement, loss of loved ones, social network, the previous status in the society and financial difficulties (Dhungana et al. 54). In this regard people in old age make more appointments with physicians and utilize available health services to a higher degree. Such people often complain about their weakness, sleeping problems, eating habits and experiencing loneliness as potential depressive symptoms.
Koch et al. ascertain that “one of the main problems of a psychological nature in old age is depression” (5575). Taylor supports their idea by acknowledging that late-life depression is the occurrence of major depressive disorder in adults 60 years of age or older. Actually, major depressive disorder is typical of approximately 5% of community-dwelling older adults, while 8-16% of the elderly have clinically significant depressive symptoms (1228). In this respect senior citizens suffer from mood swings symptomatic of depression, which can affect older adults’ quality of life and personal well-being. Furthermore, Taylor states that irritability, anxiety and somatic symptoms are common for the elderly (1228). Kitsumban et al. explain that the elderly have risks of developing major depression, physical disabilities and medical illnesses (1).
The Onset of Depression in the Elderly
The World Health Organization predicts that depression will be the second greatest disease burden worldwide by 2020 (Kitsumban et al. 1). This case emphasizes the necessity to consider the issue of depression among older adults, which is a complex pattern of deviation of cognitive feelings and behavior. The pattern can include “a loss of interest or pleasure, depressed mood, feeling of guilt or low self-esteem, sleep or appetite disturbance, low energy and poor concentration” (Kitsumban et al. 1). Psychologically, distress can be developed differently, and in most cases it is manifested as “psychological discomfort: sadness, anxiety, distraction and psychotic symptoms in severe levels” (Gameiro et al. 35). The cause of depression can be characterized by psychosocial stress or physiological effects of disease.
According to Koch et al., depression is multifactorial, which combines elements of psychological, biological, social, cultural, economic and family (5575). Besides, the onset of depression in the elderly is not mainly relevant to genetic involvement (Gameiro et al. 32). The presence of multiple factors to explain the concept of depression is associated with a complex disorder, since it is revealed as psychosocial aspects and chronic stress. In terms of chronic stress, it may complicate the health condition among the elderly and increase the risk of depression. As a result, combination of a range of risk factors can trigger development of depression. Depression may function as a risk factor for and a manifestation of cognitive decline (Taylor 1228), which can be associated with an increased long-term risk of dementia.
The elderly encounter several adaptations which can mark the onset of depression. This condition can be attributed to some factors, such as the search for medical care more often, less biological vulnerability and greater social support. Among others Koch et al. name the independence of children, retirement, reduced income limits in the pursuit of leisure activities, satisfactory changes in self-image, social isolation, separation, loss of family and friends, use of medications (Koch et al. 5575). According to Dhungana et al., the elderly tend to suffer from depression when they encounter the following risk factors: female sex, being illiterate, adverse life events, poor physical health, disability, institutionalization and cerebral organic factors (54). Moreover, previous psychiatric history, family history of depression, a low level of education, personality factors, smoking and alcohol consumption add to the risk factors. Furthermore, the stressful psychosocial factors indicate the onset of depression: chronic distress, anxiety, bereavement, illness and economic conditions (Gameiro et al. 32).
Major Risk Factors of Depression in the Elderly
Negative life events serve as an important risk factor of depression, because life chronic stressors become dominant in the life of senior citizens. Even a personal achievement may pose negative associations if an older adult is under severe stress. Also, professional dissatisfaction can prove to be a key point in understanding depression in the elderly. As a result, “the person may lose the interest of daily activities and enhance the chance of accumulation of depressive symptoms” (Gameiro et al. 37). The possible causes of traumatic events in the lives of the elderly can be linked to negative experiences in their childhood. For instance, the parents’ divorce, leaving a familiar environment can be the reasons why depressive symptoms appeare. These examples indicate the fact that the traumatic events “double the risk of late life depression and increase risk of repeated crisis episodes” (Gameiro et al. 37).
Marital status is another risk factor, since depressive symptoms can become apparent in case of grief. Changes in family conditions, widowhood, a sense of loneliness, accompanied with no family support, are likely to bring about depression. Additionally, marital disruption relates to the onset of depression among older adults, since the former marital status presents a dependable relationship. Unlike the widowed or divorced, the single may have developed a social support network, which mitigates depressive symptoms. Loneliness may function as an essential predictor of depressive scenes, especially when senior citizens have less social support.
Gameiro et al. claim that there is “a subtle difference between genders: life events may be more associated in female cases and lack of social support in male patients” (37). However, the gender issue emphasizes differences in males’ and females’ conditions in terms of depression. Koch et al. assert that “older women tend to be poor, sick and living alone, more than elderly men” (5576). Also, long-term severe health problems and not remarrying after widowhood are characteristic of women rather than men. Also, depressive symptoms are typical of women with a low level of education and community activity as well as those who do not have a paid job.
It should be noted that there may be a bidirectional relationship between depression and a coexisting medical illness. For example, “medical problems such as chronic pain may confer a predisposition to depression, and depression is associated with worse outcomes for conditions such as cardiac disease” (Taylor 1228). In case of depression, suicide ideation frequently relates to mood disorders and depressive advanced symptomatology (Gameiro et al. 37). Suicide ideation is linked to psychosocial stress or physiological effects of disease. The effects can arise from disability, increased symptoms of medical illness, suffering and cognitive impairment (Kitsumban et al. 1). A high suicide rate can be typical of depressed older adults who are diagnosed with diseases of organic character, as this may indicate a poorer response to treatment.
Interventions to Eliminate Depression in the Elderly
The elderly should be encouraged to be involved in actions to reduce their depressive symptoms. When older adults are diagnosed with depression, they should be attended to with care. In this case nursing plays a crucial role, since detecting, treating and caring such patients indicate both medical and social support. It is crucial to regard symptomatology of depression in both clinical and psychic, since “there is a strong association between depression and physical ailments” (Koch et al. 5578). Subsequently, it is required “to strengthen facilities in this age group” (Dhungana et al. 56). Treatment of depression can be done with pharmacotherapy (antidepressants), psychotherapy, behavioral interventions, including Cognitive-Behavioral Therapy, and electroconvulsive therapy (Gameiro et al. 33, Kitsumban et al. 1, Taylor 1233).
Pharmacotherapy is related to the use of antidepressants. Potential side effects of antidepressants make it more difficult for senior citizens to use them, while newly developed ones can make it safer for older adults to utilize them. Medications as an intervention strategy may produce more side effects in the elderly than in the younger population.
Psychotherapy is associated with stressful events treatment, since it constitutes a review of daily life activities followed by the relevant treatment. Accordingly, psychological accompaniment assists the elderly to solve their problems linked to stressful events. Psychotherapy is a successful method of dealing with depression among older adults when no medications are involved. Individual and group psychotherapy posits “effective treatments for latelife depression and may be considered as firstline therapy, depending on availability and patient preference” (Taylor 1232). Standardized approaches involve weekly visits on a short-term basis although in some cases patients may need to utilize a longer period of treatment.
The strengths of Cognitive-Behavioral Therapy make it the most effective treatment for the elderly with moderate depression (Kitsumban et al. 1). Social activity establishes changes in the view of life and explains a fewer risk of depression. For instance, visiting friends, going to cafes or restaurants, attending sporting events, playing games can contribute to decreased manifestations of depressed conditions among the elderly. In particular, “a strong sense of meaning in life helps older adults cope more effectively with the effects of lifetime trauma” (Gameiro et al. 34). “Depressed older adults should be encouraged to increase their physical activity to the extent that they can” (Taylor 1230). In order to mitigate their depressive symptoms, it is also advisable for older adults to become involved in group activities which relate to “learning, sharing of ideas, experiences and reflections on their everyday lives” (Koch et al. 5575). Communicating with people in the similar health conditions proves to be advantageous for the elderly in depression. Such activities enable them to experience belonging to the group, which enhances their well-being and subsequently the quality of life.
Electroconvulsive therapy is considered to be the most successful method of treating severely depressed elderly patients. According to Taylor, this therapy is beneficial if older adults are “suicidal, have not had a response to antidepressant pharmacotherapy, have a deteriorating physical condition, or have depression-related disability that threatens their ability to live independently” (Taylor 1233).
Conclusion
The concept of depression, which is psychological in nature, characterizes changes typical of the aging process. The concept also reveals that senior citizens experience depression as the most widespread mental health problem, which is supported by their complaints in terms of increasing depressive symptoms. Depressed older adults present poor functioning, enhanced perception of poor health, alongside with an increase in using medical services and health care costs. Furthermore, the onset of depression is multifactorial, since depression combines elements of psychological, biological, social, cultural, economic and family. Still, the cause of depression can be characterized by psychosocial stress or physiological effects of disease. Among the major risk factors of depression are negative life events and marital disruption, which constitute gender differences among the elderly population. In case of depression, suicide ideation frequently relates to mood disorders and depressive advanced symptomatology. As a result, it is necessary to strengthen facilities in the age group by utilizing relevant interventions in due time. Mitigation of depressive symptoms in older adults can be implemented by pharmacotherapy with the use of antidepressants, psychotherapy as firstline therapy, behavioral interventions in terms of Cognitive-Behavioral Therapy and electroconvulsive therapy effective for severely depressed elderly patients.
Works Cited
Dhungana, S., et al. “A Retrospective Review of Elderly Patients Admitted in Psychiatry Department of a Tertiary Care Center Over 3 Years.” Journal of Institute of Medicine, 36.3 (2014): 53-57. Print.
Gameiro, Gustavo Rosa, Minguini Isabela Pasqualini, and Tania Correa de Toledo Ferraz Alves. “The Role of Stress and Life Events in the Onset of Depression in the Elderly.” Revista de Medicina, 93.1 (2014): 31-40. Print.
Kitsumban, Voranut, Darawan Thapinta, and Wilawan Picheansathian. “The Effectiveness of Cognitive-Behavioural Therapy on Depression in the Elderly.” The JBI Database of Systematic Reviews and Implementation Reports, 10.14 (2012): 1-9. Print.
Koch, Rosane Fátima et al. “Perception of Depression in Elderly in Groups of Familiarity.” Journal of Nursing, 7.9 (2013): 5574-82. Print.
Taylor, Warren D. “Depression in the Elderly.” The New England Journal of Medicine, 371.13 (2014): 1228-1236. Print.
