Elderly depression stems from a variety of causes. Elderly men encompass the highest suicide rate in the United States. The condition affects 6.5 million out of 35 millions Americans aged 65 years old and above.
Some of the identified causes of depression among the elderly are;
- Memory problems
- Social withdrawal
- Confusion
- Demanding behavior
- Lack of active movements
Depressive disorders are described in the Diagnostics and Statistical Manual for Mental Disorders (DSM-IV) that caused by general medical condition. Variants of geriatric-spectrum of depression were introduced to reflect differentiate depletion syndrome and depression without illness.
- Other causes of depression attributed to elders aged 65 and above are (refer to slide six).
- Depression occurs due to biological factors that include weakening of the neuro-transmitter receptors found at end of the nerves (see diagram at slide 7).
- Other signs and symptoms related to depression (see table at slide 8).
However, depression among elderly can be treated through helpful therapies such as medication and or exercise (refer to slide 10-12). Exercise is also recommended to reduce the effect of depression among elderly and to minimize occurrence of the factors leading to the condition (see slide 14-15). In order to ensure the effectiveness of exercise in treating depression, an exercise test is recommended trough the use of nomogram (see diagram at slide 17).
Test procedure described as “Nomogram of the prognostic relations embodied in the treadmill score. Prognosis is determined in five steps: (1) the observed amount of exercise-induced ST-segment deviation (the largest elevation or depression after resting changes have been subtracted) is marked on the line for ST-segment deviation during exercise. (2) The observed degree of angina during exercise is marked on the line for angina. (3) The marks for ST-segment deviation and degree of angina are connected with a straight edge. The point where this line intersects the ischemia-reading line is noted. (4) The total number of minutes of exercise in treadmill testing according to the Bruce protocol (or the equivalent in multiples of resting oxygen consumption [METs] from an alternative protocol) is marked on the exercise-duration line. (5) The mark for ischemia is connected with that for exercise duration. The point at which this line intersects the line for prognosis indicates the 5-year cardiovascular survival rate and average annual cardiovascular mortality for patients with these characteristics. Patients with <1 mm of exercise-induced ST-segment depression should be counted as having 0 mm. Angina during exercise refers to typical effort angina or an equivalent exercise-induced symptom that represents the patient’s presenting complaint. This nomogram applies to patients with known or suspected coronary artery disease, without prior revascularization or recent myocardial infarction, who undergo exercise testing before coronary angiography” (Gibbons et. al., 1997).
Summary
Having to effectively measure and establish an exercise test, the next step to recovery for elderly suffering from depression is outlined in FITT (slide 17-18). Depression is imminent among elders due to a number of factors ranging from lack of social mobility and health problems. There are several approach that clinicians can take to address treatment and prevention. Apart from medication-based approach, depression can also be addressed by promoting exercise particularly aerobics, which encompasses positive results on depression prevalence Elders experience depression because of factors that affect their way and quality of life. However, encouraging them to do physical activities draws them away from depression.
References
Cole, M. G., & Dendukuri, N. (2003). Risk Factors for Depression Among Elderly Community Subjects: A Systematic Review and Meta-Analysis. American Journal of Psychiatry, 160, 1147–1156. doi:10.1176/appi.ajp.160.6.1147
Brown, J. E., & Isaacs, J. S. (2011). Nutrition through the life cycle. Belmont, CA: Wadsworth, CENGAGE Learning.
Duckworth, K. (2009, October). NAMI | Depression In Older Persons. Retrieved November 22, 2013, from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515
Fiske, A., Loebach-Wetherell, J., & Gatz, M. (2009). Depression in Older Adults. Annu Rev Clin Psychol, 5, 363–389. doi:10.1146/annurev.clinpsy.032408.153621
Gibbons, R. J., Beasley, J. W., Duvernoy, W. F., Mark, D. B., McCallister, B. D., & Winters Jr., W. J. (1997). ACC/AHA Guidelines for Exercise Testing: Executive Summary, A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation, 96, 345-354. doi:10.1161/01.CIR.96.1.345
Kritz-Silverstein, D., Barrett-Connor, E., & Corbeau , C. (2001). Cross-sectional and Prospective Study of Exercise and Depressed Mood in the Elderly : The Rancho Bernardo Study. American Journal of Epidemiology, 153(6), 596-603. doi:10.1093/aje/153.6.596
Mather, A. N., Rodriguez, C., Guthrie, M. F., McHarg, A. M., Reid, I., & McMurdo, M. T. (2002). Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. British Journal of Psychiatry, 180, 411-415.
Rodda, J., Walker, Z., & Carter, J. (2011). Depression in older adults. BMJ Clinical Review, 343, 1-7. doi:10.1136/bmj.d5219
Scogin, F. (2009, September). Depression and Suicide in Older Adults Resource Guide. Retrieved November 22, 2013, from http://www.apa.org/pi/aging/resources/guides/depression.aspx?item=1
