Abstract

Depression is one of the commonest conditions seen in primary care so, with a rapidly expanding older population, knowledge of managing depression in later life is increasingly important.

There is a range of severity in depressive disorders in older people and symptoms are often chronic.

Older people with depression often present with a different symptom profile than younger adults: they are less likely to report low mood but more likely to experience agitation and psychosis. Risk factors are diverse and include structural brain changes and life changes such as taking on caregiving roles or moving into care home accommodation. There is a bidirectional link between depression and chronic physical illness.

Assessment for a possible depressive disorder requires a careful review of symptoms, their impact on function, and consideration of other mental health conditions. There is an array of evidence-based interventions – pharmacological, psychological and social – to help the older person with depression which can be used in a multi-faceted approach with respect to an individual’s medical and personal circumstances.

There is a worldwide upward trend in life expectancy. By 2066 it is predicted that just over one in four UK residents will be over 65 years, with the proportion of people over 80 years growing the fastest.1 Depression is the worldwide leading cause of disability worldwide and is one of the most common conditions seen in primary care. Including milder forms, depressive disorders are present in up to a third of older adults. Depression in older people is associated with significant economic costs and more functional and cognitive impairment than depression in younger adults. In older adults, depression is generally under-reported, under-recognised, and under-treated. To help older adults who are experiencing depression requires awareness of different symptom patterns, the role of physical and psychological comorbidities and social factors.

Older adults with depression have a greater functional disability, slower treatment response and worse outcomes compared to younger people and over a quarter will experience continued symptoms. Depression that is persistently severe is also linked to the onset of dementia.2

Depression is the most common risk factor for completed suicide, and there is a twenty times higher risk of this within the year following an episode of self-harm. The majority of older adults who die by suicide have seen a health professional within the previous month, so it is important to be vigilant to this risk.

References

  1. Office for National Statistics. Living longer: how our population is changing and why it matters. 2018; www.ons.gov.uk. [Accessed 20/03/19]
  2. Mirza SS, Wolters FJ, Swanson SA, et al. 10-year trajectories of depressive symptoms and risk of dementia: a population-based study. Lancet Psychiatry 2016;3: 628-35.

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