Depression in Later Life: A Multidisciplinary Psychiatric Approach PDF

Preface

The high prevalence, frequent recurrence, and serious consequences of depressive disorders in young and middle-aged adults are well recognized. The effects of depression on the elderly population, however, have been less widely appreciated. Although demographic studies indicate a low rate of major depressive disorder among community-dwelling elderly Americans, the prevalence approaches 15% when nonmajor depressive disorders are included. Studies among the medically ill or institutionalized elderly, furthermore, reveal very high rates of major depression. In long-term care facilities, where late-life depression is most rampant, more than 40% of residents show significant depressive symptoms. These are alarming numbers, because the presence of depression in later life has dire health consequences: excess suffering and functional limitation, increased morbidity from medical causes, and accelerated mortality as a result of concurrent medical illnesses or suicide. In the highest risk group for suicide— depressed white males 85 years of age and older—the suicide rate is more than five times that of the general population.

Given the aging of the American population and the enhanced survival of the infirm elderly, it is increasingly important that clinicians know how to diagnose and treat late-life depression. At present, however, even recognition of this disorder is too limited. Affected seniors may minimize their psychological distress and focus more directly on somatic or cognitive concerns, inadvertently

obscuring the correct diagnosis. Primary care clinicians—the health care providers likely to see the greatest number of depressed elderly individuals and therefore most in need of awareness—frequently miss the correct diagnosis. Even when the proper diagnosis is made, elderly patients who present depressive symptoms to a primary care physician are less likely than younger ones to receive adequate antidepressant treatment, psychotherapy, adequately intensive follow-up care, or referral to a mental health specialist. Mental health specialists, too, have shown limited recognition of depression among older patients. The need is apparent, therefore, for greater awareness of geriatric depression in its varied manifestations and for further education of all clinicians and the public, including family members and caregivers of depressed elders.

The literature on treatment of late-life depression includes numerous studies of pharmacotherapy and a smaller number of psychotherapy studies, but our therapeutic approach still contains many areas of uncertainty. Treatments for depression among the oldest old, the medically ill, and the demented elderly, for example, have received much less attention than treatment of younger, medically healthier late-life depressives. Beyond effects on symptom alleviation, we still know too little about how treatment affects quality of life. Furthermore, we need to better understand how to integrate somatic therapies with psychotherapeutic approaches, which are now recommended by experts as an important treatment component for late-life depression but still too infrequently applied in practice.

With invaluable contribution from noted experts, we have tried to present herein a comprehensive picture of late-life depression and to identify the areas in need of further investigation. This volume is intended for use by all clinicians who evaluate and treat depressed elderly individuals. Psychiatrists and other mental health specialists, as well as primary care clinicians, should find information that is both up to date and practical. In addition, we, along with the chapter authors, have attempted to present this important illness and its treatment in a larger context, highlighting its multifaceted manifestations and effects as well as the currently available range of treatments. It is our earnest hope that the publication of this book will increase professional and public awareness of latelife depression, disseminate the most current knowledge, help identify areas for further inquiry, and contribute to a growing body of literature dedicated to improving quality of life in the later years.