Our mental health status affects our ability to fully engage in life, cope with change, and adapt to new and unexpected situations. Our physical well-being and other dimensions of wellness also influence our mental health as they are inextricably connected.

We know that a healthy mental and emotional state is important at every stage in life, but takes on special significance as we age. Older adults experience many changes that affect our emotional, physical, occupational, intellectual, social, and spiritual wellness. Consider this: If you had to choose between your mental and physical health, which would you consider most important? Why?

Clinical depression is a major mental health problem that affects all aspects of one’s life. It is difficult to diagnose in older people because of medical conditions that may masquerade as depression such as anxiety and dementia. As a result, depression is often an under report and undiagnosed condition that is considered the “most untreated treatable mental disorder in older adults.”¹ Complicating this picture is the many myths and inaccurate stereotypes surrounding aging and depression.

Based on our personal and professional experiences with older adults, we understand that these beliefs are not true. Depression is not a part of the normal aging process. As professionals, we know that complex factors such as medical conditions, functional impairment, medications, alcohol, financial and spiritual distress, along with demographic and personality characteristics combine to increase the vulnerability of late-life clinical depression. Although facts on aging and depression are widely varied, consider the following:

• 12-37% community dwelling older adults are depressed
• 12% hospitalized (rates increases significantly with chronic illness/disability)
• 25% nursing home residents
• Elderly white males have highest suicide rates.²

Depressive symptoms such as exaggerated physical complaints, feelings of emptiness, lack of interest, and withdrawal from pleasurable activities are more common in older people and may differ from symptoms reported by younger adults. Consequences of depression result in considerable cost to older people and society in terms of excess disability, harmful interaction with physical health, and a general decrease in quality of life for older people and their families.³

The U.S. Preventive Screening Task Force (USPSTF), considered as the “gold standard” for clinical preventive services, recommends that professionals screen older adults. The USPSTF also reports that treatment for depression improves clinical outcomes.⁴

Two suggested screening questions are:

1. Over the past 2 weeks, have you felt down, depressed, or hopeless?
2. Over the past 2 weeks, have you felt little interest or pleasure in doing things?⁵

The good news is that according to the Surgeon General’s office, even though it takes longer, treatment for depression and depressive symptoms is successful in 60-80% of older adults.⁶

Evelyn’s Pics: Recommended Resources

• Geriatric Depression Scale SF: This screening tool has been found 89-92% sensitive for detecting depression in older adults.
• The National Institute of Mental Health (NIMH) is dedicated to metal health research, treatment, and prevention. 
• DSM-IV-TR Handbook of Differential Diagnosis. This manual includes a diagnostic decision tree for differential diagnosis of mental conditions. Published by the APA in 2002.

Resources:

1. Miller, C. (2004). Nursing for Wellness in Older Adults: Theory and Practice. 4th Edition. Philadelphia: Williams, Lippincott Williams & Wilcott.
2. Mauk, K. (2006). Gerontological Nursing:Competencies for Care. Sudbury, MA: Jones & Bartlett Publishers.
3. Office of the Surgeon General of the United States. Mental Health: A Report of the Surgeon General, Chapter 5.  
4. Agency for Healthcare Research and Quality. US Preventive Task Force Recommendations (2004).  
5. Agency for Healthcare Research and Quality.
6. Office of the Surgeon General. Ibid.

GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

For more information:

Go to the Senior Health health topic.