Everyone occasionally feels sad, low, and tired with the desire to stay in bed and shut out the world. These episodes often are accompanied by anergia ( lack of energy ), exhaustion, agitation, noise intolerance, and slowed thinking processes, all of which make decisions difficult. Work, family and social responsibilities drive most people to proceed with their daily routines, even when nothing seems to go right and their irritable mood is obvious to all.
Such “ low periods “ pass in a few days, and energy returns. Fluctuations in mood are so common to the human condition that we think nothing of hearing someone say, ” I’m depressed because I have to much to do. “ Everyday use of the word “depressed “ does not actually mean that the person is clinically depressed but is just having a bad day. Sadness in mood also can be response to misfortune. Death of a friend or relative, financial problems, or loss of a job may cause a person to grieve.
Depression, the most common mental/behavioral health disorder among older adults, is a response to multiple life stresses, a single situation ( situational depression ), a primary disorder, or a problem associated with dementia, a broad term used for a syndrome that is characterized by a slow progressive cognitive decline. It can range from mild, transient feelings of sadness to a severe sense of helplessness and hopelessness. Depression is thought to result from a lack of the neurotransmitters norepinephrine and serotonin in the brain.
It is often underdiagnosed by physicians and is therefore undertreated. Families and nurses are often in a position to suspect depression in an older adult. Several screening tools are available to help determine if the client has clinical depression. The Geriatric Depression Scale – Short Form ( GDS – SF ) is commonly used and completed by the client. A score of 11 or greater is consistent with a diagnosis of clinical depression. Without diagnosis and subsequent treatment, depression can result in the following:
Worsening of medical conditions Risk of physical illness Alcoholism Increased pain and disability Delayed recovery from illness Suicide ( especially among older men ) Older adults have the highest suicide rate of any age-group ( Uncapher and Arean 2000 ). In their study, Uncapher and Arean ( 2000 ) sent two cases of suicidal, depressed clients to primary care physicians to determine if any bias in treatment would be present. The two cases were the same except for age – one client is age 38 years and the other one was aged 78 years.
The 215 physician responses showed that all providers recognized depression and suicide risk but were less willing to treat the older client. They believed that suicidal ideation was normal for the older client. Elders with depression may experience early morning insomnia, excessive daytime sleeping, poor appetite, a lack of energy and an unwillingness to participate in social and recreational activities. The primary treatment for depression usually includes drug therapy and psychotherapy. In some parts of the country, electroconvulsive therapy ( ECT ) may be used either as a last resort or when drugs are not effective.