by Steve Christensen

Created on: January 05, 2010

Approximately one in five Americans over the age of 65 is clinically depressed, and nearly a million of these individuals suffer from major depression. Remarkably (although not surprisingly), the rate of depression among residents of long-term care facilities can be as high as 30 percent, and elderly people who live alone are far more likely to be depressed than their counterparts who live with companions.

Despite the high prevalence of depression among elderly persons, this condition is not a normal part of the aging process; untreated depression takes a heavy toll on this vulnerable segment of our population: 63% of persons who commit suicide are white, elderly men, and depression is the most common diagnosis in older people who complete suicide (substance abuse and psychosis are most commonly associated with suicide in younger individuals).

Oddly enough, three-quarters of elderly suicide victims visit their primary care physicians during the month preceding their suicides; unfortunately, their symptoms often go unrecognized or untreated.

There is no specific diagnostic test for depression, and screening tests consume more time than many physicians are allowed to spend with their patients. Furthermore, elderly patients often consult medical providers for other reasons and fail to report depressed moods to their doctors or family members. Therefore, it is important for everyone associated with elderly persons to become familiar with the sometimes subtle signs of depression.

Signs and Symptoms of Depression in Elderly Persons

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) outlines nine criteria for depression; the presence of five or more of these criteria, occurring every day during the same two-week period, supports a diagnosis of depression:

1. Depressed mood

2. Sleep disturbance (insomnia or excessive sleepiness)

3. Lack of interest or pleasure in activities ("anhedonia")

4. Feelings of guilt or worthlessness

5. Lack of energy

6. Decreased concentration and difficulty with decision making

7. Loss of appetite or weight loss

8. Agitation or lethargy

9. Suicidal ideation or expressions of death being a welcome event

Other behaviors that might suggest depression include persistent complaints of pain despite a lack of evidence that anything is amiss; unexplained gastrointestinal complaints (nausea, diarrhea, constipation, bloating, etc.); frequent visits to medical providers for minor complaints; refusal of treatment for bona

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