Depression in Older Adults

Depression is a serious health problem, often leading to unnecessary suffering, impaired functioning, increased mortality and excessive use of health care resources. Primary care settings deliver over 80 percent of mental health treatment for depressed older adults. Consequently, recognition and management of late-life depression is an important responsibility for the primary care clinician.

Depression is also costly. An analysis of medicare claims determined that participants who have diabetes or congestive heart failure as well as depression have significantly higher health care costs than their counterparts who do not have co-existing depression.

Diagnosing depression in older adults may be complicated by a number of factors including:

Diagnostic Tools There are a number of effective tools to help diagnose and monitor depression. We recommend the PHQ-9, but other tools also work with the IMPACT model. To learn more about why we recommend the PHQ-9 and some of the alternatives, click on the link below. More about PHQ-9

• concurrent medical illness
  
• medication side effects
  
• impaired communication skills in the elderly
  
• multiple somatic complaints
• lack of time in the clinical exam

Diagnostic Criteria for Depression

A diagnosis of depression is based on the following criteria:

Five or more symptoms listed below should be present daily or for most of the day for at least two weeks.

At least one symptom is depressed mood OR lost of interest or pleasure in nearly all activities.

Other symptoms may include:

• changes in appetite or weight
• feelings of worthlessness or guilt
• insomnia or hypersomnia
• difficulty thinking, concentrating or making decisions
• psychomotor agitation or retardation
• fatigue or loss of energy
• recurrent thoughts of death or suicideal ideation, plans or attempts

Adapted from: DSM-IV, American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Primary Care Version (DSM-IV-PC). American Psychiatric Association Press, Washington DC, 1995.