What are symptoms of depression in the elderly?

Symptoms of the elderly are not unlike that of adolescents. Yes, there are crying episodes and withdrawn behavior that we frequently see in others who are depressed; however agitation is very common in the elderly. Some display paranoia or hyper-vigilance, they sometimes feel that they will be taken advantage of. It is sad to even admit the truth; the elderly in the United States are very poorly taken care of. Depression is under diagnosed with our health care system, and families are so busy that less and less time is spent with them. Loss of weight, decreased appetite, poor memory and decreased interest are all contributing signs, as well as symptoms of depression. Difficulties in daily living are immense.  Driving, reaching for objects, remembering, and moving a simple grocery cart and remembering to turn off the stove all may seem, trite but all are daily tasks that the elderly frequently struggle with. It does not take many contributing factors to elicit a depressive phase. Please remember there WILL be a time when you too will obtain the silver hair, loss of memory and crave hearing from your family. We cannot escape the aging process, acknowledge their plight, observe for symptoms, and take care of your aging relatives.

What is the (GDS) Geriatric Depression Scale?

When individuals reach their geriatric years, there is a statistically significant increase in the rate of suicide, particularly with a move to a nursing home. With respect to suicidal attempts, in general, the geriatric population has a 15-20% increase over the general population.

In Native American Culture, elders are revered. They are looked up to and embraced, their wisdom sought after. With each passing year their value increases.

It is clear that in our nursing homes, there are either nonexistent, or minimal at best, assessment tools available to assess the elderly residents for depression. This is a grossly negligence, and needs addressing, if not addressed by our healthcare providers, then by family members of nursing home residents who bring it to their attention.

The Geriatric Depression Scale (GDS) is a short questionnaire used to diagnose depression in an elderly patient. It is quick and easy to administer. Please feel free to copy this:

*	1.	Are you basically satisfied with your life?		YES		NO
	2.	Have you dropped many of your activities or interests?		YES		NO
	3.	Do you feel that your life is empty?		YES		NO
	4.	Do you often get bored?		YES		NO
*	5.	Are you hopeful about the future?		YES		NO
	6.	Are you bothered by thoughts you can’t get out of your head?		YES		NO
*	7.	Are you in good spirits most of the time?		YES		NO
	8.	Are you afraid something bad is going to happen to you?		YES		NO
*	9.	Do you feel happy most of time?		YES		NO
	10.	Do you often feel helpless?		YES		NO
	11.	Do you often get restless and fidgety?		YES		NO
	12.	Do you prefer to stay at home ratherthan going out and doing new things?		YES		NO
	13.	Do you frequently worry about the future?		YES		NO
	14.	Do you feel you have more problems with memory than most?		YES		NO
*	15.	Do you think it is wonderful to be alive now?		YES		NO
	16.	Do you often feel downhearted and blue?		YES		NO
	17.	Do you feel pretty worthless the way you are now?		YES		NO
	18.	Do you worry a lot about the past?		YES		NO
*	19.	Do you find life very exciting?		YES		NO
	20.	Is it hard for you to get started on new projects?		YES		NO
*	21.	Do you feel full of energy?		YES		NO
	22.	Do you feel your situation is hopeless?		YES		NO
	23.	Do you feel that most people are better off than you are?		YES		NO
	24.	Do you frequently get upset over little things?		YES		NO
	25.	Do you frequently feel like crying?		YES		NO
	26.	Do you have trouble concentrating?		YES		NO
*	27.	Do you enjoy getting up in the morning?		YES		NO
	28.	Do you prefer to avoid social gatherings?		YES		NO
*	29.	Is it easy for you to make decisions?		YES		NO
*	30.	Is your mind as clear as it used to be?		YES		NO

*Appropriate (non-depressed) answers = “Yes.” All others answers = “No.” Count the number of depressed (“No”) answers.

Score: __________ (# of “Depressed answers”)

Values:
Normal: 5 (+/- 4)
Mildly depressed: 15 (+/- 6)
Very depressed: 23 (+/- 5)

Yesavage, JA, Brink, TL, Rose, TL et al. Development and Validation of a Geriatric Depression Rating Scale, a Preliminary Report, Journal of Psychology, 1983.

Sheikh, JI, Yesavage, JA, Geriatric Depression Scale, Recent Evidence and Development of a Shorter Version, Clinical Gerontology, 1986.

What is the treatment for depression in the elderly?

Where indicated, low dose SSRI’s have been extremely beneficial with minimal side effects, and surprisingly, enjoyment of others, as well as life in general is dramatically increased in many cases. When prescribing any medication in the elderly, one must be cautious due to other medication they are usually taken. Medication interaction is a common concern with health care providers. One of the best treatment interventions in mild depression is, taking the time to spend the time. Make time out of your life for family members that are not visited frequently, try to get them involved in hobbies. These could be puzzles, gardening, a simple pet they could take care of, or inquire what their interests may consist of. Granted, they may be set in their ways, and mildly agitated when confronted. An indirect approach has been very beneficial. Show them your interests and leave something at their home. It may be a bird book, a puzzle, or paints. When you leave, you will be surprised how often they will pick that item up to try it out.

One of the most important treatment interventions is social support and family involvement. I can’t emphasize enough that this should not be forced, but genuine and spontaneous. There is nothing more effective for the geriatric population targeting their depression than seeing their children and grandchildren.

In closing, aging is a privilege. Our societal view of aging is somewhat different, and that is indeed our misfortune. Let’s take care of our elders, as someday, our children will be taking care of us.