Recognizing Depression in Older Adults: Not Just an Inevitable Sign of Old Age
Depression in older adults is getting more and more attention from the public, and it should. The proportion of older adults diagnosed with depression nearly doubled, from 3.2 percent to 6.3 percent, across all older persons' demographics, between 1992 to 2005. Until recently, the condition was under-reported, often because of assumptions that depression and decreased mood were just symptoms of old age. While treatment of depression in older adults still lags behind the younger population, the gap is closing.
New Research in the Journal of the American Geriatrics Society
Studying data from the Medicare Current Beneficiary Survey covering the period from 1992 to 2005, researchers from the Rutgers State University of New Jersey and Columbia University found that across all demographic populations of older adults, diagnoses of depression and prescriptions for medication increased. However, the use of psychotherapy - which has been shown to be the most effective treatment when combined with drug therapy -- decreased.
Data from the Surveys indicated that antidepressant medication use among older adults diagnosed with depression increased from 53.7% to 67.1%, while psychotherapy treatment dropped from 26.1% to 14.8%. Adjusting for other factors, the researchers found that the probability of treatment of depression for older adults was 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for community persons living in cities, and 55% greater for rural older adults.
The probability of being treated was 54% greater if diagnosed with major depressive disorder, compared to 83% greater among those with other depression diagnoses. The probability of receiving psychotherapy was 29% lower among those with major depressive disorder and 74% lower among those with other depression diagnoses.
The researchers also learned that the probability of receiving the combined treatment of psychotherapy and drug treatment for older adults diagnosed with major depressive disorder was greater if seen by a psychiatrist rather than a primary care provider. From 2002-2005, for older adults who did not receive care from a psychiatrist, use of combination therapy was rare and continued to decline to as low as 4%.
"These findings show clear shifts in the care of depression for older adults," said Ayse Akincigil, PhD, of the Center of Health Services Research on Pharmacology, Chronic Disease Management and Outcomes at Rutgers University and lead author of the study. Changing cultural attitudes regarding help for mental health problems and safer medications may be some reasons for this change in care. Dr. Akincigil added, "Greater public acceptance of antidepressant medications and a reduction in stigma surrounding mental health care may have fueled these trends as well."
What Should I Do?
Antidepressants and medicines alone may not be the most effective strategy to treat depression. A combined treatment of both psychotherapy (counseling) and medicine may work better than either treatment alone. If you or someone you know suddenly experiences a prolonged sense of sadness, loss of interest in activities that used to be enjoyable, please seek medical help. Be aware of signs of depression in yourself or in older adults you care for, and visit a healthcare professional to ensure a proper and timely diagnosis. Consider psychotherapy and counseling options to supplement any medications prescribed.
The Summary above is from the full report titled, Diagnosis and Treatment of Depression in Older Community-Dwelling Adults: 1992-2005. It is in the June 2011 issue of the Journal of the American Geriatrics Society (JAGS). The report is authored by Ayse Akincigil, PhD, Mark Olfson, MD, James T. Walkup, PhD, Michele J. Siegel, PhD, Ece Kalay, BS, Shahla Amin, MS, Karen A, Zurlo, PhD, and Stephen Crystal, PhD.