Depression in Older Adults

Depression ◽  
2019 ◽  
pp. 418-434
Author(s):  
Hanadi Ajam Oughli ◽  
Jordan F. Karp ◽  
Eric J. Lenze
Keyword(s):  
Older Adults ◽  
Antidepressant Treatment ◽  
Functional Decline ◽  
Treatment Algorithm ◽  
Mechanisms Of Action ◽  
Current Data ◽  
Psychotropic Medications ◽  
Psychosocial Treatment ◽  
Late Life Depression ◽  
Chronic Course

Late-life depression (LLD) is relatively common in older adults. It is associated with deleterious health outcomes, exacerbates frailty and functional decline, and contributes to all-cause mortality. LLD tends to have a chronic course, with frequent recurrences and relapses. This chapter reviews the clinical presentation, assessment, and etiologies of LLD. The chapter also focuses on therapeutic targets of LLD, which include pharmacotherapy, neurostimulation, and psychosocial treatment. An antidepressant treatment algorithm based on a summary of current data, clinical evidence and expert opinion is included to help guide physicians. Additionally, psychotropic medications with novel mechanisms of action are discussed with some directions for further research.

scholarly journals Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

2019 ◽  
Vol 69 (680) ◽  
pp. e171-e181 ◽  
Author(s):  
Rachael Frost ◽  
Angela Beattie ◽  
Cini Bhanu ◽  
Kate Walters ◽  
Yoav Ben-Shlomo
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Older People ◽  
Functional Decline ◽  
Late Life ◽  
Later Life ◽  
Healthcare Services ◽  
Qualitative Studies ◽  
Late Life Depression ◽  
Psychological Therapies

BackgroundDepressive symptoms are common in later life and increase both the risk of functional and cognitive decline and the use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged ≥80 years.AimTo explore how healthcare professionals (HCPs) manage older people in relation to depression and referrals to psychological therapies.Design and settingSystematic review and thematic synthesis of qualitative studies.MethodMEDLINE, Embase, PsycINFO, CINAHL, and the Social Sciences Citation Index (inception–March 2018) were searched for studies exploring HCPs’ views regarding management of late-life depression across all settings. Studies of older people’s views or depression management across all ages were excluded.ResultsIn total, 27 studies, were included; these predominantly focused on the views of GPs and primary and community care nurses. Many HCPs felt that late-life depression was mainly attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time in consultations and the complexity of needs in later life meant physical health was often prioritised over mental health, particularly in people with frailty. Good management of late-life depression appeared to depend more on the skills and interest of individual GPs and nurses than on any structured approach.ConclusionMental ill health needs to be a more-prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.

The Role of Community- and Home-Based Interventions in Late-Life Depression

2014 ◽  
Author(s):  
Laura N. Gitlin
Keyword(s):  
Older Adults ◽  
Depressive Disorders ◽  
Treatment Guidelines ◽  
Underserved Populations ◽  
Functional Decline ◽  
Late Life ◽  
Evidence Base ◽  
Late Life Depression ◽  
Home Based

Depressive disorders are highly prevalent and among the most debilitating conditions in late life. If untreated, depression has profound effects on quality of life and health; it also increases the risk for dementia, other comorbidities, functional decline, and mortality. Although primary care is the principal setting for the detection and treatment of depression, older adults and particularly, minorities do not always receive evidence-based treatment guidelines. Thus, new care models are urgently needed. This chapter considers the role of community- and home-based approaches to depression care, their theoretical underpinnings and advantages, and exemplary programs. Twenty-three rigorously tested community- and home-based interventions with positive depression outcomes are identified, suggesting a robust and growing evidence base. Community- and home-based approaches may overcome persistent mental health disparities by reaching underserved populations, minimizing stigma by normalizing depression detection and delivering treatments at home, and increase access to nonpharmacological approaches—such as psychosocial and behavioral approaches—f or older adults who are at risk for or have late-life depression.

Access to mental health care in depressed older patients

2013 ◽  
Vol 28 (S2) ◽  
pp. 44-44
Author(s):  
M. Tournier ◽  
F. Etchepare ◽  
T. Sanglier
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Older Patients ◽  
Treatment Duration ◽  
Antidepressant Treatment ◽  
High Rate ◽  
Late Life Depression ◽  
Historical Cohort ◽  
Younger Adults

Late-life depression presents clinical challenges, including more comorbidities, longer time to treatment response, longer treatment duration, and older age stigmatization. Such characteristics may increase the perception that depressed older adults are difficult to treat, but evidence suggests that benefits from treatment are similar to these observed in younger adult patients. Antidepressant treatment may confer even greater protection against suicide in older than younger adults. However, a retrospective matched cohort study carried on in American managed care population showed that depression goes commonly untreated in older people compared with younger adults. Despite a high rate of comorbidity that was associated with more frequent antidepressant dispensing, this age group was at higher risk of untreated illness either by antidepressant (25.6% vs. 33.8%) or by psychotherapy (13.0% vs. 34.4%) and of later treatment after depression diagnosis (51 vs. 14 days), showing a lower access to treatment. In this study, before 2006, older adults treated for depression received more frequently antidepressants at lower prescribed doses, had poorer adherence and higher non-persistence to treatment than younger adults. However, these differences disappeared or reversed after Medicare Part D implementation, which improved the refunding of drugs in the elderly population. Similarly, a historical cohort study showed, in the French universal health care system, that antidepressant treatment duration and adherence were better in the treated older patients than in the younger ones. This favourable finding may be partly attributed to the universal healthcare system in which all subjects are treated in the same way, regardless of age. However, the reasons for the more appropriate use of antidepressants in the older subjects remain to be elucidated.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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