Geriatric Depression and the Medically Ill

Researchers in the field of geriatric depression, have found that the elderly have very high levels of medical and psychiatric comorbidity (coexisting symptoms), and seem to recognize a correlation between the level of acute medical and psychiatric symptoms. Shinkawa, Yamaya, Ohrui, Arai and Sasaki (2002) stated that “Older persons with a medical condition tended to show higher depressive symptoms compared to those free from disease. The frequency of depressive disorders among stroke survivors is significantly higher than the non-stroke subjects aged 65 years and over” (p.215). A review of the literature by Fischer, Wei, Rolnick, Jackson, Rush, Garrard, Nitz and Luepke (2002) concluded that about 20% to 25% geriatric primary care patients have clinically significant symptoms of depression. The prevalence rate for geriatric depression in the United Kingdom was identified in data from the National Service Framework for Older People (Cullum, Nandhra, Darley & Todd, 2003). It was concluded that the rate for geriatric depression among people over the age of 65 on medical inpatient units was around 25%, and also found that these patients had higher rates of mortality and longer durations of stay in the hospital, and that they were more likely to remain depressed.

Geriatric Depression in Long Term Care Facilities:

Higher levels of comorbid medical symptoms and geriatric depression also seem to extend into long-term care facilities. The National Institute of Health (1991) reported over a decade ago that approximately 15%-25% of nursing home and extended care clinic residents had symptoms of depression. More recently, Soon and Levine (2002) found the prevalence of major depression among long-term care patients to be between 12%-25%, with lower levels of minor depression present in an additional 18%-30% of long-term residents. Teresi et al. (2001) estimated a prevalence rate for probable and/or definite major depressive disorder to be 14.4% and for minor depression to be 16.8%. They also concluded that the prevalence of significant depressive symptoms among geriatrics in nursing homes (including the category of possible depression) to be 44.2%. Based upon estimates of recognized geriatric depression by nursing home staff, corresponding estimates of any depression were 19.7% for social workers, 29% for nurses and 32.1% for nurse aides. Cohen, Hyland and Kimhy (2003) estimated the prevalence of geriatric depression among nursing home residents to range from 6% to 24% for major depression and 30% to 50% for patients with minor depression. Similarly, Lasser, Siegel, Duckoff and Sunderland (1998) found that rates of geriatric depression in long-term care facilities to range from 20% to 50%, and concluded in stating that ”When the institutionalized elderly are included in epidemiological samples, the 1-year incidence of major depression in the elderly increases to over 50% (p.18).

By Paul Susic MA Licensed Psychologist Ph.D. Candidate