Depression in the Elderly
Depression affects millions of Americans every year, in all age groups, in both genders; there are a variety of predisposed factors for depression. Depression appears to run in some families, so it may have a genetic basis, but that genetic basis is not well understood, nor is the base for those cases of depression that have no prior history of depressive disorders. Although depression can occur at any age, with a variety of pre-existing factors for depression, this condition is most prevalent among older adults, and it can have devastating consequences. Depression affects functional status, the quality of life elderly people may enjoy, and it affects mortality. Depression in the elderly increases health care costs and has serious consequences for family caregivers. Although there are treatments available, some of which work, the fact remains that depression in the elderly often goes undiagnosed; these people are either untreated, or if they see a doctor, sometimes undertreated (Ell, 2006). This paper will explore the findings of several experts in the field, as well as indicators for elderly depression based on a personal assessment of an elderly client. Discussion of Findings
Miller (2012) discusses impaired effective functions in those elderly who displayed depressive symptoms. She begins by stating that there is no single theory concerning depression in older adults, but then points to the theories which most likely describe what occurs in the etiology of depression in older adults. First, she discusses psychosocial theories which focus on the impact of loss as a cause of depression in older adults; these include the realization that one is older, the loss of social roles, and the decrease in earning power, all three important if one has identified strongly with a certain socioeconomic status. Psychosocial theories also embrace such ideas as childhood poverty and perhaps childhood trauma, especially if the family was in many ways dysfunctional. Additional psychosocial explanations may include stressful life events that are of recent origin, a social network that is inadequate to the needs of the depressed patient (no spouse or partner, few friends, or a small extended family), social interaction that has become diminished, and inability to integrate into social networks, and, of course, any combination of these explanations. Another theory that may be at work with depression in the elderly is known as a learned helplessness theory. This may result from a diminished sense of cognitive ability, a lack of drive to care for oneself, a loss of self-esteem, and an impaired affective-somatic perception of the self. These symptoms combined with the above can result in a severely diminished capacity for self-esteem, and a very bleak outlook for the future (Miller, 2012). The Cognitive Triad Theory (Miller, 2012) suggests that late life depression is a result of people evaluating themselves with regard to their self-image, their personal experiences or the environment in which they are currently living, and their personal future. Depressed adults, in particular, believe that these three areas are lacking something that is necessary for their personal happiness. Then, of course, there are theories about depression in older adults that are a result of either biological causes or some combination of genetic involvement. A longitudinal study with 110 dementia free older adults (Dotson, Davatsikos, Kraut, and Resnick, 2009, as reported in Miller, 2012) found that, over time, depressive symptoms in these older adults were associated with a reduction in brain volume in several different areas (NIH Senior Health, 2011). Also, in those adults who develop depression, there were unique patterns of glucose metabolism. Blazer (2002, as reported by Miller, 2012) reported that the risk for developing depressive symptoms increases with age. According to Miller (2012, p. 289),...
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