Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Depression in older people has a prevalence of 5-10% over those aged over 65, but is frequently under-recognised.
It is associated with higher morbidity and poorer outcomes from physical illness.
Older people under-report symptoms of depression, and may attribute them to the effects of ageing.
Somatic symptoms are more common than in younger people with depression.
Physical ill health
Chronic illness, dementia, stroke, Parkinson’s, chronic pain
Social isolation, being a carer, bereavements
Prior history of depression
Substance misuse may be either a cause or consequence of depression
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
If the answer to either of these questions is positive, further assessment of mental state, functional abilities and social situation should be undertaken by a trained person.
Diagnosing depression in the presence of dementia :
This is a diagnostic challenge, and specialist referral is usually required.
Some symptoms of depression such as tiredness, weight loss and psychomotor retardation also occur in dementia.
A history of the symptoms from an informant may be helpful.
Risk of suicide in older people with depression :
Older adults with depression are at higher risk of completed suicide that younger people, so specific enquiry into suicidal thoughts should always be made. Risk factors for suicide in older people include:
Older age, male sex
History of attempts
Evidence of planning
Chronic painful illness or disability
Drug or alcohol use
Any co-existing physical health problems should be optimised. General advice should include good sleep hygiene, maintaining physical activity and limiting alcohol intake.
For mild or subthreshold symptoms, psychosocial interventions such as increasing social contact and physical exercise may be sufficient. Medication should not be offered as a first-line treatment but reserved for those who do not respond to initial measures.
When drug treatment is required, selective serotonin re-uptake inhibitor (SSRI) should be the first-line therapy. SSRIs may cause hyponatraemia, postural hypotension, and increase the risk of gastrointestinal bleeding.
Tricyclic antidepressants have anti-cholinergic side effects and should be avoided in older people.
Psychological therapies are effective in older people, and in combination with drug treatment is more effective than either therapy alone.
Those with moderate to severe symptoms are likely to require referral for specialist support.
People who have responded to medication should continue is for at least six months after recovery to reduce the risk of relapse.
NICE guidelines : CG90
The treatment and management of depression in adults (Nice CG90, 2009)
NICE guidelines : CG91
Depression in adults with a chronic physical health problem (Nice CG91, 2009)
Geriatric Depression Scale - 15
App for iPhone and iPad
Geriatric Depression Scale 2.0
App for android devices
This Read More page is an extension of Depression
Back To : Depression
Depression is one of 4 sub-domains of the
Back To : Psychological Assessment
The Psychological Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
Back To : Comprehensive Geriatric Assessment