Why Diagnosing Depression In Older Adults Can Be Difficult

Last Updated: May 2, 2019

Aging often comes with increased health issues, but it doesn’t have to include depression.
 
Dr.-Natalia-OrtizAnd yet many older Pennsylvanians over age 55 suffer from severe depression without knowing it, says Philadelphia psychiatrist and PAMED member Natalia Ortiz, MD.
 
“Sometimes patients say ‘oh, this is part of my thyroid disease.’ Or ‘it’s part of my heart disease,’ ” says Dr. Ortiz. “But depression is not part of normal aging. It’s a reversible condition that, if treated, will help the quality of life and help independence.”
 
Dr. Ortiz spoke with the Pennsylvania Medical Society’s “Building Healthy Communities” public health initiative to raise awareness and encourage primary care physicians to screen their geriatric patients.
 
Complicated by Other Conditions
 
Symptoms of depression in adults 55 and older tend to be the same as younger patients: feeling sad or guilty, losing interest in their favorite activities, changes in appetite, changes in sleep, concentration/memory problems, and fatigue. It is also associated with suicidal attempts and can be complicated with psychosis.  
 
But diagnosing depression in older populations tends to be clouded by other medical conditions, such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or, according to the National Institute on Aging, they may be taking medications with side effects that contribute to depression. 
 
Depression in the aging population can also present with somatic complaints. Some people might not recognize it since they think it is part of “normal aging.”
 
“If patients don’t get screened on time, they can suffer quietly,” Dr. Ortiz says. “One of the things that happens when you’re depressed is you don’t want to bother people. You don’t want to be a burden to people, so you keep everything to yourself.”
 
Importance of Screening
 
Physicians at the Pennsylvania Medical Society’s 2018 House of Delegates voted to support widespread implementation of evidence-based treatment programs for depression in older adults. In order to do that, Dr. Ortiz said screening needs to increase in primary care settings.
 
A 2018 study published in the Journal of the American Board of Family Medicine found that only 57.5 percent of adults ages 65-74 and 47.9 percent of adults over age 75 were assessed for depression by their health care provider.
 
Some of the questions in the geriatric screening tool can seem invasive (for example, “Do you feel pretty worthless the way you are now?”). Dr. Ortiz likens it to screening for diabetes or heart diseases.
 
“The most difficult part is how to have this conversation in a respectful way,” Dr. Ortiz says. “Sometimes, your patients look at you like you’re crazy. But we want to break the stigma and say ‘depression in the aging population is a high rate and I want to make sure you’re well taken care of.’ ”
 
Treatment Options
 
Once physicians identify depression and refer their patient to a psychiatrist or psychologist, there are a number of treatment options:
 
  • For minor depression, there’s psychotherapy, where patients talk with a psychiatrist or psychologist. Dr. Ortiz says patients discuss different stressors and gain a better understanding of the aging process.
  • If therapy alone isn’t effective or there are more severe symptoms, another option is antidepressant medication.
  • For the most severe cases, a final option is electroconvulsive therapy, which involves using a small electric current to stimulate the brain while under anesthesia.
Find resources on treating older patients with depression on PAMED's website, including a sample screening tool.

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