Depression
Carole K. H. Bartoo
Depression has a significant impact on older adults, yet there is little theory-based research on the most serious effect of late-life depression: suicide (Van Orden, 2016). According to the World Health Organization (2014), adults aged 70 and older have the highest rates of suicide deaths in most regions in the world. In the US, elder suicide risk among is second only to the risk of suicide in adolescents, and the use of firearms in suicide attempts is more common in older men than younger men (Kaplan & Geling, 1999). It is likely that physical decline and functional change are involved in depression in the older adult.
Definition
1.The definition of major depression is the same for older adults as younger, including but not limited to depressed mood, sadness, and sleep disturbances lasting more than 2 weeks. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for major depressive disorder lists the criteria for diagnosis.
Screening
An annual assessment is important in older adults who are already being treated for depression. Screening is a good idea on a periodic basis for all older adults, especially those who are experiencing physical or mental stressors:
a.Tools include the following:
i.The Patient Health Questionnaire (PHQ-9) is available at www.phqscreeners.com/sites/g/files/g10016261/f/201412/PHQ-9_English.pdf.
ii.The Geriatric Depression Scale, short form, is a 15-item questionnaire that can be quickly applied in the clinical setting (web.stanford.edu/yesavage/GDS.english.short.html).
iii.A quick test to determine risk for depression can be memorized and applied to determine if further testing is required. The GDS-5 asks yes/no questions:
•Are you basically satisfied with your life?
•Do you often get bored?
•Do you often feel helpless?
•Do you prefer to stay home rather than going out and doing new things?
•Do you feel pretty worthless the way you are now?
If score is 2 or greater, further evaluation is recommended (sagelink.ca/sites/default/files/clinical-resources/geriatric_depression_scale_5_item.pdf ).