How can you tell when someone is depressed?
Sometimes, it's obvious. You may notice that your friend has started eating too much (or not at all), or that he's barely sleeping (or sleeps through the entire day). Perhaps no one's seen her in a while -- she's declined every social invitation and doesn't seem to have any energy.
The signs are easy to miss when other factors are clouding your judgment. With older people, for example, symptoms of depression can be confused with medication side effects or other conditions. A son or daughter may deny his or her parent's depression due to feelings of guilt. Depression can be written off as a bout of grief, or, worst of all, as just part of aging.
Wrinkles are a sign of aging. Depression is not.
Unlike skin elasticity, mental well-being can be regained with treatment. Left untreated, depression in older people increases any pain they may be experiencing, lengthens recovery times and impacts their nutrition levels [source: Kurlowicz and Harvath]. In other words, it leaves them in such ill health that death rates increase, as well.
In addition to making death from illness or surgery more likely, depression can be more directly fatal. Of all age groups, older adults have the highest suicide rate [source: Scogin].
But suicide is not an inevitable endpoint to depression. One study of 354 depressed patients aged 61 or older showed that more than a third of those who committed suicide saw their doctor within the week they killed themselves [source: Scogin]. Surely, there is room for prevention -- and certainly for screening.
There are many tests available to screen for depression in late life, but one of the most widely used methods is the Geriatric Depression Scale (GDS), developed in the 1980s by Dr. Jerome Yesavage of Stanford along with his colleagues. The GDS may very well be the gold standard for evaluating the need for psychiatric assessment in older populations.
Results of the Geriatric Depression Scale Explained
The GDS relies on self-reporting. There are two iterations of the test, a long- and a short-form version. The short form is 15 questions, while the long version is twice that. The short version works well for people who are tired easily or suffering from dementia.
Unlike most depression screening tools, the GDS requires only yes or no answers. Questions are short and simple: Are you basically satisfied with your life? Do you feel that your life is empty? Do you feel full of energy? Questions are based on characteristics most often seen in late-life depression, with the exception of somatic, or physical, symptoms. Since so many older people have physical ailments, asking about somatic symptoms could skew results [source: Montorio and Izal].
You can find both versions of the GDS in English, with scoring, on Yesavage's Web site. Contributors have also posted the tool translated into languages from Haitian Creole to Welsh. There's even a free app for the GDS in the iTunes store and the Android marketplace.
A score greater than five on the short-form, or 10 on the long-form, indicates the possibility of at least mild depression. A psychiatric evaluation is the next step to assessing the severity of the person's depression so that treatment options can be discussed.
It's important to remember that there's no depression treatment that's just right for everyone. It can take a while to find the method that works.
The first line of treatment is usually an antidepressant, ideally combined with psychotherapy. It can be tricky to find the right drug for an older person, however, as many seniors are on other drugs that may interact badly with one another, and an older person's body processes antidepressants differently.
An option for people who are seriously depressed, those who can't take antidepressants or whose treatments haven't otherwise worked is electroconvulsive therapy (ECT). Despite the (erroneous) public perception of its brutal nature, a la "One Flew Over the Cuckoo's Nest," ECT is a very effective and helpful treatment for depression. The response rate in older patients is 90 percent; in older people with depression resistant to medication, it's 70 percent [source: Alexopoulos and Kelly]. (Remission rates are 70 percent and 50 percent, respectively.)
As the baby boomer generation ages, mental health in late life will undoubtedly become a larger public health concern. According to the Administration on Aging, people ages 65 and older will make up 19 percent of the U.S. population by 2030 [source: AOA]. That's a large chunk of the country that will need mental health services -- services that the nation's health care system has to be prepared to provide.
To learn more about depression and mental health, visit the links and resources on the next page.
- Administration on Aging. "Aging Statistics." Sept. 1, 2011. (Jan. 21, 2012) http://www.aoa.gov/aoaroot/aging_statistics/index.aspx
- Alexopoulos, George S. and Robert E. Kelly Jr. "Research advances in geriatric depression." World Psychiatry. Oct. 8, 2009. (Jan. 19, 2012) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755271/
- Kurlowicz, Lenore and Sherry A. Greenberg. "The Geriatric Depression Scale (GDS)." Hartford Institute for Geriatric Nursing. 2007. (Jan. 19, 2012) http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf
- Kurlowicz, Lenore and Theresa A. Harvath. "Nursing Standard of Practice Protocol: Depression." Hartford Institute for Geriatric Nursing. January 2008. (Jan. 19, 2012) http://consultgerirn.org/topics/depression/want_to_know_more
- Montorio, Ignacio and Maria Izal. "The Geriatric Depression Scale: A Review of Its Development and Utility." International Psychogeriatrics. 1996. (Jan. 19, 2012) http://www.public-health.uiowa.edu/icmha/outreach/documents/TheGeriatricDepressionScale.pdf
- Schmall, Vicki L. and Sally Bowman. "Depression in Later Life: Recognition and Treatment." A Pacific Northwest Extension Publication. July 2004. (Jan. 19, 2012) http://extension.oregonstate.edu/catalog/pdf/pnw/pnw347.pdf
- Scogin, Forrest. "Depression and Suicide in Older Adults Resource Guide." American Psychological Association. September 2009. (Jan. 19, 2012) http://www.apa.org/pi/aging/resources/guides/depression.aspx