Why is the diagnosis of depression in the elderly often overlooked?

Geriatric Depression and the Body-Mind Connection

Physical disability fosters depression in the elderly.
Physical disability fosters depression in the elderly.

­The primary reason that depression is often overlooked in geriatric patients is that caregivers and physicians neglect the innate connection between the body and the mind. We associate old age with body aches and pains. Arthritis stiffens joints. Teeth wear down. Eyesight weakens. At the same time, the mind suffers from the loss of mobility and independence.

Generally speaking, physical disability is considered an independent risk factor for depression [source: Lenze et al]. As many as 40 percent of stroke victims, for example, will become depressed [source: Shulman]. Parkinson's disease, Alzheimer's, heart disease and other medical conditions have also been strongly linked to geriatric depression [source: Geriatric Mental Health Foundation]. Beyond that, the medications used to treat late onset ailments can also alter brain chemistry and trigger depression.

When we get older, our brains undergo various changes, including a decreased amount of neurotransmitters, smaller cerebral cortex and damaged blood vessels [source: Harvard Medical Letter]. When brain function diminishes, it can lead to a depressive state, which physicians may treat as a cognitive impairment or dementia [source: Chapman and Perry].

For geriatric patients, this interaction between physical and mental health can obscure depression, and only one in six cases of geriatric depression receives adequate attention [source: Rimer]. Rather than directly expressing changes in their mood, the elderly are more likely to report bodily ailments. As a result, doctors may attribute a noticeable increase in irritability or trouble sleeping to symptoms of a physical illness instead of depression. In that case, the patient may receive treatment for the physical problems exclusively.

Failing to treat depression can prolong and intensify medical issues. Depression can slow the body's healing process, worsen symptoms and even cause new illnesses. On the flip side, studies have found that treating depression can improve one's mental and physical health and lessen the chances of injury [source: Pennix et al]. And as long as an elderly person's mentality remains positive, he or she can benefit physically. For instance, people can continue building muscle strength into their 90s [source: Neighmond].

But doctors aren't the only ones who shoulder the blame for underdiagnosed geriatric depression. It can take a community of caregivers, healthcare providers and the patients themselves to recognize and treat the mental illness.