Developmental Resources And Depression In The Elderly

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A longitudinal study was carried out with 28 clinically depressed and 28 mentally healthy older adults, matched on age, sex, and years of education. Developmental resources and depression were measured on three occasions using the Developmental Resources of Later Adulthood and the Center for Epidemiological Studies Depression scales. A 2 X (3) repeated measures factorial analysis of variance indicated that the depressed group had significantly lower developmental scores across all three time periods. Results of cross-lagged panel correlation analyses suggested that the direction of the relationship between developmental resources and depressive symptoms differed markedly between the two groups. The mentally healthy group showed a significant causal tendency for developmental resources to influence level of depression; a reverse trend was noted in the depressed group.

Depression is one of the most prevalent mentally ill health problems facing European citizens today [5], and it is considered one of the most frequent mental disorders in the elderly population. Moreover, depression is particularly common among these living in long-term care facilities [6]. Reported rates of major depression in older adults, depending on the location and characteristics of the sample, have ranged from 1% to 42% [7]. In general, the prevalence of late-life depression has been found to be higher in those patients with more medical illness. Specifically, rates of depression in NHs are three to four times higher than those in community-dwelling older adults [8]. Also, elderly who lack social/emotional support tends to be more depressed [9]. A review that included 36 studies from various countries reported a prevalence rate for major depression ranging from 6% to 26% and for minor depression from 11% to 50%. The prevalence rate of depressive symptoms ranged from 36% to 49% [10].

Clinical determinants of suicidal ideation and behavior in geriatric depressionAlexopoulos, G., Bruce, M. L., Hull, J., Sirey, J., & Kakuma, T. (1999). Archives of General Psychiatry, 56(11), 1048-1053.Most older adults who commit suicide see their physicians within a few months of their death and more than a third within the week of their suicide. Therefore, reliable assessment of suicide risk is critical; protective measures may avert suicide. The principal aim of this study was to determine which clinical characteristics could be used to assess suicidality in 354 61-93 yr old patients with depression who were studied for a mean of 1.8 yrs. Results demonstrate that elderly patients with severe depression, poor social support, and history of serious suicide attempts have high suicide potential.

The \"vascular depression\" hypothesisAlexopoulos, G.S., Meyers, Barnett S., Young, R.C., Campbell, S., Silbersweig, D., & Charlson, M. (1997). Archives of General Psychiatry, 54(10), 915-922.Proposes the \"vascular depression hypothesis\" which suggests that cerebrovascular disease can predispose, precipitate, or perpetuate a depressive syndrome in many elderly patients with underlying neurologic brain disorders. This article reviews findings relevant to the vascular depression hypothesis and discusses their clinical and heuristic implications. The vascular depression hypothesis is supported by the high frequency of depression in patients with hypertension, diabetes, coronary artery disease, and stroke; the frequency occurrence of silent stroke and white matter hyperintensities in geriatric depression; and the association of depression with lesions impairing the integrity or regulation of the circuits linking basal ganglia and prefrontal cortex.

Depression in Older AdultsFiske, A., Wetherell, J. L., & Gatz, M. (2009). Annual Review of Clinical Psychology, 5, 363-389.Depression is less prevalent among older adults than among younger adults, but it can have serious consequences. More than half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and are more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are depressed younger adults. Risk factors leading to the development of late-life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late-life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but are too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

Hopelessness as a measure of suicidal intent in the depressed elderlyHill R.D. Gallagher D., Thompson H.W., & Ishida T. (1998). Psychology and Aging, 3(3), 230-232.Suicidal ideation in the elderly has been related to depression, changes in health and anticipation of a limited future. The present study examined the Hopelessness Scale (HS) and its relation to these factors in a depressed geriatric population. A total of 120 elderly outpatients, who had applied to receive psychotherapy for depression, completed the HS, Beck Depression Inventory (BDI), health ratings, and the Schedule for Affective Disorder and Schizophrenia (SADS) at intake. The HS was found to be internally consistent, and a principal component analysis revealed three distinct factors that were related to hope, feelings of giving up, and future planning. The HS, BDI, and health ratings were predictive of suicidal ideation as measured by specific items in the SADS. The relationship between suicidal ideation hopelessness, depression, and health perceptions for the depressed aged are discussed.

Assessment and psychological treatment of depression in older adults with terminal or life-threatening illnessKing. D. A., Heisel, M. J., & Lyness, J. M. (2005). Clinical Psychology: Science and Practice, 12(3), 339-353.Depression decreases the quality of life and hinders efforts to palliate symptoms of adults with terminal or life-threatening illness. Nevertheless, depression often may go undetected and untreated in palliative care and hospice settings due to a number of factors, including the overlap of depressive symptoms with those of serious medical illness and concern that frail elderly patients cannot tolerate psychotherapy or antidepressant treatment. In this paper we review the available research regarding assessment and treatment of depression in older adults with terminal or life-threatening illness, focusing on patients who are seen in palliative care, cancer treatment, or hospice settings. Although the prevalence of depression is relatively high in these settings in mixed-age adult samples, studies focused exclusively on older adults are rare and there appear to be no randomized controlled trials of psychotherapy conducted to date that specifically address their needs. There are, however, promising psychological approaches featured in case reports and pilot studies that are consistent with empirically supported therapies for the general treatment of depression in older adults. Based on these preliminary findings and reports, we offer tentative recommendations for the assessment and treatment of depression in terminally ill older adults. We conclude that controlled research on psychotherapy for late-life depression is both feasible and urgently needed in palliative care, cancer care, and hospice settings.

Treatment of depression and anxiety in the agedNiederehe, G., & Schneider, L. S. (1998). In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 270-287). New York: Oxford Press.Antidepressant medications, ECT, and selected psychosocial interventions have all been shown to be efficacious treatment approaches for depression in the elderly. Most studies have used drug and psychotherapy protocols specifically tailored for use with older patients. This chapter evaluates the efficacy evidence for these treatments, emphasizing randomized clinical trials with elderly samples in which depression or anxiety have been objectively characterized. 153554b96e

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