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Depression and Anxiety in the Elderly

December 19, 2012

Currently, there are 35 million people over the age of 65 in the United States, and by 2050, this population will double to more than 70 million. Unfortunately, in addition to dementia and Alzheimer’s disease, behavioral health disorders such as depression and anxiety are not uncommon in older adults.  Here, Dr. Rajesh Tampi, Director of Behavioral Health for Masonicare and an expert in the field, discusses these disorders and explains how identifying and treating the symptoms can greatly improve a person’s quality of life – and his or her family’s as well.

 Clinical depression in the elderly is a widespread problem, but only about 10% of individuals receive treatment for their depression. There are a few reasons.  One is that symptoms of depression in the senior population can be displayed in a variety of ways, making it harder to diagnose, or the symptoms can be confused with illnesses and the affects of the array of medicines used to treat them.  As a result, early depression may be ignored or mistaken for other conditions common in the elderly. It is very important to address these symptoms, however, as they can lead to poor healthcare outcomes.

Anxiety disorders are the most common of all psychiatric disorders across the life span. Among seniors, clinically significant anxiety is seen in about one-fifth of the population. Phobias (irrational fears) are the most common of all anxiety disorders in older adults, followed by generalized anxiety disorder (excessive worry) and posttraumatic disorder (significant worry after a trauma). In later life, anxiety often occurs along with depression. A third of seniors have both clinically significant anxiety and depression.

Depression and anxiety are more common in older women. These two disorders also tend to be genetic, with certain families having a greater prevalence. Risk factors include social problems, psychological disorders, medical illnesses, and the use of substances such as alcohol, cannabis and cocaine. Higher rates of these disorders are seen in older adults who have suffered from personal losses, moved from their place of stay to a nursing home or hospital, and have limited financial or social support. Medical conditions, such as thyroid disease, heart attack or stroke, are known risk factors. The use of prescription drugs, such as those used to treat thyroid disease or cancer, can lead to depression, and asthma medications, for example, can cause significant anxiety in the elderly. 

If untreated in older individuals, depression and anxiety can have serious consequences. Evidence indicates that without appropriate treatment, older adults with these disorders suffer from significant physical and cognitive decline. Untreated depression and anxiety increases the rate of suicide in older adults. When untreated, these conditions can be extremely costly to the individual and society in terms of loss of productivity, overall cost of care, and the loss of life from suicides.

Most older adults who want treatment for their depression and anxiety tend to seek it from their primary care providers, not from a behavioral health specialist, and only one half are correctly diagnosed. Only one third of the elderly with depression or anxiety are evaluated by a behavioral health specialist. Common screening tools, such as the SF-36 health survey, can help identify symptoms of depression and anxiety and is recommended for use during routine visits to the primary care physician.

Once the symptoms of depression or anxiety have been identified, clinicians can use specific rating scales as diagnostic tools and have several options available to treat these conditions. Psychotherapies (also known as talk therapies) have been effective, and antidepressants can be useful, either alone or in combination with psychotherapy.  When symptoms are severe, combinations of medications with or without psychotherapy may be needed to treat the symptoms. Electroconvulsive Therapy (also known as shock therapy) is another treatment option, and evidence indicates it can be as effective as it is in younger adults.  More than three quarters of seniors with depression and anxiety show significant improvement with treatment. Because these are recurring disorders, however, regular follow-up visits with a healthcare provider are essential to properly monitor progress.

Depression and anxiety are common conditions among older adults, and if left untreated, they can cause significant problems. Early diagnosis and treatment of these conditions will reduce unnecessary suffering – for the individual and for his or her family as well.

If you or a loved one is having prolonged feelings of stress, grief or sadness, have trouble sleeping, or have lost interest in life’s daily pleasures, help is available through Masonicare Behavioral Health.  The practice is conveniently located in theMedicalOfficeBuildingon the Masonicare campus inWallingford.  For additional information or to schedule a confidential evaluation, please call 203-265-5720.