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Mental Health and Depression in the Older Adult

Shelby L. Bowling

School of Nursing, James Madison University

NSG 325: Concepts of Aging

Prof. Janelle Garman

November 12, 2022

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Abstract

The following is a literature review that aimed to uncover the impact of aging on the

mental health of the elderly, particularly depression in the elderly. Numerous sources were

referenced, including gerontological textbooks, psychological and comprehensive healthcare

databases, and healthcare provider reference websites. The search was limited to sources

within the last 5 years. Though numerous sources were referenced, a final four were utilized

for the review. It was discovered that while there are no specific age-related changes that

impact normal mental health, there are several cerebral changes that may lead to increased

depression in the elderly. It was discovered that depression is highly prevalent in the elderly,

though diagnosis is difficult due to symptomology. Recommended treatment focuses on talk

therapy, psychosocial support and medication. More research is required to confirm the age-

related changes that lead to depression and continued treatment.

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Mental Health and Depression in the Older Adult

Although aging does not have a direct impact on mental health, the aging population

encounters numerous risk factors that may contribute to poor mental health and depression, a

common ailment in the elderly. Depression is often misdiagnosed or poorly managed in the

elderly due to a multitude of reasons. Recommended management focuses on psychotherapy,

psychosocial support, and pharmacotherapy.

How Aging Impacts Mental Health

Changes in mental health or cognitive function are not a normal part of the aging process.

Mental health is the ability of a person to cope with diversity and maintain a state of emotional

well-being. Resilience is often related to one’s ability to cope with life’s stressors, and older

adults typically face greater and more frequent adversity that challenges this resilience as

compared to their younger counterparts. This adversity may include the death of loved ones,

social isolation, illness, retirement, increased vulnerability, awareness of one’s own mortality,

and more. Older adults have higher rates of depression than the younger population, and

frequently encounter paranoia and substance abuse (Eliopoulos, 2018).

Increased Susceptibility of Depression in the Elderly

The prevalence of depression as well as the severity of depressive symptoms increases

with age due to a plethora of risk factors (Eliopoulos, 2018). As discussed, prior, the elderly are

at increased risk for depression related to the higher incidence of challenges to their mental

health later in life. About 30% of the elderly living in nursing homes have depression, an

additional 25% of older adults in nursing homes have symptoms of depression, and roughly 25%

of older adults living in the community have depression (Eliopoulos, 2018). Depression in the

older adult may be lingering from a diagnosis when the patient was younger or may present itself
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later in life (Eliopoulos, 2018). Additionally, older adults are more likely to take daily

medications which may have side effects of depressive symptoms (Eliopoulos, 2018). Other risk

factors for depression in the elderly include uncontrolled pain, female gender, lower

socioeconomic status, sleep disturbance, cognitive impairment, nursing home residence, as well

as medical and psychiatric comorbidity (Espinoza & Unutzer, 2022). Patients with a history of

myocardial infarction and stroke are particularly at increased risk for depression.

The Aging Process Leading to Depression

There are several age-related and pathological cerebral changes that scientists believe

may contribute to depression in the elderly. Research suggests that age-related or disease-related

damage to certain cortical pathways is linked to depression later in life. cerebrovascular disease

may be related to the presence of depression in the elderly. Additionally, it is thought that

cerebrovascular disease may also increase the risk of depression in the elderly. This may include

cerebral atrophy, the presence of white matter, certain ischemia in the brain, and decreased

ventricular volume. It is thought that heart attacks and strokes may lead to “vascular depression”

related to cerebral ischemia. In fact, patients with a history of stroke and myocardial infarction

are 10% more likely to have depression (Espinoza & Unutzer, 2022).

Clinical Presentation of Late-Life Depression

There are extensive symptoms of depression in the elderly, however, these symptoms

often blur with other comorbidities. These symptoms may include fatigue, sleep disturbance,

changes in appetite, agitation, restlessness, sadness, frustration, feelings of hopelessness, anxiety,

functional decline, and poor hygiene (Albougami et al., 2021). Other symptoms include self-

deprecation, guilt, feeling as if they are a burden, constipation, weight loss, somatic symptoms

such as headache and indigestion, as well as a cognitive impairment that is also known as
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pseudodementia (Eliopoulos, 2018). Depressive episodes tend to last longer in adults than in

younger people (Eliopoulos, 2018).

Treatment of Depression in the Older Adult

The recommended treatment of depression in the elderly includes psychosocial support,

medication, and talk therapy. Treatment is complicated by numerous factors including

knowledge deficiency, misdiagnosis, stigma, and more (Albougami et al., 2021). According to

UpToDate, psychotherapy is the first-line treatment for late-life depression (2022). Albougami et

al. report that social intervention and talk therapy also aid in alleviating depressive symptoms

(2021). Patients report that feeling like they belong, and interconnectedness improve symptoms

(Espinoza & Unutzer, 2022). Pharmacotherapy is also common. Roughly 40% of the depressed

elderly are treated with antidepressants. Common medications include SSRIs and SNRIs. SNRIs

are the preferred medication for those with comorbid conditions. Atypical antidepressants as well

as tricyclic antidepressants are less commonly used (Espinoza & Unutzer, 2022). Other

treatments for depression that showed some efficacy included music therapy and reminiscence

therapy (Albougami et al., 2021). Older adults with depression reported a preference for

psychotherapy, medication, and exercise to treat their depression (Luck-Sikorski et al., 2017).

Luck-Sikorski et al. suggest an increase in psychotherapy in older adults will occur in the coming

years due to increased demand (2017). Challenges in treatment include patient hesitancy to

obtain treatment, healthcare personnel’s inadequate knowledge of the presentation of depression

in the elderly, and similar symptomology to other geriatric ailments.

Conclusion

Although there are no expected age-related changes to mental health, the elderly are at a

significantly increased risk of depression related to physical, environmental, and psychosocial

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factors. Though there remains room for improvement in diagnosis and healthcare education;

psychotherapy, medications, and psychosocial support can assist older adults in navigating

depression in later life.

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References

Albougami, A. S. B., Almazan, J. U., Stitt, N., Cruz, J. P., Colet, P. C., & Adolfo, C. S. (2021).

Challenges of nurses and care management of depressed older adults: A narrative

literature review. Scandinavian Journal of Caring Sciences, 35(3), 710–721.

https://doi.org/10.1111/scs.12908

Eliopoulos, C. (2022). Gerontological nursing (9th ed.). Wolters Kluwer.

Espinoza, R. T., & Unutzer, J. (2022, September 14). Diagnosis and management of late-life

unipolar depression. UpToDate. Retrieved November 12, 2022, from

https://www.uptodate.com/contents/diagnosis-and-management-of-late-life-unipolar-

depression?

search=depression+treatment+adult&source=search_result&selectedTitle=5~150&usage

_type=default&display_rank=5

Luck-Sikorski, C., Stein, J., Heilmann, K., Maier, W., Kaduszkiewicz, H., Scherer, M., . . .

Riedel-Heller, S. (2017). Treatment preferences for depression in the

elderly. International Psychogeriatrics, 29(3), 389-398.

doi:10.1017/S1041610216001885