What is Depression?
• Depression is a highly prevalent but under recognized and undertreated mental health problem in community- dwelling, medically ill, and institutionalized older adults
• Depression is defined as a syndrome comprised of a constellation of affective, cognitive, and somatic or physiological manifestations.
– Minor
– Major

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) currently lists specific criteria that are necessary for a diagnosis of a major depressive disorder, the most severe form of depression, and that are frequently used as the standard by which elderly patients' depressive symptoms are counted in clinical settings.

Etiology
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Genetic/Hereditary
Biological
Psychosocial
Social
Medication Induced

Incidence and Demographics
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Depression is a highly prevalent but underrecognized and undertreated mental health problem in conmunity-dwelling, medically ill, and institutionalized older adults. •

Some estimates of major depression in older people living in the community range from less than 1% to about 5% but rise to 13.5% in those who require home healthcare and to 11.5% in older hospital patients.

INCIDENCE AMONG
OLDER ADULTS

• Minor depression is common
– 15% of older persons overall
– 50% long-term care
– Causes  use of health services, excess disability, poor health outcomes, including  mortality

Slide 4

• Major depression is not common
– 1%–2% of physically healthy community dwellers
– 12-16% in long-term care
– Elders less likely to recognize or endorse depressed mood

THE STATE OF MICHIGAN
Current Depression
Age 50: 8.6 %
50-64 : 10.3%
65+ : 5.7%

DSM-IV DIAGNOSTIC CRITERIA
FOR MAJOR DEPRESSION
*5 of the 9 symptoms must be present

• Gateway symptoms (must have 1)
• Depressed mood
• Loss of interest or pleasure (anhedonia)

• Other symptoms
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Appetite change or weight loss
Insomnia or hypersomnia
Psychomotor agitation or retardation
Loss of energy
Feelings of worthlessness or guilt
Difficulty concentrating, making decisions
Recurrent thoughts of suicide or death
Slide 7

Age related differences
• Older adults are less likely to endorse cognitive-affective symptoms of depression, including dysphoria and worthlessness/guilt, than are younger adults (Gallo et al., 1994).
• Sleep disturbance, fatigue, psychomotor