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Mental Health in the Elderly Population: Late-life Depression

Kim E. Lesniak

School of Nursing, James Madison University

NSG325: Concepts of Aging

Dr. Nena Powell

November 14, 2021

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Abstract

This paper discusses the prevalence of late life depression in the elderly. Suggested reasons for

the depression and treatments that have shown promising results are explored including

studies on medications, exercise, social networks, and patient participation in the choice of

treatments. Also discussed is the important role geriatric nurses have in the accurate

assessment, early diagnoses, appropriate treatment choice, and follow-up of these patients.

Keywords: Depression, late-life depression, elderly, geriatric nurse, treatment, diagnosis

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Mental Health in the Elderly: Late-life Depression

As people get older, their ability to deal with life’s stresses and crises is usually

enhanced, mainly due to their experiences coping, managing, and problem solving over their

lifetime. Eliopoulos states, “Mental health indicates a capacity to cope effectively with and

mange life’s stresses in an effort to achieve a state of emotional homeostasis” (2018, p. 411).

Studies have shown that, while many elderly people have established a coping mechanism

throughout their lives, there is a large percentage of the population that reach their golden years

while simultaneously dealing with mental health issues. Aging is not a simple or uniform

process, and each individual has a diverse set of circumstances that may affect their mental

health later in life, including the development of late life depression. Nurses can play an

important role in detecting symptoms of depression that may be underestimated, or completely

overlooked, in this population. In addition to helping to identify this issue, nurses can play a

vital role, within an interdisciplinary team, in the identification and implementation of different

treatment options that may be beneficial for individual patients.

The elderly population in the United States is the largest that it has ever been. Those over

the age of 65 represent more than 13% of the population. This generation has experienced some

of life’s worst stressors including fighting and surviving wars, immigrating to a new country,

losing loved ones to illnesses and epidemics, and surviving the Great Depression (Eliopoulos,

2018). These experiences have resulted in a unique strength; however, many of the elderly carry

with them mental health disorders that may have their roots early in life. This, in combination

with other losses and challenges of later life, may exceed the physical, emotional, and social

resources of some and contribute to possible mental illness (Eliopoulos, 2018).

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Despite being one of the most underdiagnosed disorders in this population, late life

depression is the leading mental health diagnosis doctors treat in the elderly, with a prevalence of

ten to twenty percent, (Avasthi and Grover, 2018). There are many factors that can contribute to

late life depression including, but not limited to, significant changes or losses of traditional roles,

the reality of retirement, realization of reduced lifespan, reduced income that may affect meeting

basic needs, living situations and conditions, loss of loved ones and friends, chronic illnesses and

comorbidities, decreased mobility, sedentary lifestyles and increased loneliness. This disorder is

often underdiagnosed because of the accepted myth that depression is just part of the aging

process and is considered a “normal” pathological symptom of old age. Depression in the

elderly may differ from other age groups in that it may present itself with fewer emotional

symptoms but with increased cognitive effects, and it may often be misdiagnosed as a type of

dementia (Luck-Sikorski et al, 2017).

Misdiagnosis and underdiagnosis of depression is the elderly can contribute to

difficulties in activities of daily living, cognitive impairments, physical comorbidities and a

higher risk of suicide (Avasthi and Grover, 2018). In order to properly diagnosis mental illness

and begin treatment which may be beneficial to the patient’s quality of life, it is important to

assess for depression during routine health visits. The nurse can begin with a general

observation of the patient as soon as she or he enters the room. This includes assessing level of

consciousness, facial expression, posture and movements. The nurse should ask certain

questions in the interview portion of the exam and utilize the many tools available for cognitive

testing and mental assessment (Eliopoulos, 2018). Nurses should also recognize that the elderly

patient may be experiencing normal reactions to a life experience and not hastily label it as a
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mental health disorder. A thorough assessment can help distinguish the difference between the

two.

Once a patient has been diagnosed with late life depression, and the cause of that

depression has possibly been determined, a treatment plan may be discussed with the patient and

their families. The best practice is an individualized treatment plan that may include a

combination of any of the following: prescribed medications, psychotherapy, electroconvulsive

therapy, guided imagery, light therapy, acupuncture, acupressure, and herbs. Researchers

continue to attempt to find reasons and treatments for late life depression. A study showed that

depression worsens existing physical illness and increases risk of dementia. This study

suggested that, for some patients, a combination of physical activity and antidepressant

medications showed a greater reduction in the patient’s depressive symptoms than medication

alone (Neviani et al, 2017). The exercise with the most noticeable effect was aerobic and

progressive in nature. The study subjects showed significant reduction of their depression related

to cognitive and physical disabilities. These subjects had improvements in both executive and

working memory and also engaged in more physical activities independently. Another study

showed that, if treatment for depression is given in a manner consistent with the preference of

the patient, the chances of reducing the patient’s depressive symptoms is increased. The authors,

Luck-Sikorski et al, explained that the treatment options most preferred included medication,

psychotherapy, talking to friends and family, and exercise (2017). Many times, patients with a

depressive disorder find it difficult to make decisions, including those regarding their own

treatment. Therefore, participation and input from family members, friends and trusted advisors

chosen by the patient can be beneficial as the patient is going through the decision making

process. When given information about treatments that may be helpful to their condition, along
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with the autonomy to make the decision as to which ones they prefer, patients tend to be more

compliant with these treatments (Luck-Sikorski et al, 2017). Researchers have also studied

elderly patients experiencing depression and what role their social networks may have on their

perception of loneliness and the effect it has on their depression. It was found that those with

larger social networks had fewer depressive symptoms. In that study, other factors, such as

gender and marital status, were taken into consideration (Domenech-Abella et al, 2017).

Geriatric nurses have a very important role in the treatment of these patients. In addition

to the possible identification of symptoms, geriatric nurses can provide explanations of different

treatment options, and combinations of those options, which may be offered by mental health

providers. These nurses are a helpful resource for patients and their families, providing

information on community-based options and resources. These may include exercise facilities

for the elderly, support groups and community-based social opportunities for people of a similar

age or situation. Nurses are often the liaison and communication conduit between physicians and

patients. Most importantly, nurses are often given the opportunity to listen to and observe their

patients during follow up medical appointments. This gives them a unique opportunity to assess

what interventions are working for these patients and what are not. It also allows a nurse to ask

questions of the patient and to observe their behaviors and body language more closely.

Information gleaned during these one-to-one interactions can then be shared with the team of

healthcare providers in order to assess the effectiveness of the current treatment plan, the

patient’s compliance with that plan and what, if any, changes could be made for the benefit of

the patient.

Late life depression is not part of the normal progression of aging. There are many

reasons that this disorder inflicts so many older people. Depression needs to be identified and
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treated as soon as possible after the onset of symptoms. Symptoms aren’t always immediately

apparent to the patient, his or her family, or the health team working with this person. By

performing a thorough assessment on an elderly patient using many different methods and tools

available, a geriatric nurse can help the patient, family, and team of providers recognize a

problem in the beginning stages so that treatment options may be provided. This will help

minimize the impact of this psychiatric problem and give the patient a greater quality of life.

The role of a nurse often makes him or her uniquely qualified to help identify an issue and help

navigate through treatment while providing information, guidance, education and follow-up with

the patient and family. It is important that geriatric nurses stay knowledgeable of current

evidence-based treatments for this population by reading nursing journals and studies available.

This will help facilitate the best care for the patient within the continuum of treatment that is so

often necessary for older patients. As patients approach the remaining years of their lives, quality

of life is often at a premium. We, as nurses, owe it to them to give them every chance we can to

be as healthy and happy as possible.

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References

Avasthi, A., and Grover, S. (2018). Clinical practice guidelines for management of depression in

elderly. Indian Journal of Psychiatry, 60(3), S341-S362.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840909/

Domenech-Abella, J., Lara, E., Rubio-Valera, M., Olaya, B., Monet, M., Rico-Uribe, L., Ayuso-

Mateos, J., Mundo, J., Haro, J. (2017). Loneliness and depression in the elderly: The role

of social network. Social Psychiatry and Psychiatric Epidemiology 52, 381-390.

https://pubmed.ncbi.nlm.nih.gov/28154893/

Eliopoulos, C. (2018). Gerontological nursing (9th ed.). Wolters Kluwer.

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

Weyerer, S., Werle, J., Wiese, B., Moor, L., Bock, J., Konig, H., Riedel-Heller, S.,

(2017). Treatment preferences for depression in the elderly. International

Psychogeriatrics Association, 29(3), 389-398.

https://pubmed.ncbi.nlm.nih.gov/27890036/

Neviani, F., Murri, M., Mussi, C., Triolo, F., Toni, G., Simoncini, E., Menchetti, M., Ferrari, S.,

Cersini, G., Cremonini, A., Berolotti, M., Neri, G., Squatrito, S., Amore, M.,

Zanetidou, S., Neri, M., (2017). Physical exercise for late life depression: Effects on

congnition and disability. International Psychogeriatric Association, 29(7), 1107-1112.

https://pubmed.ncbi.nlm.nih.gov/28412979/