Depressive illness in people over 65

Depression is common in the elderly. However, the first onset of depressive illness becomes less common after the age of 60 and rare after the age of 80.

The incidence of suicide increases with age and suicide in the elderly is usually associated with depressive illness.

Clinical features are similar to those in younger people, but some symptoms are more prominent in the elderly and these include:

Retardation and agitation,

Cognitive impairment,

Delusions (False beliefs that are unshakeable) concerning poverty and physical illness. Occasionally there are nihilistic delusion such as the belief that the body is empty, non existent or not functioning.

Hallucinations may be accusatory or obscene.

Depressive symptoms may not be conspicuous and the person may present with hypochondriasis, anxiety or confusion.

A small proportion may present with pseudodementia i.e. they have difficulty with concentrating and remembering but formal testing of memory demonstrates no significant deficit.

The prognosis for depressive illness in the elderly is poorer than that for younger people. About 85 percent display considerable improvement within a few months. The other 15 percent do not recover completely.

Of the 85 percent that initially recover:

One third remain completely well,

One third have further depressive episodes with complete remission between episodes,

One third become chronically disabled by depression.

Poor outcome is associated with:

Onset over the age of 70,

Long duration of illness,

Associated physical illness,

Poor recovery from previous episodes,

Associated organic brain pathology,

Poor compliance with treatment,

Serious coincidental life events,

The principles of treatment are the same as that for younger adults. Certain modifications are required in the elderly, for example, physical disorders should be effectively treated; ECT is more frequently used and is an effective treatment of severe depressive illness in the elderly; Antidepressant medication dose should be specifically tailored and life long treatment should be considered following the first episode of depressive illness.