"Depression" in Old People

Depression in the elderly is the most frequent psychiatric pathology in this age group, being a relevant source of disability, significant deterioration of the quality of life, increasing morbidity and mortality, as well as health resources. All these consequences in a population with a short life expectancy, constitute an important public health problem. The form of presentation in the elderly differs from the adult, without taking into account the diagnostic classifications (DSM V, ICD 10), appearing in the form of various somatizations, cognitive disorders, social withdrawal, accentuating previous personality disorders.

All this causes that in epidemiological studies of prevalence the rates of major depression are lower in the elderly (2% in the elderly vs 12% in adults), however minor depression, dysthymia and depressive symptoms increase with age (rates of minor depression of 10% vs 4% adults). In the elderly who frequently have different comorbidities, the rates of depression may increase, as well as worsening the clinical course of the different pathologies, especially in cerebrovascular accident, acute myocardial infarction or different types of neoplasias. Likewise, different frequently used medications may produce as an adverse effect mood disorders such as digoxin, thiazides, levodopa, ranitidine, etc.

For all these reasons, an adequate integral assessment is particularly relevant, and different validated assessment scales are useful in elderly patients without cognitive impairment (Hamilton, Goldberg, Yessavage) or with cognitive impairment (Cornell). In the interview with the patient, the risk of suicide should be systematically evaluated, knowing the different risk factors and the planning and structuring of such autolithic ideas, since consummated suicides increase in this age group.

In this paper published in the BMJ in 2013 (*) by Professor Gallo and his collaborators, it is shown that community work of a multi-component nature, coordinating different resources by means of advice to general practitioners by psychiatry on therapeutic aspects, the use of psychotherapy and structured follow-up by nurses, social workers and psychologists, improves results in mortality and quality of life. 1226 primary care patients (599 with depression and 627 controls) were analysed during 1999 and 2001. Two groups were assessed: 60 to 74 years old and > 75 years old, with a median follow-up of 98 months, and 405 people died. Those patients recruited with major depression reduce the mortality risk by 24%, being similar to those without depression, while in the control group mortality almost doubles; those with minor depression have no effect of the intervention on mortality, however it improves certain indicators of quality of life.

This work shows that well-structured multidisciplinary work has a great benefit, knowing how to coordinate all the available resources or being able to implement communicating vessels between the mental health network and the community, in a pathology in which clinical trials show a high response rate to the placebo effect and which generates great suffering for the person and their environment.

(*) Gallo J, Morales K, Bogner H, et al.Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ 2013;346:f2570.