********** Depression is not a no...

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Depression is not a normal part of aging. (1) The lack of connection between health care and mental health providers has created a fragmented classification of care for depressed somewhat old patients that is often inadequate. (2) agreeing medical problems and lower functional expectations of somewhat old patients often obscure the extent of impairment. (3) Typically, somewhat advanced in life patients with depression do not report make saded moods but instead present with les specific symptoms like as insomnia, anorexia, and fatigue. somewhat advanced in life persons sometimes dismiss less rigid depression as an acceptable answer to life stress or a normal part of aging. Depression take away froms $43 billion annually in the United States, in direct and indirect costs--about the same as coronary heart disease. (2)

Epidemiology

MAJOR DEPRESSION

Nearly 5 million of the 31 million Americans who are 65 years or older are clinically sinked and 1 million have major depression. (4) The prevalence of depression in the total U population is 1 percent (14 percent in women 04 percent in men) and the rate approaches 12 to 30 percent in patients who live in long-term care facilities. (5) Depression has been identified in 17 to 37 percent of somewhat old patients treated in primary care settings; of these patients, about 30 percent have been diagnosed with major depression. (1) Approximately 3 percent of healthy somewhat old persons living in the community have major depression, (6) and 75 percent initially quick in emergencies to a primary care physician. (4)

resort may be as high as 40 percent Suicide rates are nearly twice as high in dispirited patients as in the general population. (5) Sixty-three percent of bodily substances who commit suicide are white, somewhat old men, and 85 percent of them have an associated psychiatric or physical illness. (7) Approximately 75 percent of somewhat old persons who commit suicide had visited a primary care physician within the preceding month yet their symptoms were not recognized or treated. (7-9) Depression is the most numerous common diagnosis in older living bodys who commit suicide; in younger bodily forms who commit suicide, the greatest in number common diagnoses are substance abuse and psychosis, alone or in combination with a vein disorder. (1)

Risk factors for depression in somewhat advanced in life persons include a history of depression, chronic medical illness, female sex being single or divorced, brain disease, alcohol abuse, use of certain medications, and stressful life circumstances (4) Up to 15 percent of widowed adults have potentially serious depression for a year or longer after the death of a spouse. (4)

Unlike younger ones with depression, elderly persons with depression usually have a medical comorbidity. (910) Major depression is more belonging to all in medically ill patients who are older than 70 years and hospitalized or institutionalized. (4) plain or chronic diseases associated with high rates of depression include hardship (30 to 60 percent), coronary heart disease (8 to 44 percent) cancer (1 to 40 percent) Parkinson's disease (40 percent) Alzheimer's disease (20 to 40 percent) and dementia (17 to 31 percent) (4)

MINOR DEPRESSION

Minor depression is a clinically significant depressive disorder that does not fulfill the duration criterion or the number of symptoms necessary for the diagnosis of major depression. (11) Minor depression, which is more belonging to all than major depression in somewhat old patients, may follow a major depressive episode. It also can be a reaction to routine stressors in older populations. Fifteen to 50 percent of patients with minor depression bring to maturity major depression within two years. (11)

The prevalence of minor depression in the general population ranges from 25 to 94 percent however significantly increases (to about 47 to 53 percent) in clinical settings. (212) About 30 percent of nursing household residents have minor depression, and the female-to-male ratio is 13:10 compared with a 14:04 ratio for major depression. (5)

Untreated, the natural course of minor depression is united to two years. Patients with minor depression are les likely to require hospitalization or to commit suicide than patients with major depression, unless 51 percent of patients with minor depression report more disability days than living bodys with major depression. (12) bodily substances with minor depression also are more likely to have a concomitant anxiety disorder.

Pathophysiology/Pathogenesis

There is evidence of a genetic basis for depression in parts of all ages. (11) There also is substantial evidence that a history of depression is a risk factor for depression later in life. somewhat old persons with depression have higher rates of cognitive impairment, cerebral atrophy, enlarged ventricles, leukoencephalopathy, and astute white-matter changes. Left frontal lesions, left lesions of the basal ganglia, and cortical and subcortical atrophy also are public (13) Medical comorbidity is frequent

Evaluation

The Diagnostic and Statistical Manual of Mental Disorders, 4th ed (11) gives nine criteria for depression: bring downed mood, sleep disturbance, lack of interest or pleasure in activities, guilt and feelings of worthlessness, lack of pluck loss of concentration and difficulty making decisions, anorexia or weight los psychomotor agitation or retardation, and suicidal ideation. The nearness of at least five of these criteria, occurring nearly each day during the same two-week period, or a score of more than 10 upon the Beck Depression Inventory (14) or 10 or more forward the Geriatric Depression Scale (15) supports the diagnosis of depression in somewhat old patients (Table 1).