Depression in the Elderly Mental Case Study

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Changes in the brain such as decreased adaptive capacity, neurotransmitter and receptor changes, cognitive impairment, and dementia increase the risk of depression, as more factors enter the equation and the patient becomes more depressed, the likelihood of a suicide attempts increases (McFarland, 2005).As previously mentioned, diagnosing depression in the elderly can be a challenging task due to all of the factors involved. When considering if an individual is depressed, one must examine the individual's background, cognition, medical history, etc. In order to diagnose depression, there are written and oral inventories of a person's mind that need to be performed. Symptoms of severe depression include: diminished interest in usual activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to concentrate, and recurrent thoughts of death or suicide. Depression does not always have to be severe. To be diagnosed with mild depression or dysphoria, the mood of the patient would first need to be depressed for two years. In addition to that, two of the following characteristics would need to be present: low self-esteem, poor concentration, difficulty making decisions, overeating or a poor appetite, low energy level, insomnia or hypersomnia, and feelings of hopelessness (Unutzer, 2003).

Diagnosing depression can be a difficult task due to the human element involved. A recent study by Jackson and Baldwin tested nurses' skills of observation in detecting depression in hospital patients. They were asked to categorize patients as definitely not depressed, probably not depressed, probably depressed, and definitely depressed. The responses given by the nurses were checked against written inventories that had been filled out and analyzed. The results indicated the nurses were not accurate in their assessment until those labeled as "probably not depressed" were moved into the "definitely depressed" category.

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This illustrates that the patient may have exhibited symptoms of depression, but those symptoms were attributed to another health problem leading to the diagnosis of depression being overlooked (Corsini and Wedding, 2007).

Another way to diagnose a patient is by having the patient complete the GDS, or Geriatric Depression Scale once he or she had been treated for the primary illness. This is a 30-question survey of things happening to a patient, both physically and mentally. These results are then analyzed using the Geriatric Mental Status Schedule (GMSS) on a computer. The GMSS compares psychiatric symptoms in stage 1 to organic disorders in stage 2. Preferences are given to organic disorders in stage 2 because it is believed that these are the primary causes. In GMSS stage 1 the patient must score a severity level of 3 (out of 5) to be classified as syndromal depression. In the experiment conducted by Jackson and Baldwin 36% of the sample was classified as having syndromal depression. This sample was made up of elderly medically ill hospital inpatients. The selection appears to reflect the general population fairly well, as it is believed that between 9% and 45% of the medically ill elderly experience depression (Thase and Lang, 2004).

Therapies for depression in the elderly - There are many ways to go about treating depression in the elderly. According to most professionals, there are 7 guidelines to follow: 1) correct any underlying illness; 2) avoid, if possible, prescribing medications that may cause or exacerbate depression; 3) decrease isolation due to sensory deprivation; 4) increase stimulation; 5) consider psychotherapy; 6) consider psychiatric referral for severe depression, and 7) consider.....

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