Dr Gillian McLean

Depression in the Later Years

by Dr Gillian McLean
Consultant Old Age Psychiatrist

The UK has an ageing population with 9.7 million people currently over the age of 65. This number will rise to around 12.5 million by 2020. Age 65 is the point at which you retire from work, access your pension and enter the realms of ‘geriatric’ care, although some geriatric medical services will be restricted to those over 75. Similarly changes in the social care system take place at 65. So, in general those in our society who have reached or exceeded 65 are rightly or wrongly described as‘older people’

Depression is not an inevitable feature of ageing, but it is common. Depression affects one in seven older people to a degree that their day to day functioning is severely disrupted. One in four older people are affected by some form of Depression which equates to 2.4 million people

The public and many professionals fail to recognise this rising tide of disability, largely due to lack of knowledge. Older people are more often isolated from friends and family, they have less disposable income and often more than one medical problem. Solitude, bereavement, poverty and pain are major risk factors for Depression in old age. Increased drowsiness , over eating and agitation are also common. Thus the diagnosis is frequently missed. Suicide in old age accounts for almost 25% of completed suicides, yet little attention is given to this group when examining thenational policies.

Depression in old age can be just as successfully treated as Depression in younger age groups. However this age group has long been denied access to psychological therapies. Often when older people are given antidepressants, they are of inadequate dose and for inadequate periods of time.

The best form of intervention is prevention. As people approach retirement, there is a significant amount of readjustment required. Loss of earnings, loss of status, loss of role and the prospect of age related illnesses can all cause a change in mood. Planning for retirement is an essential part of preparing for old age. Keeping busy with a range of activities to stimulate both mental and physical health and a positive approach can help. Making older people feel valued and included will help increase their self-esteem.

Where medication is required, doctors should ensure the dose is adequate and prescribed for a minimum of six months. They should also ensure any physical issues are addressed e.g. pain control, thyroid function and diabetes, as all can lead to low mood. Care must be taken when prescribing antidepressants as some can interact with other medications.

Self-help groups and supportive psychotherapy can help. Basic education about the illness is valuable not just for patients but for front line staff working with vulnerable groups such as those in hospital or care homes, where levels of Depression are much higher than in the general population.

Depression in older people has for too long been under recognised, under diagnosed and under treated. The risk factors are different to those we see in younger people, the symptoms are often ‘masked’ and the consequences too often just attributed to age.