Depression is not a normal effect of aging and healthy, independent elders actually have a lower depression rate than the general population, but this changes drastically if medical illness also exists.
Late life depression remains under-diagnosed and inadequately treated. The rate of depression for seniors in the community setting is only two percent and slightly higher in the general adult population (six percent). However, in those living at home with chronic illness the rate rises to nine percent but jumps significantly to 33 percent in the hospital population and even higher if there is a diagnosis such as heart attack, Parkinson disease or cancer.
The likelihood of serious depression approaches 50 percent in stroke patients, who are over three times more likely to die within 10 years compared with those without depression.
To make the diagnosis, I look for depressed mood or loss of interest or pleasure in previously enjoyable activities. In addition, I ask about changes in appetite or weight, too much or too little sleep, slowing of physical or mental activity, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty thinking, concentrating or making decisions and, most importantly, recurrent thoughts of death or plans for suicide.
When I served as medical director of nursing homes in Lake Placid and Tupper Lake, I understood that nearly 20 pecent of residents with healthy brain function have significant depression and the statistic jumps as high as 70 percent in those with deteriorating mental ability. In men this is more likely to show up as anger or irritability and frequently there is a history of alcohol abuse as they are less likely than women to acknowledge sadness or other psychological symptoms.
Depression is a major risk factor for suicide in the elderly, who account for 13 percent of the population but nearly 24 percent of all completed suicides. White men over 85 have the highest rate of completed suicide, 55 per 100,000.