Page 151 - Encyclopedia of Nursing Research

118 n DEPRESSion in oLDER ADULTS

30% of older adults seen in primary care clinical depression into major depressive dis-
settings (Alexopoulos, 2005) to up to 42% of order and dysthymic disorders. Major depres-
D residents of long-term care facilities (Blazer, sion refers to a depression that meets specific
2003; Djernes, 2006; Fiske, Wetherell, & Gatz, diagnostic criteria for duration, impairment
2009). Approximately 50% of older adults of functioning, and presence of a cluster of
who are hospitalized for medical illnesses physiological and psychological symptoms
or receiving long-term care experience clin- (American Psychiatric Association, 2000).
ically significant depression (Alexopoulos, The DSM-IV-TR recognizes five further sub-
2005). older adults are vulnerable to depres- types of major depressive disorder, called
sion for a number of reasons. Approximately specifiers, in addition to noting the length,
80% have at least one chronic medical con- severity, and presence of psychotic features,
dition that can trigger depression (Jang, namely, melancholic, atypical, catatonic,
Bergman, Schonfeld, & Molinari, 2006; Sable postpartum, and seasonal affective disorder.
et al., 2002). in addition, approximately 6 mil- Dysthymia is a chronic, milder mood distur-
lion older adults need assistance with their bance in which a person reports a low mood
daily activities (Sable et al., 2002), and inabil- almost daily over a span of at least 2 years.
ity to meet one’s own personal needs has The symptoms are not as severe as those for
been associated with increased vulnerability major depression, although people with dys-
to late-life depression (Fiske et al., 2009). thymia are vulnerable to secondary episodes
Although depression is often viewed as of major depression (sometimes referred to
a clinical syndrome with specific diagnostic as double depression; American Psychiatric
criteria, depression has also been concep- Association, 2000).
tualized as a mood state or as a collection Diagnosing depression in older adults
of symptoms (Goodwin & Jamison, 2007). is fraught with challenges. Depressed mood
Because older adults may not meet the diag- is one of the depressive symptoms that older
nostic criteria for the clinical syndrome, adults may experience, but others may also
studies of older adults commonly use the experience a range of affective responses such
term depression to mean depressive symp- as hopelessness and loss of interest in living
toms (Fiske et al., 2009; Martin et al., 2008). (Fiske et al., 2009). indeed, many studies have
Clinical depression is usually qualified by an reported that in older adults, a predominant
adjective to specify a particular type or form, depressed mood may not be as prominent as
including reactive, agitated, and psychotic. symptoms of irritability, anxiety, or physical
in addition, on the basis of etiology, depres- or somatic symptoms and changes in func-
sion is classified as endogenous (because of tioning (Alexopoulos, 2005; Fiske et al., 2009;
internal processes) or exogenous (because of Sable et al., 2002). in addition, symptoms of
external factors). Depression is termed pri- cognitive impairment that may occur in elders
mary when it is not preceded by any phys- with depression may be mistaken for demen-
ical or psychiatric condition and secondary tia (Charney et al., 2003; olin et al., 2002;
when preceded by another physical or psy- Sable et al., 2002). it is estimated that approx-
chiatric disorder. Finally, depression is clas- imately 15% of older adults have depressive
sified as acute (less than 2 years duration) or symptoms that do not meet diagnostic crite-
chronic (more than 2 years). Clinical depres- ria specified by the DSM-IV-TR (American
sion consists of characteristic signs and Psychiatric Association, 2000) for diagno-
symptoms as well as type of onset, course, sis of major depression (Alexopoulos, 2005).
duration, and outcome. The Diagnostic and nevertheless, these older adults can experi-
Statistical Manual of Mental Disorders, Fourth ence functional deficits in activities of daily
Edition, Text Revision (DSM-IV-TR; American living and instrumental activities of daily
Psychiatric Association, 2000) classifies living that compromise their independence