Depression in Late Life: Etiology, Presentation, and Management

Abstract

Depression in late life is common with a community prevalence of approximately 15%. The figures are higher among hospital inpatients (20–25%) and patients in long-term care (10–40%). It is the most frequent cause of emotional suffering in the elderly and can have a significant impact on a person's physical health and cognitive and social functioning. Suicide among older adults is more often associated with depression than at any other age, and suicide attempts are more likely to be fatal. Depression in late life may refer to either depression with first onset in later life (late-onset depression) or depression that occurs for the first time in younger years and recurs in later life (early-onset depression). The two syndromes differ in terms of etiology, presentation, and natural history. Late-onset depression can be considered to be a geriatric syndrome similar to frailty, falls, or incontinence. Affective symptoms may be less to the fore with motiva-tional-type symptoms and somatic complaints relatively more prominent. The physiological and psychological effects of poor physical health and the organic changes of the aging brain are fundamental considerations in this age group. Successful management of depression in late life, regardless of the subtype, requires a flexible and thoughtful multidisciplinary approach. While pharmaco-therapy undoubtedly plays a vital role in moderate to severe cases, it must be used cautiously given the increased risk of adverse side effects in the elderly. Physical health, social disconnection, and functional or occupational decline must also be identified and targeted according to the individual needs and abilities of the patient.