Question:
Depressed older people are much more likely to decline physically,
government researchers report, bolstering the notion that mental well-being
profoundly influences bodily health? Or is decline linked to depression. With age comes aches and pains
and loss of taste (food tastes like cardboard), same age friends are
dying, children are too busy for them, etc ad infinitum
Do mediational analyses prove this link? In which direction?
Answer:
This has been a well-known and documented phenomenon for quite some time.
It is referenced in decade-old psychiatry manuals as well as the _Merck
manual of Geriatrics_. It's ben discussed in the psychology internets,
the geropsych mailing lists, various geropsych Web sites... Where has the
government been all this time? Has anyone notified them that the Earth is
round? There are indeed psychosocial stressors that may be linked to higher
incidence of depression in the elderly. However, major depression (as
distinct from discontent or dysphoria related to the circumstances of
growing older) is clearly identified as the cause of physical decline and
death in older adults. The incidence of major depression is twice as high
in institutionalized elderly (e.g., nursing homes) as in
community-dwelling elderly in the U.S. About one-third of nursing home
residents typically meet the criteria for major depression, depending on
which research you review. Depression tends to be slightly more prevalent
among the elderly than the adult population, although this has to be taken
with a grain of salt. First-episode depressions may be actually *less*
common among the elderly than among young adults. Depressed elderly tend to become irritable, withdrawn, anenergic,
anhedonic and present a distinct risk for "failure to thrive" syndrome.
Weight loss is endemic among depressed elderly and tends to result in
dehydration, malnutrition, complications of these including weakness,
falls with injury, urinary tract infections causing delirium, decubiti,
medication toxicity related to dehydration, bowel obstruction, etc. Major
depression is a major source of morbidity and mortality among the
elderly... not even including suicide. Males with painful illnesses,
living alone, over the age of 80 are one of the highest risk groups for
suicide. Also, depressed elderly are often profoundly affected by
depression in terms of cognitive status and may appear confused and
demented; they are often misdiagnosed as having Alzheimer's or other
dementing illnesses. Depressed elderly may be mistakenly assumed to be
"failing" due to age/illness, rather than considering depression, which
can result in unnecessary deaths among this population, typically from
malnutrition, dehydration and/or nosocomial infections such as pneumonia.
The good news is that elderly patients respond well to standard forms of
treatment including antidepressant medications (preferably avoiding the
tricyclics with significant anticholinergic side effects- SSRIs are the
treatment of choice for the elderly unless there are other serotonergic
medications prescribed), psychotherapy and ECT. Aggressive,
multidisciplinary treatment is quite possible in the nursing home setting,
allowing higher dosing of antidepressants, better compliance with
treatment, targeted psychosocial interventions such as therapeutic
recreation, restorative nursing, nutritional support, etc. Dementia is a
contraindication for psychotherapy, although cognitive status may improve
dramatically with the resolution of the depression. I have seen people go
from 5/30 on the MMSE to 30/30 with the treatment of their depression. The fault is more likely with USA Today and their one-paragraph synopsis.
They probably didn't understand what was different about this study
compared to previous research and went with a title that they thought
would grab attention, however banal the point. Consider the source. There
is a lot of frustration among researchers about how the media picks up on
results. The reporters don't understand enough about this area to know
what is new. This study wouldn't have been funded in the first place if it
were going to establish a point that has already been well-researched. APS (or was it APA?) recently gave fellowships to three science writers in
order to train them to understand and report on psychology more
accurately. One was Bruce Bower who writes for Science News. They do a
much better job of reporting new findings.
Well, now you've gone and disappointed me. For a minute there, I thought if
I just took enough Prozac, I could stay out of church.
