de an accurate history because of cognitive impairment, reluctance, or denial; the patient may have a coexisting medical condition which may mimic or mask depressive disorders. Depression may not be the main complaint when an elderly patient is experiencing major depressive disorder; he/she may be experiencing a change in personality, mentation, or level of functioning. Depressive symptoms in the elderly tend to be physical rather than mood-related (Martin, Fleming, & Evans, 1995).
A factor that may predispose the patient for depression includes stroke. In this case, impairment of speech or mentation make interviewing the patient even more difficult, and relatives may assume that depressive symptoms are normal responses to losses of functions rather than a separate treatable disorder. Additional conditions associated with depression are dementia, myocardial infarction, coronary artery bypass grafting, and terminal illnesses. For these conditions and other disabilities, untreated depression may slow recovery rates or increase debility (Martin, Fleming, & Evans, 1995).
Martin et al. (1995) report that assessment of depression in the elderly requires the obtaining of outside information, a detailed history, to consider thinking and behavioral changes, and consideration of the differential diagnosis of depression along with numerous other conditions (also thyroid dysfunction, kidney failure, Parkinson's disease, viral encephalitis, brain tumor, alcoholism, lung or pancreas cancer, pernicious anemia or folate deficiency, and undiagnosed sleep disorder).
The literature reports varied treatment results. Patients considered at high risk for depression relapse or chronicity are those with health problems and poor social support systems. Guidelines for treatment of elderly depression include the following: correct identification of underlying organic illnesses; minimum use of depression-inducing medications; attempts to alleviate ...