Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management

Figures & data

Table 1 Depression Symptoms in Younger and Older Adults: Typical and Atypical Presentation

Symptoms and Clinical Presentation		Older Adults	Younger Adults
DSM* 5 core symptoms	Depressed mood	↓	↑
	Anhedonia	↑	↓
Somatic symptoms		Loss of appetite	Hyperphagia
		Insomnia	Hypersomnia
		Physical tiring/lack of energy	Fatigue
		Cognitive deficits	Poor concentration
		GI** complaints	–
		Psychomotor retardation	Agitation

Abbreviations: *DSM, Diagnostic and Statistical Manual of Mental disorders; **GI, gastrointestinal.

Table 2 Risk and Protective Factors for Depression in Elderly

	Risk Factors	Protective Factors
Gender-related factor	Being woman^Citation40
Physical-related factors	Heart disorder^Citation13 Digestive disorder^Citation13 Respiratory disorder^Citation13 Urinary incontinence^Citation4 Sleep disorder^Citation13 Impairment of hearing^Citation15 Abdominal obesity^Citation14 Metabolic syndrome^Citation14 Kidney disease^Citation15
Psychological-related factors	Neuroticism^Citation26	High level of self-esteem^Citation20 Resilience^Citation21 Extroversion^Citation26 Good emotional regulation^Citation24 Positive self-perception of aging^Citation25 Self-efficacy^Citation24 High sense of control^Citation20 Positive coping strategy^Citation24
Social-related factors	Psychological stress in daily life^Citation17 Loss of social and supportive network^Citation20 Isolation^Citation5,Citation17 Low emotional support from family members^Citation17 Loss of spouse^Citation19 Take care of relatives with chronic disease^Citation18	Having hobbies (for men)^Citation27 Being religious^Citation28 Physical activity^Citation22
Cognitive-related factors	Cognitive impairment^Citation16	Cognitive-reserve^Citation23

Figure 1 Pocket guide for the assessment and management of geriatric depression in everyday clinical practice.

Olsen CDH, Möller S, Ahrenfeldt LJ. Sex differences in quality of life and depressive symptoms among middle-aged and elderly Europeans: results from the SHARE survey. Aging Ment Health. 2021;1–8. doi:10.1080/13607863.2021.2013434

 Web of Science ®Google Scholar

Weyerer S, Eifflaender-Gorfer S, Wiese B, et al. Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study. Age Ageing. 2013;42(2):173–180. doi:10.1093/ageing/afs184

 Web of Science ®Google Scholar

Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372–387. doi:10.1111/j.1600-0447.2006.00770.x

 PubMed Web of Science ®Google Scholar

Melrose S. Late life depression: nursing actions that can help. Perspect Psychiatr Care. 2019;55(3):453–458.

 Web of Science ®Google Scholar

Birrer RB, Vemuri SP. Depression in later life: a diagnostic and therapeutic challenge. Am Fam Physician. 2004;69(10):2375–2382.

 PubMed Web of Science ®Google Scholar

Gallo JJ, Rabins PV, Lyketsos CG, Tien AY, Anthony JC. Depression without sadness: functional outcomes of nondysphoric depression in later life. J Am Geriatr Soc. 1997;45(5):570–578. doi:10.1111/j.1532-5415.1997.tb03089.x

 PubMed Web of Science ®Google Scholar

Nelson BD, Kessel EM, Klein DN, Shankman SA. Depression symptom dimensions and asymmetrical frontal cortical activity while anticipating reward. Psychophysiology. 2018;55(1):e12892. doi:10.1111/psyp.12892

 Web of Science ®Google Scholar

Invernizzi S, Simoes Loureiro I, KandanaArachchige KG, Lefebvre L. Late-life depression, cognitive impairment, and relationship with alzheimer’s disease. Dement Geriatr Cogn Disord. 2021;50(5):414–424.

 Web of Science ®Google Scholar

Husain-Krautter S, Ellison JM. Late life depression: the essentials and the essential distinctions. Focus. 2021;19(3):282–293. doi:10.1176/appi.focus.20210006

 Google Scholar

Koenig HG, George LK, Peterson BL, Pieper CF. Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Am J Psychiatry. 1997;154(10):1376–1383.

 PubMed Web of Science ®Google Scholar

Gallo JJ, Rabins PV. Depression without sadness: alternative presentations of depression in late life. Am Fam Physician. 1999;60(3):820–826.

 PubMed Web of Science ®Google Scholar

Park M, Unützer J. Geriatric depression in primary care. Psychiatr Clin North Am. 2011;34(2):469. doi:10.1016/j.psc.2011.02.009

 PubMed Web of Science ®Google Scholar

Triolo F, BelvederiMurri M, Calderón-Larrañaga A, et al. Bridging late-life depression and chronic somatic diseases: a network analysis. Transl Psychiatry. 2021;11(1):557. doi:10.1038/s41398-021-01686-z

 Web of Science ®Google Scholar

Schaakxs R, Comijs HC, Lamers F, Beekman AT, Penninx BW. Age-related variability in the presentation of symptoms of major depressive disorder. Psychol Med. 2017;47(3):543–552. doi:10.1017/S0033291716002579

 PubMed Web of Science ®Google Scholar

Brodaty H, Connors MH. Pseudodementia, pseudo-pseudodementia, and pseudodepression. Alzheimers Dement. 2020;12(1):e12027.

 Web of Science ®Google Scholar

Morimoto SS, Kanellopoulos D, Manning KJ, Alexopoulos GS. Diagnosis and treatment of depression and cognitive impairment in late life. Ann N Y Acad Sci. 2015;1345(1):36–46. doi:10.1111/nyas.12669

 PubMed Web of Science ®Google Scholar

Hegeman JM, Kok RM, van der Mast RC, Giltay EJ. Phenomenology of depression in older compared with younger adults: meta-analysis. Br J Psychiatry. 2012;200(4):275–281. doi:10.1192/bjp.bp.111.095950

 PubMed Web of Science ®Google Scholar

Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363–389. doi:10.1146/annurev.clinpsy.032408.153621

 PubMed Web of Science ®Google Scholar

Bennabi D, Vandel P, Papaxanthis C, Pozzo T, Haffen E. Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. Biomed Res Int. 2013;2013:158746. doi:10.1155/2013/158746

 Web of Science ®Google Scholar