A survey of physical functioning in over 11,000 patients found that depression strongly affected the ability of the older patient to carry out the activities of daily living. The disabling effects of depression on bathing, climbing stairs, dressing, socializing, walking, and working were comparable to those of serious heart condition and greater than those of most of the chronic conditions of angina, arthritis, back problems, coronary artery disease, diabetes, gastrointestinal problems, hypertension, and lung problems.
Depression is the most common mental disorder of later life. Depressive symptoms occur in 30 percent to 65 percent of individuals over the age of 60). Depression is the major precipitating factor in suicide among the elderly. Suicide is the most serious negative consequence of depression; however, there are many other negative consequences. Depression frequently causes severe emotional pain that can decrease social and physical activity, increase insomnia and anorexia, and reduce functional abilities. Unfortunately, depression in the elderly is often unrecognized and untreated.
Organically based major depression, also referred to as primary depression, results from various biological and chemical changes in the brain and nervous systems or from changes in the endocrine system. Situational or reactive depression, on the other hand, is an emotional response to various losses, stresses, changes, and other external events experienced by adults in late life. Another important distinction in the depression states is between primary and secondary depression. Depression may be the major illness or may occur secondary to other illnesses or to the effects of various medications. The latter is referred to as secondary depression. (Bahr, R. T., & Gress, L. D. 1999)
This chapter will examine the biological basis of major depression, the psychosocial factors in reactive depression, and the illnesses and drugs that contribute to the development of secondary depression. Diagnosis of late life depression will be the focus of the last half of this chapter...................
