Diagnosis and Management of Depression in the Elderly

Elderly depression is among the most common psychiatric diseases, and it significantly influences the quality of life as well as the demand for health care; in general, well-being has seriously deteriorated (Baba et al., 2022; Gundersen & Bensadon, 2023). Diagnosis and treatment of depression in old age are complicated because of the overlap of symptoms of depression with age-related pathologies, medication side effects, and comorbidities (Devita et al., 2022; Frost et al., 2019): Diagnosis and Management of Depression in the Elderly.

This, therefore, calls for an integrated approach that includes accurate diagnostic tools, tailored treatment, and social support. This paper synthesizes the literature on the diagnosis and management of depression among the elderly, exploring the major concepts, points of consensus, and areas of controversy from the studies covered by the annotated bibliography.

Primary Research article, Meta-analyses, Guidelines, and Evidence-Based Practice Identification

Some of the articles are based on primary research by the authors, such as Goswami and Deshmukh’s (2021) article that evaluates the prevalence of depression amongst the elderly in rural India. Laird et al. (2023), on the other hand, primarily conducted research through a longitudinal study on the effects of physical activity on depression in older adults. Both these articles present empirical data and particular findings about the depression of the elderly, hence serving to render valuable information directly from studied populations.

Meta-analyses, such as those conducted by Krishnamoorthy et al. (2020) and Lee et al. (2022), synthesize data from a number of studies into broader conclusions regarding the efficacy of depression screening tools and social support interventions, respectively. These are comprehensive overview studies of tendencies and best practices in the field. Some articles, such as Baba et al. (2022) and Simon et al. (2024), present recommendations on clinical practices or evidence-based practice in diagnosing and treating depression in older adult populations—hence structuring a fine approach to patient care.

Critical Comparison Concepts: Diagnosis, Treatment Modalities, and Long-Term Care Plans

Diagnosing depression might be quite difficult, especially for elderly adults, since the clinical presentation may overlap with other diseases or conditions, such as dementia. Baba et al. (2022) insisted on using a standardized tool in the diagnosis, such as the Geriatric Depression Scale, while Krishnamoorthy et al. (2020) found that the GDS-15 could be more effective because of its high sensitivity and specificity. Devita et al. (2022) encouraged the use of diagnostic tools such as the Patient Health Questionnaire-9 (PHQ-9), and Frost et al. (2019) examined additional barriers, including stigma, to early diagnosis. Together, these articles provide evidence for the utility of using targeted diagnostic tools while addressing psychosocial barriers to care.

Pharmacological interventions are a common treatment choice for depression among elderly patients, although there are major concerns regarding side effects and drug interactions. Mallery et al. (2019) question the benefits of second-generation antidepressants, especially for frail elderly patients, while Gundersen and Bensadon (2023) recommend antidepressants but under close monitoring.

Thus, Lee et al. (2022) and Laird et al. (2023) point out the non-pharmacological approaches in the treatment of social support and physical activity, respectively. Both proved to have positive effects on mental well-being without medication side effects. The range of perspectives represented here brings into focus the need for person-centered treatment plans, which may include medication but also non-pharmacological approaches.

Maj et al. (2020) and Sekhon et al. (2023) enforced the use of tailored and patient-centered approaches in the treatment of depression in the elderly population. Maj et al. (2020) call for the individualization of every patient in the assessment of his or her biological, psychological, and social factors to determine the most effective treatment. Sekhon et al. (2023) advocate careful evaluations for patients with late-onset depression, taking into consideration the interactions between physical and psychological health and changes in life. This follows the proposition that the treatment of long-term depression should be based on unique individual needs and consideration of the wide range of determinants of mental health in older adults.

Conflicting and Controversial Information

There are contradictions throughout the articles regarding the approaches to treatment, most especially between pharmacological and non-pharmacological treatments. Mallery et al. (2019) point out the concern that the prescription of second-generation antidepressants comes with the risks of having adverse effects, especially in frail elderly patients, while Gundersen and Bensadon (2023) take the stand that antidepressants are necessary but require great caution in their prescription. Simon et al. (2024) support the combination of pharmacotherapy and psychotherapy as the most effective, while Lee et al. (2022) and Laird et al. (2023) encourage social support and physical activity as a safe and effective alternative.

The divergence here suggests further research and consideration of patient-specific factors at play in treatment decisions. Moreover, Mirza (2020) offers another way of screening elderly depression by applying artificial neural networks, which contrasts with traditional screening tools like the GDS recommended by Baba et al. (2022).

Despite the fact that ANN can become very accurate, Mirza (2020) has pointed out that there are some inconveniences in using ANN applications, mostly in situations where there are limited digital resources. This difference in diagnosis raises a larger question about the blending of new technologies in elder care.

Conclusively, diagnosing and managing elderly depression encompasses more than one or a few dimensions that diagnostic methods should address, appropriate dosages of medications, and primarily by a conceptual vision of a humane, patient-oriented care approach. As for pharmacological treatments, non-pharmacological treatment options, such as social support and exercise, are also safer and effective, especially for frail elderly.

The diverse findings across the literature indicate a clear need for individualized care tailored to the unique biological, psychological, and social contexts of each patient. Considering the technological advances and addressing these diverse aspects, it is possible to help healthcare providers improve outcomes in elderly patients with depression and, consequently, enhance their quality of life and mental well-being.

References

Baba, H., Kito, S., Nukariya, K., Takeshima, M., Fujise, N., Iga, J., Oshibuchi, H., Kawano, M., Kimura, M., Mizukami, K., & Mimura, M. (2022). Guidelines for diagnosis and treatment of depression in older adults: A report from the Japanese Society of Mood Disorders. Psychiatry and Clinical Neurosciences. https://doi.org/10.1111/pcn.13349

Devita, M., De Salvo, R., Ravelli, A., De Rui, M., Coin, A., Sergi, G., & Mapelli, D. (2022). Recognizing depression in the elderly: Practical guidance and challenges for clinical management. Neuropsychiatric Disease and Treatment, 18, 2867–2880. https://doi.org/10.2147/ndt.s347356

Frost, R., Beattie, A., Bhanu, C., Walters, K., & Ben-Shlomo, Y. (2019). Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies. British Journal of General Practice, 69(680), e171–e181. https://doi.org/10.3399/bjgp19x701297

Goswami, S., & Deshmukh, P. (2021). The prevalence of depression among the elderly people living in rural Wardha. Industrial Psychiatry Journal, 0(0), 0. https://doi.org/10.4103/ipj.ipj_43_17

Gundersen, E., & Bensadon, B. (2023). Geriatric Depression. Primary Care: Clinics in Office Practice, 50(1), 143–158. https://doi.org/10.1016/j.pop.2022.10.010

Krishnamoorthy, Y., Rajaa, S., & Rehman, T. (2020). Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: Systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 87(1), 104002. https://doi.org/10.1016/j.archger.2019.104002

Laird, E., Charlotte Lund Rasmussen, Rose Anne Kenny, & Herring, M. P. (2023). Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing. Physical Activity Dose and Depression in a Cohort of Older Adults in the Irish Longitudinal Study on Ageing, 6(7), e2322489–e2322489. https://doi.org/10.1001/jamanetworkopen.2023.22489

Lee, S. H., Lee, H., & Yu, S. (2022). Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis. Healthcare, 10(9), 1598. https://doi.org/10.3390/healthcare10091598

Maj, M., Stein, D. J., Parker, G., Zimmerman, M., Fava, G. A., De Hert, M., Demyttenaere, K., McIntyre, R. S., Widiger, T., & Wittchen, H. (2020). The clinical characterization of adult patients with depression is aimed at the personalization of management. World Psychiatry, 19(3), 269–293. https://doi.org/10.1002/wps.20771

Mallery, L., MacLeod, T., Allen, M., McLean-Veysey, P., Rodney-Cail, N., Bezanson, E., Steeves, B., LeBlanc, C., & Moorhouse, P. (2019). Systematic review and meta-analysis of second-generation antidepressants for the treatment of older adults with depression: questionable benefit and considerations for frailty. BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1327-4

Mirza, M. (2020). Detecting Depression in Elderly People by Using Artificial Neural Network. Elderly Health Journal. https://doi.org/10.18502/ehj.v6i2.5017

Sekhon, S., Patel, J., & Sapra, A. (2023). Late Onset Depression. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551507/

Simon, G. E., Moise, N., & Mohr, D. C. (2024). Management of Depression in Adults. JAMA, 332(2). https://doi.org/10.1001/jama.2024.5756

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Guidelines for Literature Synthesis Assignment

The student should review all the resources provided in this module prior to writing the Literature Synthesis.  Begin by organizing your synthesis based on your literature findings. Identify themes or common findings and your paper can focus on these as your write it. Below are some general tips to use that may be helpful.

Requirements:

1. Formal paper, APA format required, 3-4 pages in length, not including title page and reference list.
2. Title page required
3. Introduction- first paragraph (no heading), short paragraph, sample format:

_____________  ranks as the _________ cause of death in the United States (author1, date; author5, date;  author 9, date).   Chronic __________ decreases quality of life, _________ , _________ (author6, author 7).   This paper presents a synthesis of literature reviewed on your topic.

Diagnosis and Management of Depression in the Elderly

4. Compares/contrasts articles used in annotated bibliography. Concepts used should be evident and addressed in separate paragraphs.  Group authors with similar statements together.
5. Identifies which articles are primary research (conducted by authors), a summary of research done by others (includes meta-analyzes), published clinical guidelines or evidence based practice focused.
6. Concepts used to compare/contrast articles are evident. Concepts may include content related to genomics, causes, diagnosis, recommended treatment, prognosis, and long term approaches to care.  Concepts will depend upon your topic.
7. Identifies conflicting or controversial information reported in articles.

Sample format: Research indicated there are a number of approaches to treating ___________. One study by Williams et al.(2020) described numerous treatments using a retrospective review of 1,500 hospitalized adult patients and included various treatments and success rates.  A study specifically focusing on comparing two treatments (name these) across 400 patients identified the best treatment as ______ (Miller & Smith, 2019). Another study reported the use of an experimental treatment and provided contrast to the most popular treatment (Adams et al., 2018). All the methods yielded effective results as noted by each study, but the standard of practice seems to offer slightly different treatment standards.

5. Address all articles included in your annotated bibliography and include a reference list in APA format.

You will use the literature synthesis to develop the abstract/poster for your presentation in NSG 6697.