Prevalence and Treatment for Depression and Anxiety Among the Elderly

Introduction

Depression is one of the major psychological symptoms of stress. Depressive disorders constitute a serious mental health problem that bear adverse impacts on the health and well-being of especially among the elderly. Research shows that depression is some of the leading depressive disorders and suicide risk factor among the old population, which is estimated to cause about 24 percent of successful suicidal attempts, decreased quality of life, increased drug and substance abuse and care costs, among other related social and economic challenges facing the elderly (Towhid, Reza, Farhad, Fatemeh & Fraiba, 2016). Depression and other depressive disorders are high prevalent among the elderly. This paper conducts a review of the literature on depression in an attempt to understand the prevalence, causes, impacts and treatment of this health condition among the elderly.

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Literature Review

The presenting problems for my patient include depression, anxiety, PTSD, and hypertension. These symptoms my client reports are in tandem with the fifth Edition of the American Psychological Associations(APA) Diagnostic Statistical Manual of mental Disorders (DSM-V) description of depressive symptomology. According to DSM-V, depression is depressed mood most of the day, nearly every day, markedly diminished pleasure in all or almost all activities, significant weight loss or weight gain, insomnia or hypersomnia nearly every day, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death, recurrent suicidal ideation, a suicide attempt, or a specific plan for committing suicide, (American Psychological Association (APA), 2013, pp. 160 161).

Several studies have investigated the prevalence of depression among the elderly. Towhid, Reza, Farhad, Fatemeh & Fraiba (2016) identified depressive disorders including depression, stress, and anxiety as common challenges that impact the quality of life, lead to suicidal attempts and other physical and socioeconomic problems in elders. With the growing number of the elder population in Khoy County, Iran, the researchers felt the need to investigate the levels of depression, anxiety, and stress in this population. The researchers conducted a cross-sectional study in which 383 elderly individuals referred to health facilities in the County were sampled using a cluster sampling technique.

The study utilized the Depression, Anxiety, Stress Scale 21 (DASS-21) standard questionnaires to gather date from the research participants. The researchers computed data using the SPSS software and adopted descriptive statistic, t-test, and one-way ANOVA for data analysis. The study determined P < 0.050 as the significant. The outcome of this investigation diagnosed 1.3%, 1.3% and 3.1% of the elderly population with very severe stress, severe depression, and severe anxiety, respectively. The study concluded that depressive disorders, including depression, prevail among the elderly. I chose this particular study because the DASS tool the researchers utilized can provide a more accurate measure of the participants level of depressive disorders. However, it is imperative to note that the sample size (383) was relatively small, therefore the results may not be generalized to a large population

In an earlier study, Yohannes, Baldwin & Connolly (2008) confirmed the current prevalence of depression among the elderly. In the research, Prevalence of depression and anxiety symptoms in elderly patients admitted to post-acute intermediate care, the researchers investigated the prevalence and predictors of depression and anxiety symptoms among elderly patients admitted for rehabilitation in post-acute intermediate care. The participants in the observational cohort study included 173 referred to intermediate care in a North Western England facility. The study utilized the Hospital Anxiety and Depression Scale to depression and anxiety manifestations. The severity of depression, physical disability and quality of life were assessed by the Montgomery Asberg Depression Rating Scale, the Nottingham Extended ADL Scale, and the SF-36, respectively. 38% of the participants were found to exhibit depressive symptoms, while 17%, 43%, and 25% were diagnosed with clinical depression, anxiety symptoms, and clinical anxiety, respectively. The conclusion of this study is that clinical depression and anxiety are common in older patients admitted to intermediate care.

I selected this study because its results resonate with the depression and anxiety symptoms my client presents. Also, the findings of the research showed that longer stay in the unit was predicted by the severity of depression, physical disability, staying alone and reduced cognition. In fact, the client stays alone as her three daughters stay away and visit her only during the weekend. This explains her feelings of social isolation, sad mood, tearfulness, worthlessness, excessive worry & restlessness every day. She also has hearing issues which are very hard for her to hear others and its a big problem for her. Besides that, the perception of having lost her former role as a person can be another significant source of depression.

Old age, environment and socio-economic factors place the elder at a greater risk of developing generation. Ranjan, Bhattarai & Dutta (2014) sought to determine whether the increasing number of older people are at a greater risk for depression. The scholars identified that despite many studies having explored the physical wellbeing of the elderly, there existed limited studies focusing on depression among older people, particularly in developing countries. Therefore, in the study Prevalence of depression among elderly people living in old age home in the capital city Kathmandu, sought to determine the prevalence of depression among elderly staying an old age home in Kathmandu and its relationship with several socio-demographic factors. The researchers conducted a random sample of 150 Nepal elderly individuals residing in staying in a Nepal based social welfare center elderly facility. The study utilized the geriatric depression scale (GDS) to measure the prevalence and severity of depression.

The research established that 47.33% of the population reported experiencing depression. Among the elderly found with depression, 70.42% and 29.58% exhibited mild depression and severe depression, respectively. Moreover, the research findings indicated a significant relationship between the prevalence and history of physical illness. This relationship is also depicted in my clients presentation. Being a survivor of an abusive marriage elevates her risk for depressive disorders. Building on the findings of this study, Ranjan, Bhattarai & Dutta (2014) concluded that depression is highly prevalent among old individuals leaving in the old age home in Kathmandu who has suffered physical illness in their past.

Depressive disorders are common among older survivors of different forms of domestic abuse. According to the National Coalition Against Domestic Violence (NCADV), on average, about 20 individuals per minute suffer physical abuse from an intimate partner in the U.S. In a one-year span, this equates to over 10 million men and women (NCADV, 2015. NCADV (2017) further reports that 1 out of 3 women and 1 out of 4 men have suffered physical molestation by an intimate partner within their lifetime. Also, 1 in 4 and 1 in 7 women have been physically violated and stalked by an intimate partner during their lifetime, respectively (NCADV, 2017).

Furthermore, the Coalition holds that women who suffer sexual assault by their intimate partners suffer severe and long-lasting physical and mental health challenges, which are similar to those exhibited among victims of rape. Another fact that relates to clients experience is that women who are sexually assaulted by intimate partners have higher rates of depression and anxiety compared to those who have been sexually or physically abused by a non-intimate partner (NCADV, 2017). Given this observation, it is accurate to assert that the domestic violence and abuse my client experienced is a precursor to the high rates of depression and anxiety she reports in her old age.

Empirical studies have also confirmed the relationship between intimate partner abuse and depressive disorders. Mechanic, Weaver & Resick (2008) observed that battered women are likely to experience multiple forms of abuse from their intimate partners. These researchers conducted a study to determine how physical violence, sexual coercion, psychological abuse, and stalking contribute independently to symptoms of posttraumatic stress disorder (PTSD) and depression. The researchers sampled 413 that had been severely battered and in dire need of help, help among adult women. The scholars conduct hierarchical regression test of the specific impacts of psychological abuse ad stalking on mental health outcomes, after controlling for physical violence, injuries, and sexual coercion.

Even after the researchers controlled for the distinct consequences of physical violence, injuries and sexual coercion, the findings of the study show that both psychological abuse and stalking contribute distinctively to the prediction of PTDS and depression. I found this study very relevant because it highlights the significance of determining multiple dimensions of abuse perpetrated by intimate partners. In my clients case, different forms of abuse perpetrated by her ex-husband could have contributed uniquely to her current depression and anxiety conditions.

In a similar investigation, Avdibegovic & Sinanovic (2006) passed psychological effects of domestic violence and determined the frequency and forms of domestic violence against women in Bosnia and Herzegovina. The study incorporated a sample of 283 female participants from the Tuzla Canton. Domestic Violence Inventory, Cornell Index, Symptom Checklist-90-Revised, PTSD Checklist Version for Civilians and Beck Depression Inventory were utilized in gathering data.

Out of the 283 female participants, 215 (75.9%) reported having encountered physical, psychological, and sexual assault by their husbands. Out of the 215 women who were assaulted, 107 (50.7%) had suffered multiple forms of intimate partner abuse. Those who reported having suffered domestic violence exhibited a significantly higher rate of general neuroticism, depression, somatization, sensitivity, obsessive-compulsive behaviors, anxiety symptoms, and paranoid tendency compared to their counterparts who were not assaulted. Coincidently, my client presents all these effects that were reported by the victims of domestic violence.

There exists a wide range of treatment strategies for depression among the elderly population. Generally, depression treatments fall under two major categories pharmacological or medical and non-pharmacological treatments (Hegerl, Hautzinger, Mergl, Kohnen, Schutze, Scheunemann, ... & Henkel (2010). The latter includes non-medical treatments such as cognitive, behavioral and psychiatric therapies. Hegerl et al., 2010) asserts that pharmacotherapy and psychotherapy can be used either independently or in combination to treat depression symptoms. Hegerl et al (2010) conducted a randomized, controlled trial to determine the efficacy of sertraline (pharmacotherapy) and cognitive-behavioral group therapy (psychotherapy) for the treatment of primary-care patients suffering from depression. Their study also sought to determine whether receiving treatment according to free choice is related to a pos...