Skip to main content
SpringerLink
Log in

The epidemiology of depressive states in the elderly: implications for recognition, intervention and prevention

  • Review
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

The evidence is reviewed on factors that might affect the onset of new depressive symptoms (destabilization) or loss of depressive symptoms (restitution) in the elderly. These factors are grouped into three broad categories: health-related factors (physical ill health, disability, and dementia and cognitive impairment); social factors (living in a nursing home, social support, bereavement, caring for a disabled person); and personal vulnerability factors (level of depressive symptoms at previous time points, history of depression, personality). The possible implications for preventing destabilization, aiding restitution and identifying high-risk groups are considered. Many of the factors are not easily modifiable, but there is potential for intervention with the physically ill and care givers. The physically ill may also merit routine screening. As in younger age groups, the greatest and most difficult challenge is to modify personal vulnerability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abraham IL, Neundorfer MM, Currie LJ (1992) Effects of group interventions on cognition and depression in nursing home residents. Nurs Res 41: 196–202

    Google Scholar 

  • Alexopoulos GS, Young RC, Abrams RC, Meyers B, Shamoian CA (1989) Chronicity and relapse in geriatric depression. Biol Psychiatry 26: 551–564

    Google Scholar 

  • Ames D (1990) Depression among elderly residents of local-authority residential homes: its nature and the efficacy of intervention. Br J Psychiatry 156: 667–675

    Google Scholar 

  • Baldwin RC (1991) Depressive illness. In: Jacoby R, Oppenheimer C (eds) Psychiatry in the elderly. Oxford University Press, Oxford, pp 676–719

    Google Scholar 

  • Baldwin RC, Jolley DJ (1986) The prognosis of depression in old age. Br J Psychiatry 149: 574–583

    Google Scholar 

  • Baldwin RC, Benbow SM, Marriott A, Tomenson B (1993) Depression in old age: a reconsideration of cerebral disease in relation to outcome. Br J Psychiatry 163: 82–90

    Google Scholar 

  • Blanchard MR, Watereus A, Mann AH (1994) The nature of depression among older people in inner London, and the contact with primary care. Br J Psychiatry 164: 396–402

    Google Scholar 

  • Bowers J, Jorm AF, Henderson S, Harris P (1990) General practitioners' detection of depression and dementia in elderly patients. Med J Aust 153: 192–196

    Google Scholar 

  • Braithwaite VA (1990) Bound to care. Allen and Unwin, Sydney

    Google Scholar 

  • Burvill PW, Hall WD, Stampfer HG, Emmerson JP (1991) The prognosis of depression in old age. Br J Psychiatry 158: 64–71

    Google Scholar 

  • Callahan CM, Hendrie HC, Dittus RS, Brater DC, Hui SL, Tierney WM (1994) Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc 42: 839–846

    Google Scholar 

  • Clarke M, Clarke SJ, Jagger C (1992) Social intervention and the elderly: a randomized controlled trial. Am J Epidemiol 136: 1517–1523

    Google Scholar 

  • Clayton PJ (1979) The sequelae and nonsequelae of conjugal bereavement. Am J Psychiatry 136: 1530–1534

    Google Scholar 

  • Duncan-Jones P, Fergusson DM, Omrel J, Horwood LJ (1990) A model of stability and change in minor psychiatric symptoms, results from three longitudinal studies. Psychol Med [Monogr Suppl 18]: 1–28

  • Eagles JM, Beattie JAG, Blackwood DB, Restall DB, Ashcroft GW (1987) The mental health of elderly couples: 1. The effects of a cognitively impaired spouse. Br J Psychiatry 150: 299–303

    Google Scholar 

  • Finch JF, Zautra AJ (1992) Testing latent longitudinal models of social ties and depression among the elderly: a comparison of distribution-free and maximum likelihood estimates with nonnormal data. Psychol Aging 7: 107–118

    Google Scholar 

  • Forsell Y, Jorm AF, Fratiglioni L, Grut M, Winblad B (1993) DSM-III-R criteria for major depressive episode in an elderly population: comparison of demented versus nondemented subjects. Am J Psychiatry 150: 1199–1202

    Google Scholar 

  • Forsell Y, Jorm AF, Winblad B (1994) Outcome of depression in demented and non-demented elderly: observations from a three-year follow-up in a community-based study. Int J Geriat Psychiat 9: 5–10

    Google Scholar 

  • Förstl H, Burns A, Luthert P, Cairns N, Lantos P, Levy R (1992) Clinical and neuropathological correlates of depression in Alzheimer's disease. Psychol Med 22: 877–884

    Google Scholar 

  • Fuhrer R, Antonucci TC, Gagnon M, Dartigues J-F, Barberger Gateau P, Alperovitch A (1992) Depressive symptomatology and cognitive functioning: an epidemiological survey in an orderly community sample in France. Psychol Med 22: 159–172

    Google Scholar 

  • George LK, Blazer DG, Hughes DC, Fowler N (1989) Social support and the outcome of major depression. Br J Psychiatry 154: 478–485

    Google Scholar 

  • Gilewski MJ, Farberow NL, Gallagher DE, Thompson LW (1991) Interaction of depression and bereavement on mental health in the elderly. Psychol Aging 6: 67–75

    Google Scholar 

  • Goldberg D, Huxley P (1992) Common mental disorders: a bio-social model. Tavistock/Routledge, London New York

    Google Scholar 

  • Green BH, Copeland JRM, Dewey ME, Sharma V, Saunders PA, Davidson IA, Sullivan C, McWilliam C (1992) Risk factors for depression in elderly people: a prospective study. Acta Psychiatr Scand 86: 213–217

    Google Scholar 

  • Harlow SD, Goldberg EL, Comstock GW (1991) A longitudinal study of risk factors for depressive symptomatology in elderly widowed and married women. Am J Epidemiol 134: 526–538

    Google Scholar 

  • Henderson AS (1990) Co-occurrence of affective and cognitive symptoms: the epidemiological evidence. Dementia 1: 119–123

    Google Scholar 

  • Henderson S, Byrne DG, Duncan-Jones P (1981) Neurosis and the social environment. Academic Press, Sydney

    Google Scholar 

  • Henderson AS, Jorm AF, Mackinnon A, Christensen H, Scott LR, Korten AE, Doyle C (1993) The prevalence of depressive disorders and the distribution of depressive symptoms in later life: a survey using draft ICD-10 and DSM-III-R. Psychol Med 23: 719–729

    Google Scholar 

  • Henderson AS, Korten AE, Jorm AF Christensen H, Mackinnon AJ, Scott LR (1994) Are nursing homes depressing? Lancet 344: 1091

    Google Scholar 

  • Horiguchi J, Inami Y (1991) A survey of the living conditions and psychological states of elderly people admitted to nursing homes in Japan. Acta Psychiatr Scand 83: 338–341

    Google Scholar 

  • Iliffe S, Haines A, Gallivan S, Booroff A, Goldenberg E, Morgan P (1991) Assessment of elderly people in general practice. 1. Social circumstances and mental state. Br J Gen Pract 41: 9–12

    Google Scholar 

  • Jackson R, Baldwin B (1993) Detecting depression in elderly medically ill patients: the use of the Geriatric Depression Scale compared with medical and nursing observations. Age Ageing 22: 349–353

    Google Scholar 

  • Jorm AF, Henderson S, Scott R, Mackinnon AJ, Korten AE, Christensen H (1993) The disabled elderly living in the community: care received from family and formal services. Med J Aust 158: 383–388

    Google Scholar 

  • Katz IR, Simpson GM, Curlik SM, Parmelee PA, Muhly C (1990) Pharmacologic treatment of major depression for elderly patients in residential care settings. J Clin Psychiatry 51: [Suppl] 41–47

    Google Scholar 

  • Kennedy GJ, Kelman HR, Thomas C (1990) The emergence of depressive symptoms in later life: the importance of declining health and increasing disability. J Community Health 15: 93–104

    Google Scholar 

  • Kennedy GJ, Kelman HR, Thomas C (1991) Persistence and remission of depressive symptoms in late life. Am J Psychiatry 148: 174–178

    Google Scholar 

  • Kivelä S-L, Pahkala K (1989) The prognosis of depression in old age. Int Pschogeriatr 1: 119–133

    Google Scholar 

  • Kivelä S-L, Pahkala K, Laippala P (1988) The prevalence of depression in an elderly population in Finland. Acta Psychiatr Scand 78: 401–413

    Google Scholar 

  • Knight BG, Lutzky SM, Macofsky-Urban F (1993) A meta-analytic review of interventions for caregiver distress: recommendations for future research. Gerontologist, 33: 240–248

    Google Scholar 

  • Koenig HG, Breitner JCS (1990) Use of antidepressants in medically ill older patients. Psychosomatics 31: 22–32

    Google Scholar 

  • Koenig HG, Meador KG, Cohen HJ, Blazer DG (1988) Detection and treatment of major depression in older medically ill hospitalized patients. Int J Pschiatry Med 18: 17–31

    Google Scholar 

  • Koenig HG, Meador KG, Cohen HJ, Blazer DG (1992) Screening for depression in hospitalized elderly medical patients: taking a closer look J Am Geriatr Soc 40: 1013–1017

    Google Scholar 

  • Krause N, Liang J, Yatomi N (1989) Satisfaction with social support and depressive symptoms: a panel analysis. Psychol Aging 4: 88–97

    Google Scholar 

  • Macdonald AJD (1986) Do general practitioners “miss” depression in elderly patients? BMJ 292: 1365–1367

    Google Scholar 

  • Mann AH, Blanchard M, Watterreus A (1993) Depression in older people: some criteria for effective treatment. Encephale 19: 445–450

    Google Scholar 

  • Morris RG, Morris LW, Britton PG (1988) Factors affecting the emotional wellbeing of caregivers of dementia sufferers. Br J Psychiatry 153: 147–156

    Google Scholar 

  • Murphy E (1982) Social origins of depression in old age. Br J Psychiatry 141: 135–142

    Google Scholar 

  • Murphy E (1983) The prognosis of depression in old age. Br J Psychiatry 142: 111–119

    Google Scholar 

  • O'Connor DW, Pollitt PA, Roth M, Brook PB, Reiss BB (1990) Problems reported by relatives in a community study of dementia. Br J Psychiatry 156: 835–841

    Google Scholar 

  • Ong Y-L, Martineau F, Lloyd C, Robbins I (1987) A support group for the depressed elderly. Int J Geriatr Psychiatry 2: 119–123

    Google Scholar 

  • Oxman TE, Berkman LF, Kasl S, Freeman DH, Barratt J (1992) Social support and depressive symptoms in the elderly. Am J Epidemiol 135: 356–368

    Google Scholar 

  • Pathy MSJ, Bayer A, Harding K, Dibble A (1992) Randomised trial of case finding and surveillance of elderly people at home. Lancet 340: 890–893

    Google Scholar 

  • Phifer JF, Murrell SA (1986) Etiologic factors in the onset of depressive symptoms in older adults. J Abnorm Psychol 95: 282–291

    Google Scholar 

  • Phillips CJ, Henderson AS (1991) The prevalence of depression among Australian nursing home residents: results using draft ICD-10 and DSM-III-R criteria. Psychol Med 21: 739–748

    Google Scholar 

  • Pond CD, Mant A, Bridges-Webb C, Purcell C, Eyland EA, Hewitt H, Saunders NA (1990) Recognition of depression in the elderly: a comparison of general practitioner opinions and the Geriatric Depression Scale. Fam Pract 7: 190–194

    Google Scholar 

  • Pond CD, Mant A, Kehoe L, Hewitt H, Brodaty H (1994) General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? Fam Pract 11: 1–7

    Google Scholar 

  • Post F (1962) The significance of affective symptoms in old age. Oxford University Press, London

    Google Scholar 

  • Post F (1972) The management and nature of depressive illnesses in late life: a follow-through study. Br J Psychiatry 121: 393–404

    Google Scholar 

  • Rose G (1993) Mental disorder and the strategies of prevention. Psychol Med 23: 553–555

    Google Scholar 

  • Rovner BW, Katz IR (1993) Psychiatric disorders in the nursing home: a selective review of studies related to clinical care. Int J Geriatr Psychiatr 8: 75–87

    Google Scholar 

  • Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL (1984) Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med 311: 1664–1670

    Google Scholar 

  • Russell DW, Cutrona CE (1991) Social support, stress, and depressive symptoms among the elderly: test of process model. Psychol Aging 6: 190–201

    Google Scholar 

  • Rybarczyk B, Gallagher-Thompson D, Rodman J, Zeiss A, Gantz FE, Yesavage J (1992) Applying cognitive-behavioral psychotherapy to the chronically ill elderly: treatment issues and case illustration. Int Psychogeriatr 4: 127–140

    Google Scholar 

  • Santmyer KS, Roca RP (1991) Geropsychiatry in long-term care: a nurse-centred approach. J Am Geriatr Soc 39: 156–159

    Google Scholar 

  • Schifano F, Garbin A, Renesto V, De Dominicis MG, Trinciarelli G, Silvestri A, Magni G (1990) A double-blind comparison of mianserin and maprotiline in depressed medically ill elderly people. Acta Psychiatr Scand 81: 289–294

    Google Scholar 

  • Series HG (1992) Drug treatment of depression in medically ill patients. J Psychosom Res 36: 1–16

    Google Scholar 

  • Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ (1993) Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342: 1032–1036

    Google Scholar 

  • Vassilas CA (1993) Suicide and deliberate self-harm. Curr Opin Psychiatry 6: 216–220

    Google Scholar 

  • Wallace J, O'Hara MW (1992) Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study. J Abnorm Psychol 101: 398–404

    Google Scholar 

  • Wells Y, Jorm AF (1987) Evaluation of a special nursing home unit for dementia sufferers: a randomized controlled comparison with community care. Aust N Z J Psychiatry 21: 524–531

    Google Scholar 

  • Wells YD, Jorm AF, Jordan F, Lefroy R (1990) Effects on care-givers of special day care programmes for dementia sufferers. Aust N Z J Psychiatry 24: 82–90

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. NH & MRC Social Psychiatry Research Unit, The Australian National University, 0200, Canberra, ACT, Australia

    A. F. Jorm

Authors
  1. A. F. Jorm
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This article is based on a talk given to the World Psychiatric Association Symposium on Epidemiology and Community Psychiatry, Groningen, September 1993

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jorm, A.F. The epidemiology of depressive states in the elderly: implications for recognition, intervention and prevention. Soc Psychiatry Psychiatr Epidemiol 30, 53–59 (1995). https://doi.org/10.1007/BF00794942

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00794942

Keywords

Search

Navigation