Depression in the elderly causes a decrease in the quality of life. Subthreshold depression is also frequently observed in the elderly. In a study conducted in Germany, it was observed that the prevalence of depression in men aged 75 and over was 36.8/1000 in men and 46/1000 in women. In this study, it was observed that there was no significant difference between genders and the frequency of depression increased with age. Comorbidities, vision loss, mild cognitive impairment, memory problems, and smoking have been observed to be associated with depression in the elderly. In another study, female gender, financial problems, loneliness, physical diseases, and impairment in daily living activities were observed as risk factors. Depression is more common in hospitalized elderly people. Depression is common, especially in the elderly living in nursing homes, but it has been reported that it is not adequately recognized and treated. It has been observed that most cases of depression seen in older ages go unnoticed and do not receive treatment. There is no significant increase in the frequency of depression with advancing age. Although depression is more common especially in women, it has been observed that the difference decreases with advancing age.

It can be thought that depressive symptoms in the elderly may be caused by medical problems. In depressive patients with more physical symptoms, the diagnosis tends to be missed. Patients may deny symptoms of depression because psychiatric problems are stigmatized. Elderly depressed patients sometimes forget the symptoms they experience due to cognitive impairment. The patient's relative should observe the patient carefully, paying attention to introversion, weight loss, restlessness and sleep disorders. It is known that cognitive and physical symptoms are more prominent in the elderly. Forgetfulness, distraction, and cognitive slowing are common.

Depression, anxiety, hopelessness, anger, and thoughts of death may occur in the elderly. Pain perception increases, physical complaints increase, attention deficit and memory deficits are observed. Depression in the elderly is more resistant to treatment and less associated with psychological causes.

In a study conducted on the elderly in Turkey, low education level, female gender, being between the ages of 75-79, and having 4 or more children were observed as risk factors for depression in the elderly. Although depression is frequently observed in dementia; Depression increases the risk of dementia by 2-5 times and depression seen in older ages is a risk factor for dementia.

It is difficult to diagnose depression in patients with dementia, as symptoms such as disturbed sleep patterns, weight loss due to inability to cook or forgetting to eat, deterioration in social functioning, and decrease in self-esteem are similar to symptoms of depression. Situations in which depression should be suspected in patients with dementia: Sudden, unexplained cognitive impairment, dullness, decrease in physical activities, displaying an agitated, restless state, disruption of sleep patterns, loss of appetite, refusal to eat, rapid weight loss, having had depression in the past, having someone in the family with depression, the environment or caregiver is that it has changed. Depression causes deterioration in cognitive functions, decrease in quality of life and daily living activities, increased reaction towards caregivers, increased caregiver burden, additional diseases and increased treatment costs.

Suicide in the Elderly:

Yaşlılarda intihar, kadınlara göre daha fazladır. Daha çok yaşlı erkeklerde gözlenmektedir. İntihar yöntemleri kültere ve cinsiyete göre değişiklik göstermektedir. Genellikle erkekler, kadınlara göre daha vahşi ve ölümcül yöntemler seçmektedirler. Yaşlılarda yemek yememe , tedavi reddi gibi pasif intihar şekilleri de gözlenmektedir. Yaşlılarda ihtihar daha az gözlense de, intihar girişimlerinin daha fazla ölümle sonuçlandığı bilinmektdir. Türkiye’de intiharların %12’si 65 yaş ve üzerinde olup, erkeklerde iki-üç kat kadınlardan daha sık görülmekte; intiharların en sık bilinmeyen nedenlerle ve ası yoluyla gerçekleştiği bildirilmiştir. Türkiye’de intihar üzerine yapılan çalışmalarda, intiharın genellikle 80-84 yaş aralığında, ası yoluyla gerçekleştiği; yaş , ruhsal ve kronik fiziksel hastalıklar ve yalnızlık gibi faktörlerin eşlik ettiği; erkeklerde en sık finansal sorunlar, kadınlarda ise evlilik sorunları nedeniyle gerçekleştiği bildirilmiştir. Türkiye’de yaşlılarda intihar oranları az gözlenmekte, bunun da dini sebepler ve aile desteği kaynaklı olabileceği düşünülmüştür.

Dr. Gözde Ataöv
Psychiatrist and Psychotherapist

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