ABSTRACT
INTRODUCTION: THE UNIQUE CHARACTERISTICS OF DEPRESSION IN LATER LIFE The high prevalence, frequent recurrence, and serious consequences of depressive disorders among young and middle-aged adults are well recognized, yet the nature and consequences of depressive states in later life are less widely appreciated by health care providers and by the public. Although demographic studies indicate a low absolute prevalence of Major Depressive Disorder among community-dwelling elderly Americans, depressive symptoms and nonmajor depressive syndromes are common and debilitating in the elderly. The prevalence of major and nonmajor depressive states in medical and long-term care settings, moreover, is very high. In nursing homes, for example, depressive symptoms or syndromes are estimated to affect more than 40% of residents. These numbers take on alarming significance in light of the recent findings that link the presence of depression in later life with impaired functioning, diminished quality of life, excess use of nonpsychiatric medical services, and potentially dire health consequences including early mortality from suicide and other causes. Fortunately, the past decade has seen outstanding advances in our knowledge of depression’s characteristic clinical manifestations in older adults as well as its pathophysiology and optimal treatments.
