For several years now, nursing as well as other health care disciplines have identified depression in the elderly as a major problem. In many discussions, however, there seems to be an implied acceptance of depression as a natural concomitant of aging and therefore, depression is seen as normal and natural for the ederly. Although depression in persons of all ages may be recurrent and/or long lasting, depression is treatable. Further, depressions are not all the same and should not be considered as such. Some depressions indeed are self limiting and transient, but many more are not of this type. For caregivers to assume that depression in the elderly is expected and a similar phenomena in all cases in essence makes addressing the condition untreatable.
Zarit stated that the most critical step in treating depression in the elderly is conducting an individualized assessment.* Based upon a past history, the condition may be identified as, for example, a bipolar or a reactive depression.
History is especially important in the elderly, for the treatment of recurrent depressive episodes is likely to respond to the same treatment which was found effective in the past; when the depression is severe, and no known précipitants are reported, medication is usually considered. But as with all medication and the elderly, the dosage should be calibrated to fit the size and weight of the individual, interaction effects with other drugs considered, and the person must be monitored closely for reactions. Any and all ui.usual behaviors following the start of a drug should be considered a potential drug reaction until ruled otherwise.
Drug treatment is not the only treatment for depression in the elderly and may not be the treatment of choice. Physical activity, a change of scene, someone to talk with, pet therapy, supportive and cognitive therapies have all been useful in treating these depressions. Probably the worst thing that can happen is to have caregivers consider depression in the elderly normal and/or natural.