This article is for health professionals and is written by Associate Professor Stephen Macfarlane, Monash University.
Depression often presents differently in older people compared with younger populations, and in the setting of dementia, differences can be even greater, making diagnosis challenging.
Treatment of depression in older people is similar to that of any patient, albeit with particular consideration of the effects of medications on age-specific factors, such as falls risk, balance, confusional states and orthostatic hypotension.
Presentations of depression differ in older people, often appearing as prominent lethargy or hypochondriacal concerns, insomnia, anxiety, nervousness and irritability.
Older people are less likely to self-identify as having a depressed or low mood.
The presence of symptoms, including sleep and appetite changes, decreased psychomotor activity, poor concentration, indecision and fatigue, are more likely to be seen as part of a major depression in older people.
An older person presenting with a change in mood with no obvious precipitant should be assessed for a cognitive diagnosis.
Treatment for older people with depression is similar to that for any patient, and medication selection should be based on the patient’s symptoms and drug factors.
Measurable and observable traits, such as changes in sleep and appetite, can help in diagnosing depression in older people with dementia.