Grumpy Old Men (and Women)

Clinical characteristics may accompany mood symptoms in depressed elderly

/ Author:  / Reviewed by: Joseph V. Madia, MD

When Grandma or Grandpa starts cursing or using aggressive language, it may be time to have them evaluated for depression.

In fact, in a recent study of nursing home patients conducted by the University of Missouri in Columbia, those who began using aggressive language in their Golden Years were 69 percent more likely to be diagnosed with depression.

The American Geriatrics Society has compiled a list of clinical characteristics that elderly patients may develop as depression increases among the elderly population. These characteristics include: verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability and decline in performance of daily living activities. Since there are common symptoms among elderly patients, depression – which the AGS estimates affects some 30 percent to 40 percent of nursing home residents – often goes undiagnosed.

“Many elderly people develop certain clinical characteristics at the same time they develop depression,” said Lorraine Phillips, assistant professor in the Sinclair School of Nursing at UM-Columbia. “Understanding these changes is essential to quickly and accurately diagnosing depression in nursing home residents.”

Depression is normally accompanied by symptoms such as increased agitation, a dramatic change in appetite, difficulty concentrating, feelings of worthlessness and loss of interest in activities that were once pleasurable. The disorder is currently diagnosed using several methods that emphasize mood symptoms. These methods include patient interviews and reports of depression symptoms.

“Since elderly depression may appear with non-mood symptoms, these characteristics identified in this study can help diagnose depression that may be overlooked by traditional screening methods,” Phillips said.

Researchers looked at some 14,000 nursing home patients aged 65 and older who were not previously diagnosed with depression. They found that men and women were equally susceptible to developing depression. That finding contrasts with general-population figures, in which women are more likely to develop the disorder. A decline in daily-living activities like feeding and dressing one’s self were seemingly associated with elevated depression diagnosis.

So if Grandpa unleashes a tirade or Grandma offends you with some surprising, off-color language this Thanksgiving, talk with him or her about their feelings.

There are a number of treatments available for depression, including tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin re-uptake inhibitors (SSRIs) and some newer antidepressant drugs. These medications in conjunction with psychotherapy have proven to be most effective. If left untreated, depression can lead to a lower quality of life and even suicide. 

“Prompt diagnosis and treatment of depression is essential to improve the quality of life for nursing home residents,” Philips said.

And even if an elderly loved one isn’t living in a nursing home, it’s still be a good idea to keep an eye out for changes in mood as well as the clinical markers indicated above.

Reviewed by: 
Review Date: 
November 17, 2010