Depression is the most common psychiatric diagnosis over the age of 65 however it is often not appreciated in the ED. Geriatric depression has several features which make it different from our usual picture of the younger depressed person:
Older people who are depressed are:
- LESS likely to complain directly of depressed mood, sadness, or dysphoria
- MORE likely to complain of somatic complaints often to the point of hypochondriasis
- MORE likely to demonstrate psychomotor retardation to the point that the depression can be mistaken for dementia
- MORE likely to express worthlessness or self-devaluing
- MORE likely to complete a first attempt at suicide – particular risk factors are male gender, living alone, co-morbid illnesses, substance/alcohol use
Given the atypical presentation of this potentially high-risk condition, it’s valuable to keep depression in mind when evaluating the frequent flyer, or the vague historian with multiple complaints or the older person with weakness who just isn’t the same as he usually is.
Sleep changes: sleepy through the day or sleepless at night;
Interest: loss of interest in activities that used to interest them;
Guilt (worthless): depressed elderly tend to devalue themselves;
Energy: lack of energy or general fatigue is a common presenting complaint;
Cognition/Concentration: reduced cognition &/or difficulty concentrating;
Appetite/Weight: usually declined;
Psychomotor: agitation (anxiety) or retardations (lethargic);
Suicide or a preoccupation with death
Assessment for Depression
One validated quick tool is the ED-Depression Screen Instrument – Fabacher, 2002” Validation of a Brief Screening Tool to Detect Depression in the Older Patient – from Science Direct: Fabacher et al Am J Emerg Med 2002;20:99-102
- Do you often feel sad or depressed?
- Do you often feel helpless?
- Do you often feel down-hearted or blue?