Clinical depression: The Underdiagnosed and Untreated Elderly

Clinical Depression: Underdiagnosed and Untreated

Although symptoms of clinical depression among the elderly are highly prevalent, they frequently go undetected, misdiagnosed, and untreated in both the community at large well as in long-term care facilities (Cohen et al., 2003;Soon & Levine, 2002; Brown, Lapane & Luisi, 2002; Teresi, et al., 2001).

Reynolds and colleagues (2002) have concluded that clinical depression in later life is common, yet it is often underdiagnosed in primary care settings, acute medical surgical facilities , and long-term care facilities. While there are many reasons given by researchers for the underdiagnosis of clinical depression among the community-based elderly, Hope (2003) has concluded that there is notable agreement in the research literature that the identification of depression in older people is problematic and consequently underdiagnosed, and under-treated.

Clinical depression in nursing homes:

Similar findings of underdiagnosis and lack of appropriate treatment of clinical depression has consistently been found in nursing homes and other types of long-term care facilities. Brown and associates (2002) have commented:

Late-life depression is recognized as an important public health issue and is more prominent in nursing homes than in communities. Prevalence rates of depression in older people residing in nursing homes are three to five times those older people living in the community. Despite increased awareness and the availability of effective treatment, including medication, psychotherapy, and electroconvulsive therapy, depression in nursing homes remains underrecognized and undertreated. Even when depression is recognized, fewer than one-quarter of those diagnosed receive treatment, and when they are treated with medications they often receive a suboptimal dose (p. 69).

Teresi and colleagues (2001) summarized data from several studies and concluded that despite the high prevalence of clinical depression symptoms among our nation’s seniors, evidence continues to support the contention that clinical depression is frequently not recognized in most health care settings, including nursing homes. One of the several studies referred to by the authors (Teresi, et al., 2001) found that only 15% - 27% of newly admitted nursing home residents were recognized as having clinical depression by nursing home staff. Also, in a separate study, they concluded that fewer than 25% of residents were recognized by nursing home physicians as being depressed and subsequently treated. They concluded that the primary reason for failure to treat depression in the elderly, is a failure to recognize it in the first place. Finally, Cohen, Hyland and Kimhy (2003) have commented: “Various studies conducted in the 1990s found that fewer than one-fourth of depressed patients were identified and treated by nursing home physicians” (p. 2012).

Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist) 

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