Older Adults - Depression

According to the American Association of Geriatric Psychiatry, more than six million of the more than forty million Americans over the age of sixty-five suffer from depression. Family members and health care professionals often fail to recognize depression among the elderly. Because older people usually suffer from comorbidity (the presence of more than one chronic illness at one time), depression may be masked by the symptoms of other disorders.

The older adult suffering from depression may mistakenly think that depression is simply a reaction to an illness, loss, or a consequence of aging. Many sufferers fail to divulge their depression because of the stigma associated with mental illness.

Suicide

According to Dr. Barry D. Lebowitz, chief of the Adult and Geriatric Treatment and Preventive

TABLE 10.5 Probability of developing invasive cancers over selected age intervals, by sex, 2000–02 "Probability of Developing Invasive Cancers over Selected Age Intervals by Sex, US, 2000 to 2002," in Cancer Facts and Figures 2006, American Cancer Society, January 2006, http://www.cancer.org/downloads/stt/CAFF06Prob.pdf (accessed February 27, 2006). Copyright 2006 American Cancer Society, Inc. Reprinted with permission.

TABLE 10.5
Probability of developing invasive cancers over selected age intervals, by sex, 2000–02
	Birth to 39 (percent)	40 to 59 (percent)	60 to 69 (percent)	70 & older (percent)	Birth to death (percent)
Note: Data are for those free of cancer at beginning of age interval. Based on cancer cases diagnosed during 2000 to 2002.
aAll sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
bIndudes invasive and in situ cancer cases.
SOURCE: "Probability of Developing Invasive Cancers over Selected Age Intervals by Sex, US, 2000 to 2002," in Cancer Facts and Figures 2006, American Cancer Society, January 2006, http://www.cancer.org/downloads/stt/CAFF06Prob.pdf (accessed February 27, 2006). Copyright 2006 American Cancer Society, Inc. Reprinted with permission.
All sitesa
Male	1.43 (1 in 70)	8.57 (1 in 12)	16.46 (1 in 6)	39.61 (1 in 3)	45.67 (1 in 2)
Female	1.99 (1 in 50)	9.06 (1 in 11)	10.54 (1 in 9)	26.72 (1 in 4)	38.09 (1 in 3)
Urinary bladderb
Male	.02 (1 in 4,375)	.40 (1 in 250)	.93 (1 in 108)	3.35 (1 in 30)	3.58 (1 in 28)
Female	.01 (1 in 9,513)	.12 (1 in 816)	.25 (1 in 402)	.96 (1 in 104)	1.14 (1 in 88)
Breast
Female	.48 (1 in 209)	4.11 (1 in 24)	3.82 (1 in 26)	7.13 (1 in 14)	13.22 (1 in 8)
Colon & rectum
Male	.07 (1 in 1,399)	.90 (1 in 111)	1.66 (1 in 60)	4.94 (1 in 20)	5.84 (1 in 17)
Female	.06 (1 in 1,567)	.70 (1 in 143)	1.16 (1 in 86)	4.61 (1 in 22)	5.51 (1 in 18)
Leukemia
Male	.15 (1 in 650)	.22 (1 in 459)	.35 (1 in 284)	1.17 (1 in 85)	1.50 (1 in 67)
Female	.13 (1 in 788)	.14 (1 in 721)	.19 (1 in 513)	.78 (1 in 129)	1.07 (1 in 93)
Lung & bronchus
Male	.03 (1 in 3,244)	1.00 (1 in 100)	2.45 (1 in 41)	6.33 (1 in 16)	7.58 (1 in 13)
Female	.03 (1 in 3,103)	.80 (1 in 125)	1.68 (1 in 60)	4.17 (1 in 24)	5.72 (1 in 17)
Melanoma of skin
Male	.13 (1 in 800)	.51 (1 in 195)	.51 (1 in 195)	1.25 (1 in 80)	1.94 (1 in 52)
Female	.21 (1 in 470)	.40 (1 in 248)	.26 (1 in 381)	.56 (1 in 178)	1.30 (1 in 77)
Non-Hodgkin lymphoma
Male	.14 (1 in 722)	.47 (1 in 215)	.56 (1 in 178)	1.57 (1 in 64)	2.18 (1 in 46)
Female	.09 (1 in 1,158)	.31 (1 in 320)	.42 (1 in 237)	1.29 (1 in 77)	1.82 (1 in 55)
Prostate
Male	.01 (1 in 10,149)	2.66 (1 in 38)	7.19 (1 in 14)	14.51 (1 in 7)	17.93 (1 in 6)
Uterine cervix
Female	.15 (1 in 657)	.28 (1 in 353)	.15 (1 in 671)	.22 (1 in 464)	.74 (1 in 135)
Uterine corpus
Female	.06 (1 in 1,641)	.72 (1 in 139)	.83 (1 in 120)	1.36 (1 in 74)	2.61 (1 in 38)

Intervention Research Branch of the National Institute of Mental Health, almost all older people who commit suicide suffer from depression. Most suicidal older adults visit their primary care physician during the month before ending their lives, and approximately 40% visit the doctor in the week before committing suicide, though frequently for chronic health problems rather than depression. However, their depression apparently had not been accurately diagnosed or effectively treated.

Depression is especially common in nursing homes. Richard N. Jones and his colleagues determined that at least 20% of nursing home residents suffer from clinical depression ("Prevalence and Correlates of Recognized Depression in U.S. Nursing Homes," Journal of the American Geriatric Society, vol. 51, no. 10, October 2003). The researchers believe that this may be an underrepresentation of the magnitude of the problem. They note that depression in long-term care settings such as nursing homes is often unrecognized. In addition, when depression is recognized it is often undertreated, treated inadequately, or treated inappropriately.

Feeling lonely, abandoned, or suffering financial woes, many depressed nursing home residents end their lives by nonviolent means such as starving themselves, failing to take prescribed medication, or ingesting large amounts of drugs. This type of suicide, as a result of depression, is different from that committed by the terminally ill who, not wishing to prolong the dying process, refuse life-sustaining medical treatment.

TABLE 10.6 Cancer incidence and mortality rates by site, race, and ethnicity, 1998–2002 "Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1998–2002," in Cancer Facts and Figures 2006, American Cancer Society, January 2006, http://www.cancer.org/downloads/stt/CAFF06IrMr.pdf (accessed February 27, 2006). Copyright 2006 American Cancer Society, Inc. Reprinted with permission.

TABLE 10.6
Cancer incidence and mortality rates by site, race, and ethnicity, 1998–2002
Incidence	White	African American	Asian American and Pacific Islander	American Indian and Alaska Native	Hispanic/Latino*
Note: Data are per 100,000, age-adjusted to the 2000 US standard population.
*Hispanic/Latinos are not mutually exclusive from whites, African Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives.
SOURCE: "Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1998–2002," in Cancer Facts and Figures 2006, American Cancer Society, January 2006, http://www.cancer.org/downloads/stt/CAFF06IrMr.pdf (accessed February 27, 2006). Copyright 2006 American Cancer Society, Inc. Reprinted with permission.
All sites
Males	556.4	682.6	383.5	255.4	420.7
Females	429.3	398.5	303.6	220.5	310.9
Breast (female)	141.1	119.4	96.6	54.8	89.9
Colon & rectum
Males	61.7	72.5	56.0	36.7	48.3
Females	45.3	56.0	39.7	32.2	32.3
Lung & bronchus
Males	76.7	113.9	59.4	42.6	44.6
Females	51.1	55.2	28.3	23.6	23.3
Prostate	169.0	272.0	101.4	50.3	141.9
Stomach
Males	10.7	17.7	21.0	15.9	17.2
Females	5.0	9.6	12.0	9.1	10.1
Liver & bile duct
Males	7.4	12.1	21.4	8.7	14.1
Females	2.9	3.7	7.9	5.2	6.1
Uterine cervix	8.7	11.1	8.9	4.9	15.8
Mortality
All sites
Males	242.5	339.4	148.0	159.7	171.4
Females	164.5	194.3	99.4	113.8	111.0
Breast (female)	25.9	34.7	12.7	13.8	16.7
Colon & rectum
Males	24.3	34.0	15.8	16.2	17.7
Females	16.8	24.1	10.6	11.8	11.6
Lung & bronchus
Males	75.2	101.3	39.4	47.0	38.7
Females	41.8	39.9	18.8	27.1	14.8
Prostate	27.7	68.1	12.1	18.3	23.0
Stomach
Males	5.6	12.8	11.2	7.3	9.5
Females	2.8	6.3	6.8	4.1	5.3
Liver & bile duct
Males	6.2	9.5	15.4	7.9	10.7
Females	2.7	3.8	6.5	4.3	5.1
Uterine cervix	2.5	5.3	2.7	2.6	3.5

In the United States the suicide rate generally increases with age. In 2002 the "oldest old" (eighty-five years and older) accounted for the highest rate—eighteen suicides per one hundred thousand people. Men age sixty-five and older had a higher rate (31.8 suicides per one hundred thousand), with the oldest old men (age eighty-five and older) most likely to commit suicide (50.7 per one hundred thousand). In contrast, the rate among women age sixty-five and older was 4.1 suicides per one hundred thousand people, and that among women age eighty-five and over was 3.8 suicides per one hundred thousand. (See Table 6.1 in Chapter 6.)

By race, white men over the age of seventy-five had the highest suicide rate—40.6 suicides per one hundred thousand people for those ages seventy-five to eighty-four, and 53.9 per one hundred thousand for those age eighty-five and older. (See Table 6.1 in Chapter 6.) One generally held theory about the very high rates of suicide among white men age seventy-five and over is that they have traditionally been in positions of power and thus have great difficulty adjusting to a life they may consider useless or diminished.

TABLE 10.7 Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years 1950–2002

TABLE 10.7
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years 1950–2002
[Data are based on death certificates]
Sex, race, Hispanic origin, and age	1950a	1960a	1970	1980	1990	2000	2001	2002
All persons	Deaths per 100,000 resident population
All ages, age adjustedb	180.7	177.9	147.7	96.2	65.3	60.9	57.9	56.2
All ages, crude	104	108	101.9	75.0	57.8	59.6	57.4	56.4
Under 1 year	5.1	4.1	5.0	4.4	3.8	3.3	2.7	2.9
1-4 years	0.9	0.8	1.0	0.5	0.3	0.3	0.4	0.3
5-14 years	0.5	0.7	0.7	0.3	0.2	0.2	0.2	0.2
15-24 years	1.6	1.8	1.6	1.0	0.6	0.5	0.5	0.4
25-34 years	4.2	4.7	4.5	2.6	2.2	1.5	1.5	1.4
35-44 years	18.7	14.7	15.6	8.5	6.4	5.8	5.5	5.4
45-54 years	70.4	49.2	41.6	25.2	18.7	16.0	15.1	15.1
55-64 years	194.2	147.3	115.8	65.1	47.9	41.0	38.0	37.2
65-74 years	554.7	469.2	384.1	219.0	144.2	128.6	123.4	120.3
75-84 years	1,499.6	1,491.3	1,254.2	786.9	498.0	461.3	443.9	431.0
85 years and over	2,990.1	3,680.5	3,014.3	2,283.7	1,628.9	1,589.2	1,500.2	1,445.9
Male
All ages, age adjustedb	186.4	186.1	157.4	102.2	68.5	62.4	59.0	56.5
All ages, crude	102.5	104.5	94.5	63.4	46.7	46.9	45.2	44.2
Under 1 year	6.4	5.0	5.8	5.0	4.4	3.8	3.1	3.2
1-4 years	1.1	0.9	1.2	0.4	0.3	*	0.3	0.4
5-14 years	0.5	0.7	0.8	0.3	0.2	0.2	0.2	0.2
15-24 years	1.8	1.9	1.8	1.1	0.7	0.5	0.5	0.5
25-34 years	4.2	4.5	4.4	2.6	2.1	1.5	1.6	1.4
35-44 years	17.5	14.6	15.7	8.7	6.8	5.8	5.7	5.3
45-54 years	67.9	52.2	44.4	27.2	20.5	17.5	16.7	16.7
55-64 years	205.2	163.8	138.7	74.6	54.3	47.2	43.4	42.7
65-74 years	589.6	530.7	449.5	258.6	166.6	145.0	140.4	135.0
75-84 years	1,543.6	1,555.9	1,361.6	866.3	551.1	490.8	467.3	445.9
85 years and over	3,048.6	3,643.1	2,895.2	2,193.6	1,528.5	1,484.3	1,380.2	1,317.9
Female
All ages, age adjustedb	175.8	170.7	140.0	91.7	62.6	59.1	56.4	55.2
All ages, crude	105.6	111.4	109.0	85.9	68.4	71.8	69.2	68.2
Under 1 year	3.7	3.2	4.0	3.8	3.1	2.7	2.3	2.5
1-4 years	0.7	0.7	0.7	0.5	0.3	0.4	0.4	0.3
5-14 years	0.4	0.6	0.6	0.3	0.2	0.2	0.2	0.2
15-24 years	1.5	1.6	1.4	0.8	0.6	0.5	0.5	0.3
25-34 years	4.3	4.9	4.7	2.6	2.2	1.5	1.5	1.4
35-44 years	19.9	14.8	15.6	8.4	6.1	5.7	5.4	5.5
45-54 years	72.9	46.3	39.0	23.3	17.0	14.5	13.6	13.6
55-64 years	183.1	131.8	95.3	56.8	42.2	35.3	32.9	32.1
65-74 years	522.1	415.7	333.3	188.7	126.7	115.1	109.3	108.1
75-84 years	1,462.20	1,441.10	1,183.10	740.1	466.2	442.1	428.6	421.2
85 years and over	2,949.4	3,704.4	3,081.0	2,323.1	1,667.6	1,632.0	1,550.4	1,501.5
White malec
All ages, age adjustedb	182.1	181.6	153.7	98.7	65.5	59.8	56.5	54.2
All ages, crude	100.5	102.7	93.5	63.1	46.9	48.4	46.6	45.7
45-54 years	53.7	40.9	35.6	21.7	15.4	13.6	12.7	12.9
55-64 years	182.2	139	119.9	64.0	45.7	39.7	36.1	35.6
65-74 years	569.7	501.0	420.0	239.8	152.9	133.8	128.5	123.8
75-84 years	1,556.3	1,564.8	1,361.6	852.7	539.2	480.0	458.8	437.5
85 years and over	3,127.1	3,734.8	3,018.1	2,230.8	1,545.4	1,490.7	1,386.2	1,327.4
Black or African American malec
All ages, age adjustedb	228.8	238.5	206.4	142.0	102.2	89.6	85.4	81.7
All ages, crude	122.0	122.9	108.8	73.0	53.0	46.1	44.6	43.5
45-54 years	211.9	166.1	136.1	82.1	68.4	49.5	48.8	46.5
55-64 years	522.8	439.9	343.4	189.7	141.7	115.4	111.9	110.3
65-74 years	783.6	899.2	780.1	472.3	326.9	268.5	269.2	262.9
75-84 yearsd	1,504.9	1,475.2	1,445.7	1,066.3	721.5	659.2	613.9	587.8
85 years and over	—	2,700.0	1,963.1	1,873.2	1,421.5	1,458.8	1,349.1	1,252.2