Older Adults - Depression

Of the more than 35 million older Americans, approximately 6 million suffer from depression and 1 million of these suffer from severe depression. Family members and health care professionals often fail to recognize depression among the elderly. Since 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 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 percent visit the doctor in the week before committing suicide, though frequently for chronic health problems rather than depression. However, their depression has apparently not been accurately diagnosed or effectively treated.

Depression is especially common in nursing homes. A survey (Thomas J. Mattimore, et al., "Surrogate and Physician Understanding of Patients' Preferences for Living Permanently in a Nursing Home," Journal of the American Geriatrics Society, vol. 45, no. 7, July 1997) found that some older people would rather die than live permanently in a nursing home. Further, some older adults commit "silent suicide." Feeling lonely, abandoned, or suffering financial woes, they 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.

In the United States the suicide rate generally increases with age. In 2001 the "oldest old" (85 years and older) accounted for the highest rate—17.5 suicides per 100,000 people. Men age 65 and older had a higher rate (31.5 suicides per 100,000), with the oldest old men (85 years and older)

TABLE 10.5
Cancer incidence and mortality rates by site, race, and ethnicity, 1996–2000¹

Incidence	White	African Americand Pacific	Asian American and Pacific Islander	American Indian and Alaska Native	Hispanic/Latino2
All sites
Males	555.9	696.8	392.0	259.0	419.3
Females	431.8	406.3	306.9	229.2	312.2
Breast (female)	140.8	121.7	97.2	58.0	89.8
Colon & rectum
Males	64.1	72.4	57.2	37.5	49.8
Females	46.2	56.2	38.8	32.6	32.9
Lung & bronchus
Males	79.4	120.4	62.1	45.6	46.1
Females	51.9	54.8	28.4	23.4	24.4
Prostate	164.3	272.1	100.0	53.6	137.2
Stomach
Males	11.2	19.9	23.0	14.4	18.1
Females	5.1	9.9	12.8	8.3	10.0
Liver & intrahepatic bile duct
Males	7.3	11.0	21.1	6.1	13.8
Females	2.8	3.9	7.7	5.5	5.6
Uterine cervix	9.2	12.4	10.2	6.9	16.8
Mortality
All sites
Males	249.5	356.2	154.8	172.3	176.7
Females	166.9	198.6	102.0	115.8	112.4
Breast (female)	27.2	35.9	12.5	14.9	17.9
Colon & rectum
Males	25.3	34.6	15.8	18.5	18.4
Females	17.5	24.6	11.0	12.1	11.4
Total	20.7	28.5	13.1	14.7	14.3
Lung & bronchus
Males	78.1	107.0	40.9	52.9	40.7
Females	41.5	40.0	19.1	26.2	15.1
Prostate	30.2	73.0	13.9	21.9	24.1
Stomach
Males	6.1	14.0	12.5	7.0	9.9
Females	2.9	6.5	7.4	4.2	5.3
Liver & intrahepatic bile duct
Males	6.0	9.3	16.1	7.6	10.5
Females	2.7	3.7	6.7	4.3	5.0
Uterine cervix	2.7	5.9	2.9	2.9	3.7
1Per 100,000, age-adjusted to the 2000 US standard population.
2Hispanic/Latinos are not mutually exclusive from whites, African Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives.
SOURCE: "Table 1. Incidence and Mortality Rates by Site, Race, and Ethnicity, US, 1996–2000," in Cancer Facts and Figures 2004, American Cancer Society, Atlanta, GA, 2004

most likely to commit suicide (51.1 per 100,000). In contrast, the rate among women 65 years and older was 3.9 suicides per 100,000 people, and that among women 85 and over was 3.4 suicides per 100,000. (See Table 6.1 in Chapter 6.)

By race, white men over the age of 75 had the highest suicide rate—40.2 suicides per 100,000 people for those 75 to 84 years, and 55.0 per 100,000 for those 85 years and older. (See Table 6.1 in Chapter 6.) One generally held theory about the very high rates of suicide among white men age 75 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.