Depression and Loneliness in Geriatric Communities By: Vanessa Billingsley, MS4

Depression in Late Life“Late-life depression (occurring in persons 60 years of age

or older) is common and is often associated with coexisting medical illness, cognitive dysfunction, or both1.”

• Older adults who meet criteria for dysphoria may have higher risk of ADL/IADL impairment, psychologic distress, cognitive impairment, and death2.

• Elderly adults who are depressed tend to experience more somatic symptoms, anxiety, and irritability rather than low mood1.

Screening for Depression

• The Geriatric Depression Scale is a measure of depression based on self-reported answers to 30 questions.

• Targets elderly patients, who often present differently than younger patients.

• Originally designed and tested for validity in 19833

Photo: http://www.pgxmed.com/holiday-depression-elderly-adults/

Loneliness: Also Clinically Significant

´“Social isolation, loneliness, and lack of adequate support are social conditions that exact a significant toll on psychological well-being and physical health, with the costs of these conditions particularly high among retired and elder population4.”

´“With an increasing aging population, the effect [of loneliness] on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a ‘loneliness epidemic.’ The challenge we face now is what can be done about it5.”

Photo: http://www.mandfhealth.co.uk/a-minister-for-loneliness/

The American Psychological Association states that loneliness5:• May be more

detrimental to health than obesity.

• Has a significant effect on early death (equal to that of obesity).

“…loneliness was a predictor of functional decline and death6.“

What is Loneliness?• Subjective feeling of

being alone• Often but not always

associated with social isolation and/or social support4.

• Has been described as an “unfavorable balance between actual and desired social contact7.”

Non-integrated Integrated + -

!% LONELY "% LONELY

!

!actual!'!desired!social!contact!

Social!Network!

Alone!but!NOT!LONELY! Not!alone,!NOT!LONELY!

Alone!and!LONELY! Not!alone,!but!LONELY!

Is Loneliness Related to Depression?• Some postulate that decreased social

contacts seen among elderly individuals is explained by increase in social selectivity, suggesting that the elderly are not as lonely as we may think8.

• The same researchers state that aging adults concentrate their efforts on more satisfying relationships and that for older individuals the cost of interactions with less familiar acquaintances is higher than the benefit8, possibly explaining the loneliness experienced by those who are faced with the loss of a loved one or with abrupt change in living arrangements9.

• Others find that loneliness is underestimated and theorize that loneliness in later life can be thought of as a low-level depression for many who suffer from it10.

Photo: http://theconversation.com/the-deadly-truth-about-loneliness-43785

Both the extent of one’s social network and the subjective feeling of loneliness are highly and independently associated with depression in the elderly7.

Photo: http://blog.fshc.co.uk/blog-articles/health-care-best-practice/age-uk-report-identifying-understanding-and-supporting-loneliness-in-elderly-care-how-health-care-professionals-can-make-a-difference/

UCLA Loneliness Scale

• Measures loneliness in adults within a range of ages, including older adults.

• Consists of 20 questions, answered on a 4 point scale ranging from “never” to “always.”

• First presented in an article titled Developing a Measure of Loneliness in the Journal of Personality Assessment in 197811, and it has been modified twice since then.

Cross-Tabulation of Depression and loneliness Categories9

Hierarchical multiple regression model on Geriatric Depression Scale Scores9

Hierarchical multiple regression on UCLA Loneliness Score9

How Does This Apply to Our Patients?´ Limit the MODIFIABLE factors that

have a statistically significant association with depression9:

´ # OF HEALTH CONDITIONS

´ IDENTIFY AND SUPPORT THOSE WHO ARE GRIEVING

´ IDENTIFY WAYS TO INCREASE VISITS FROM NEIGHBORS

´ ENCOURAGE WEEKLY ACTIVITIES, INCLUDING RELIGIOUS AS APPROPRIATE

´ IDENTIFY THOSE PATIENTS WITH HIGHER LONLINESS SCORES

´ Limit the MODIFIABLE factors that have a statistically significant association with loneliness9:

´ IDENTIFY AND SUPPORT THOSE WHO ARE GRIEVING

´ IDENTIFY WAYS TO INCREASE VISITS FROM ADULT CHILDREN AND FRIENDS

´ IDENTIFY WAYS TO SUPPORT AN INCREASE IN SOCIAL NETWORK

SUMMARY´ Various forms of depression exist in geriatric populations, and elderly patients

who are depressed may present differently than younger patients. It is important to differentiate the cognitive decline suffered by depressed geriatric patients from that of those suffering from dementia 1,2,3.

´ Knowing the risk factors for depression in this population and using the Geriatric Depression Scale can be useful tools to screen for depression among these patients3,9.

´ Loneliness, which can be measured using the UCLA loneliness scale, is not equal to depression but is related to it. It is an independent risk factor for depression. Notably, loneliness itself has its own risk factors8,9,10,11.

´ Loneliness is a clinically significant social factor and is predictive of mortality and functional decline4,5,6,7.

´ When working with elderly patients, being able to identify and optimize risk and resilience factors for both depression and loneliness is important and worthwhile. Depression among the elderly is associated with comorbidities and mortality, and identifying/treating the patients at risk has the potential to markedly improve their lives.

Citations

1. Taylor, W. D. (2014). Depression in the elderly. New England journal of medicine, 371(13), 1228-1236.

2. Gallo, J. J., Rabins, P. V., Lyketsos, C. G., Tien, A. Y., & Anthony, J. C. (1997). Depression without sadness: functional outcomes of nondysphoric depression in later life. Journal of the American Geriatrics Society, 45(5), 570-578.

3. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of psychiatric research, 17(1), 37-49.

4. Tomaka, J., Thompson, S., & Palacios, R. (2006). The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of aging and health, 18(3), 359-384.

5. So Lonely I Could Die. (2017, August 5). Retrieved July 2, 2018, from http://www.apa.org/news/press/releases/2017/08/lonely-die.aspx

6. Perissinotto, C. M., Cenzer, I. S., & Covinsky, K. E. (2012). Loneliness in older persons: a predictor of functional decline and death. Archives of internal medicine, 172(14), 1078-1084.

7. Golden, J., Conroy, R. M., Bruce, I., Denihan, A., Greene, E., Kirby, M., & Lawlor, B. A. (2009). Loneliness, social support networks, mood and wellbeing in community-­‐dwelling elderly. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 24(7), 694-700.

8. Carstensen, L. L. (1992). Social and emotional patterns in adulthood: support for socioemotional selectivity theory. Psychology and aging, 7(3), 331.

9. Adams, K. B., Sanders, S., & Auth, E. A. (2004). Loneliness and depression in independent living retirement communities: risk and resilience factors. Aging & mental health, 8(6), 475-485.

10. Cohen, G. D. (2000). Loneliness in later life.

11. Russell, D., Peplau, L. A., & Ferguson, M. L. (1978). Developing a measure of loneliness. Journal of personality assessment, 42(3), 290-294.