Abstract
This chapter considers the presentation of anxiety and depression in older people and explores the challenges clinicians face in making a diagnosis in the face of multiple health problems. Depression is a major global public health threat, and by 2030, depressive disorders are predicted to be the second leading cause of disease burden and disability worldwide. Anxiety and depression commonly overlap or co-exist. Loneliness and depression are strongly associated in older people, and loneliness is an independent risk factor for depression. Depression and anxiety are more prevalent in people with long-term physical conditions, and untreated anxiety and depression leads to increased use of health and social care services and raised mortality.
This chapter discusses the challenges in making a diagnosis of anxiety and/or depression in the older person, particularly in people with co-morbid physical conditions and emphasises the importance of assessment of risk of self-harm and suicide in an older person with depression.
Two case studies are included to provide examples of the complexities of presentation of anxiety and depression in older people.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.
Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010. PLoS Med. 2013;10(11):e1001547.
Laidlaw K, Pachana N. Ageing, mental health and demographic change: challenges for psychotherapists. Prof Psychol Res Pract. 2009;40(6):601–8.
Blazer D. Protection from late life depression. Int Psychogeriatr. 2010;22(2):171–3.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic disease and decrements in health. Results from the world health surveys. Lancet. 2007;370:851–8.
Zhang MWB, Ho RCM, Cheung MWL, Fu E, Mak A. Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression. Gen Hosp Psychiatry. 2011;33:217–23.
Katon W, Ciechanowski P. Impact of major depression on chronic medical illness. J Psychosom Res. 2002;53(4):859–63.
Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman E, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D. Collaborative care for participants with depression and chronic illness. N Engl J Med. 2010;363:2611–20.
Gallo JJ, Morales KH, Bogner H, Raue PJ, Zee J, Bruce M, Reynolds C. Long term effects of depression care management on mortality in older adults: follow-up of a cluster randomized clinical trial in primary care. BMJ. 2013;346:f2570.
Heikkinen RL, Kauppinen M. Depressive symptoms in late life: a 10-year follow-up. Arch Gerontol Geriatr. 2004;38:239–50.
Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging. 2006;21(1):140–51.
Chew-Graham CA, Burns A, Baldwin RC. Treating depression in later life: we need to implement the evidence that exists. BMJ. 2004;329:181–2 [Invited Editorial].
Coventry P, Hays R, Dickens C, Bundy C, Garrett C, Cherrington A, Chew-Graham CA. Talking about depression: barriers to managing depression in people with long term conditions in primary care. BMC Fam Pract. 2011;12:10.
Burroughs H, Morley M, Lovell K, Baldwin R, Burns A, Chew-Graham CA. “Justifiable depression”: how health professionals and patients view late-life depression; a qualitative study. Fam Pract. 2006;23:369–77.
Maxwell, et al. A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK. BMC Fam Pract. 2013;14:46.
National Institute for Health and Clinical Excellence. Depression: the treatment and management of depression in adults (update) CG90. London: National Institute for Health and Clinical Excellence; 2009.
National Institute for Health and Clinical Excellence. Depression in adults with a chronic physical health problem. CG91. London: National Institute for Health and Clinical Excellence; 2009.
Buszewicz M, Chew-Graham CA. Improving detection and management of anxiety disorders in primary care. BJGP. 2011;589:489–90 [Invited Editorial].
National Institute for Health and Clinical Excellence. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. CG113. London: National Institute for Health and Clinical Excellence; 2011.
Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Eisner MD, et al. Influence of anxiety on health outcomes in COPD. Thorax. 2010;65(3):229–34.
Coventry PA, Gemmell I, Todd CJ. Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study. BMC Pulm Med. 2011;11:49.
Katon W, Russo J, Lin EHB, Schmittdiel J, Ciechanowski P, Ludman E, et al. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Arch Gen Psychiatry. 2012;69(5):506–14.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Chew-Graham, C.A. (2016). Anxiety and Depression in Older People: Diagnostic Challenges. In: Chew-Graham, C., Ray, M. (eds) Mental Health and Older People. Springer, Cham. https://doi.org/10.1007/978-3-319-29492-6_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-29492-6_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-29490-2
Online ISBN: 978-3-319-29492-6
eBook Packages: MedicineMedicine (R0)