Diagnosis of depression in the elderly

| The diagnosis of depression is a clinical diagnosis, that is, it is based on the questioning and the medical history, detecting the psychic and somatic symptoms present in the elderly with suspected depression.

For this, and especially in the elderly, a high index of suspicion is necessary, due to the characteristic features of this condition in geriatric patients and to avoid the tendency to confuse it as something typical of aging.

There are instruments in the form of questionnaires or scales that serve as screening, detection and follow-up tools, useful in this age group, but which by themselves do not provide the diagnosis; they are helpful but should not be a substitute for clinical questioning.

The diagnosis of depression in the elderly is eminently made through medical history. The questioning of these patients presents additional difficulties due to the frequent lack of emotional expressiveness (very often cultural), hearing or communication problems with the patient and the frequent and erroneous assumption by the patient of sadness as an inherent state of old age, as well as the denial of the picture as something pathological.

Therefore, it is recommended for the interview to approach the patient showing empathy, treating him with respect and education, staying physically and emotionally close, speaking clearly and slowly and with the appropriate volume, paying close attention to non-verbal communication and allowing enough time to the answers, without finishing the patient's sentences, during the clinical interview.

In this, a diagnostic evaluation will be carried out that must include a complete medical history: when did the symptoms begin, how long have they lasted, how serious and intense are they? If the patient has had them before, the doctor should find out if the symptoms were treated and what treatment was given.

The doctor should also ask about the use of alcohol and drugs and about possible thoughts of death or suicide on the part of the patient. Also, the interview should include questions about other family members: Has any relative had depression and, if treated, what treatments did they receive and what treatments were effective?

It is also interesting to carry out a general analysis to rule out somatic causes of depressive symptoms, such as hormonal changes (especially thyroid), hydroelectrolyte or mineral salts, blood glucose levels, etc. If necessary, neurological imaging tests (scan or MRI) may be considered.

Various tools, such as specific scales to assess the presence of depression in the elderly, self-esteem and suicidal ideation, psychometric tests to assess the main areas of intellectual functions or possible cognitive impairment (recent memory, remote memory, etc. ), as well as the functional assessment scales, can help to establish with greater reliability the diagnosis of depression, the type of depression that the patient presents and its degree of severity, in order to better adjust the necessary treatment.