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INTRODUCTION

The geriatric population of the United States is projected to more than double by the year 2050, boosted in a large part by the aging Baby Boomer generation. Nearly 20% of people over the age of 60 have a psychiatric disorder. The suicide rate of elderly (aged 85 and older) white men is five times the national average.

Common diagnoses in elderly patients include mood disorders, anxiety disorders, and neurocognitive disorders, though many psychiatric disorders in this population remain underreported and untreated.

image  WARDS TIP

Work up an elderly patient for major depression when they present with memory loss or nonspecific physical complaints.

NORMAL AGING

Factors associated with normal aging include:

  • Decreased brain weight/enlarged ventricles and sulci.

  • Decreased muscle mass/increased fat.

  • Impaired vision and hearing.

  • Minor forgetfulness (sometimes called age-associated memory impairment or benign senescent forgetfulness).

MAJOR DEPRESSION

Major depression is a common disorder in the geriatric population, with depressive symptoms present in 5–15% of the elderly. Depression is associated with poor physical health:

  • Post-myocardial infarction (MI) patients who develop depression have a four times increased rate of death.

  • Stroke patients who develop depression have a greater than three times increased rate of death during the 10 years following their stroke.

  • Patients with depression newly admitted to nursing homes have an increase in 1-year mortality rate.

image  WARDS TIP

Patients with a major neurocognitive disorder are more likely to confabulate when they do not know an answer, whereas depressed patients may just say that they don’t know. When pressed for an answer, depressed patients will often show the ability to answer correctly.

PSEUDODEMENTIA

Symptoms of major depression in the elderly often include problems with memory and cognitive functioning. Because this clinical picture may be mistaken for a major neurocognitive disorder (dementia), it is termed pseudodementia.

Pseudodementia is the presence of apparent cognitive deficits in patients with major depression. Patients may appear to be suffering from a neurocognitive disorder (dementia); however, their symptoms are secondary to their underlying depression, although it can be difficult to differentiate the two (see Table 9-1).

TABLE 9-1.Dementia versus Pseudodementia (Depression)

image  WARDS QUESTION

Q: What is the most common psychiatric disorder in the elderly?

A: Major depressive disorder.

Treatment

  • Supportive psychotherapy.

  • Community resources: ...

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