NCLIP

Depression in Older Adults

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Depression in Older Adults

Key Points

  • Depression is common in older adults but is not a normal part of aging.
  • Presentation may emphasize numbness, withdrawal, somatic concerns, or functional decline rather than sadness.
  • Prevention includes social connection, mobility support, chronic disease management, and early screening.
  • Treatment often combines psychotherapy, suicide-risk assessment, and carefully selected antidepressants.

Pathophysiology

Late-life depression reflects interaction among neurobiological aging changes, chronic disease burden, psychosocial losses, and reduced functional independence. Vascular disease, inflammation, polypharmacy, bereavement, and social isolation can all increase depressive vulnerability.

Symptoms may overlap with cognitive disorders; severe depression can produce reversible cognitive impairment (pseudodementia). Distinguishing depressive cognition from progressive neurocognitive decline is clinically critical.

Classification

  • Mild depression: Often managed with psychotherapy, social activation, and close follow-up.
  • Moderate to severe depression: Usually requires combined psychotherapy plus pharmacotherapy.
  • High-risk depression: Includes suicidal ideation, psychomotor slowing, or marked functional decline.

Nursing Assessment

NCLEX Focus

Always assess suicide risk directly when depression is suspected, even when clients deny feeling sad.

  • Assess mood, anhedonia, sleep, appetite, energy, concentration, and psychomotor changes.
  • Assess losses, grief burden, loneliness, and changes in ADLs/IADLs.
  • Assess suicide ideation, intent, plan, means, prior attempts, risk factors, and protective factors.
  • Assess medical comorbidities and medications that can worsen depressive symptoms.
  • Assess family stress, caregiver burden, and treatment adherence barriers.

Nursing Interventions

  • Promote structured daily routines, social engagement, and meaningful activities.
  • Reinforce psychotherapy attendance and monitor treatment response over time.
  • Implement safety planning and environmental protection when suicide risk is present.
  • Teach sleep hygiene, nutrition support, and activity pacing to improve energy and function.
  • Engage family in supportive communication and relapse-warning recognition.

Suicide Safety

Any positive suicide screen requires immediate risk stratification and active safety planning.

Pharmacology

SSRIs are commonly used in older adults due to favorable tolerability compared with many alternatives. Nurses monitor for early adverse effects, hyponatremia risk, falls, medication interactions, and functional impact. For severe or refractory episodes, electroconvulsive therapy may be considered and can be effective in older populations.

Clinical Judgment Application

Clinical Scenario

An older adult reports fatigue, withdrawal, and poor sleep after the death of a spouse, with declining self-care and missed meals.

Recognize Cues: Functional decline, isolation, and affective symptoms indicate possible major depression. Analyze Cues: Bereavement, medical burden, and social isolation are interacting contributors. Prioritize Hypotheses: Safety, nutrition, and suicide-risk assessment are top priorities. Generate Solutions: Initiate depression screening, social supports, psychotherapy referral, and medication review. Take Action: Coordinate interdisciplinary treatment and family education plan. Evaluate Outcomes: Improved participation, appetite, sleep, and reduced depressive severity.

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