Alastair Flint

Recognizing and treating depression in older people

Depression isn't just "having the blues." It's a disabling, even deadly disorder - and it's particularly common in older people living in institutions. Studying how best to treat depression and prevent relapse is the research focus of Dr. Alastair Flint, Adjunct Scientist at Toronto Rehab.

"Untreated depression can result in significant suffering and disability. People with depression frequently function at a lower than normal level - they may have difficulty caring for themselves or taking part in social activities. They are less likely to recover from concomitant physical illness. People with depression are more likely to die in the first year or two after a heart attack."

Most of Dr. Flint's patients are treated with antidepressant medication. They may also receive psychotherapy. Treatment is aimed at relieving depression and preventing relapse. This is important, because older people with depression are at high risk of future episodes. Treating them over a period of years significantly reduces this risk.

Depression is an all-too common problem. About 10 per cent of older people living in the community suffer from clinically significant depressive symptoms - roughly the same rate as other age groups. However, for older people living in institutions, the risk soars. As many as one-third of these people have depression.

"There is an association between physical illness and depression, as well as between dementia and depression," says Dr. Flint. "Many people in nursing homes are physically unwell and many have dementia. Both factors increase the risk of depression."

Sometimes, depression "masquerades" as other disorders, such as anxiety. "Some older people become very anxious or worried, constantly brooding on various concerns," says Dr. Flint. "When we dig down a little, we often find that they are depressed. We treat the depression and the anxiety improves.

"One symptom that we have looked at recently is fear of falling. In some older people, the fear is an appropriate response to falls. In others, however, the fear is excessive. In some cases, fear of falling prevents people from leaving their houses or even their chairs. They may become housebound or avoid basic activities such as taking a bath or shower. Many of these people are actually suffering from depression or an anxiety disorder."

Dr. Flint became interested in geriatrics during his internship. "I enjoy working with older people. Also, I was interested by the fact that older people have multiple, interacting problems that are best managed on a multidisciplinary basis. When I trained as psychiatrist, I was interested in geriatrics right from the start.

"One of the most satisfying aspects of my work is the astonishing improvement we see when treatment is successful. Some patients are so severely depressed they have become bedridden. They may not be eating or drinking, some have become incontinent, some delusional. After treatment, they become functioning individuals once more. These dramatic responses make my work very rewarding"