Although elderly people experience disruptive changes and are constantly faced with the challenges that accompany old age, according to the American Association for Geriatric Psychiatry, the vast majority of elderly people adapt well and do not develop depression. However, the association reports that a minority do develop clinical depression. Although the method of diagnosing an elderly patient is the same as diagnosing any patient, there are several specific issues to consider when assessing an elderly person.
Step 1
Conduct a diagnostic assessment interview. Alter the direction of the interview to thoroughly explore physical complaints which are not explained by a medical problem or the normal aging process.Clinical depression often manifests as these types of complaints in the elderly. Delusions are also more likely in late-onset depression than in younger people. Fully explores this area of symptomology while being careful to not mistake such symptoms for a psychotic disorder. The format and structure for this type of interview can be found in Michelle Karel's 2002 book ""Assessing and Treating Late-Life Depression."
Step 2
Administer the Geriatric Depression Scale (GDS), a common assessment tool fordiagnosing depression in the elderly. The GDS focuses on the elder's own perception of his moods. Use this assessment tool to clarify and open up further discussion about the possibility of depression, as opposed to using it as a tool to definitively diagnose depression.
Step 3
Interview the person to establish a baseline for previous activity levels. Compare the baseline established with the elder's current activity level. Make this comparison to distinguish between the natural aging process and behavioral impairments caused by depression. Sudden or severe behavioral changes over the last six months, which cannot be explained by a medical condition or injury, add to the clinical information gained for a possible diagnosis of depression.
Step 4
Compile the information gathered from the assessments and evaluations. Use this compilation, along with professional training and clinical judgment, to generate a full clinical picture of the person. In completing this, remember also that the onset of depression in elderly people usually creates greater cognitive impairment than in younger people. This could cause gaps in your information. Obtain more information from those who have interacted with the elderly person daily for an extended period of time--preferably two years. These supplemental interviews can fill in missing information if the person's memory is impaired.
Step 5
Document your decision about the diagnosis and support your decision by reporting your information and comparing this to the criteria established by the American Psychological Association in the "Diagnostic and Statistical Manual of Mental Disorders." This documentation is the final step in diagnosing an elderly person with depression.
References
- "Assessing and Treating Late-Life Depression;" Michele J. Karel; 2002
- "Depression in Elderly People;" Robert Howard; 1996
- "Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment;" Steven H. Zarit & Judy M. Zarit; 1998
