Key messages
- Many older people in hospital have mild depression.
- Depression is difficult to diagnose in hospital due to the high probability of delirium.
- There are key risk factors that all clinicians should be aware of.
- Identifying risks early and implementing prevention strategies may prevent depression becoming severe and improve recovery.
Being admitted to hospital can be daunting for older people and their families. People can be afraid of the unknown and concerned about loss of independence. Their concerns may be shaped by their past experience of illness, episodes in hospital and the support systems they have in place.
Treatment for depression can be complicated and take longer to take effect in older people; however, prognosis for depression in older age is no worse than for younger patients1.
Given two-thirds of older people in hospital have been found to have a mild depression there is much we can do to improve their experience and outcomes.
In hospital I was so depressed, and I was there for about eight days … it was just the whole experience, I felt depressed because nobody much was around… Nobody is taking any notice because they just think you’re old and quiet I think… [In rehab there are] lots of people around to talk to… They were lovely there and so helpful. Depression is something that a lot of people deny. I got to the point [in hospital] where I was ready to go to the doctor and get an antidepressant ... and I have never been depressed in my life… [Depression can be prevented by hospital staff]. …acknowledging, and talking to you.
- Patient, 87 years old
The experience of loneliness, like mild depression, can change over the day. It may arise due to certain trigger events, or it can be long-lasting. It is also associated with a ‘feeling of disconnection from community, and of feeling like a stranger or an outsider’.2 It is important to recognise that loneliness, like depression, can have a negative impact on a person’s health, and some people can feel very reluctant to speak openly about it. 2
Risk factors
Depression, like dementia, is difficult to diagnose in hospital due to the high probability of delirium. However, there are key risk factors that we should be aware of in order to investigate further and respond appropriately. Identifying risks early and implementing prevention strategies can help prevent depression becoming severe and improve the older person’s chance of recovery.
The following are identified risk factors:
- multiple physical health problems and chronic conditions
- a past or family history of depression
- cognitive decline or dementia (approximately 20 per cent of older people with dementia experience moderate to severe depression)
- chronic pain
- medication side effects (particularly drugs used to treat high blood pressure, some steroids and hormonal treatments, painkillers, tranquillisers and tablets or patches used for quitting smoking)
- bereavement, grief and loss, including loss of relationships, independence, work, lifestyle, self-worth, mobility and flexibility
- social isolation, lack of intimacy, poor social supports
- the experience of loneliness
- significant change in living arrangements, such as moving into a residential care setting3
- caring for a family member with chronic illness, particularly dementia
- prolonged stress, chronic or acute
- drug or alcohol abuse
- gender - older women have double the risk of depression compared to men.3
1. Snowdon, J., Late-life depression: what can be done? Australian Prescriber, 2001. 24(3): p. 65-67
2. Commissioner for Senior Victorians. Ageing is everyone’s business: a report on isolation and loneliness among senior Victorians, 2016, State of Victoria: Melbourne. p. 10
3. National Ageing Research Institute, Depression in older age: a scoping study, 2009, National Ageing Research Institute: Parkville.
Reviewed 24 March 2022