Depression of older adults: a literature review of challenges

Abstract

Background: Depression is the leading cause of premature death and disability worldwide. The globally aging population with increasing burdens of chronic diseases is certain to face increasing problems. Elderly people in whom physical and mental co-morbidities are common represent a group that is highly susceptible to the harm of depression. Worse still, the reduced accessibility of elderly to healthcare implies that the public health burden of depression seen in the healthcare sector is only tip of the clinical iceberg.

Objectives: This review aims to synthesize the current evidence of public health burden of geriatric depression, and the public health challenges in tackling this growing threat in the context of under-detection, social disparities and population ageing, and to summarize its current situation in Hong Kong and compare with other

Methods: A literature search was conducted in databases PubMed, Medline and Cochrane (January 2002-June 2012) using the keywords “depression, depressive episode, epidemiology, prevalence, incidence, elderly”. A total of 1285full-text articles were obtained, out of which 52 articles were potentially relevant. Critical appraisal was performed on articles after a priori specified inclusion and exclusion criteria were applied. After removing the duplicates and examining the contents, 15 articles were adopted for review.

Results: Depression brings along heavy disease burden which highly associated with mortality and morbidity. Late-life depression accounts for 17-37% in primary care settings, while around 3% in the community. The ongoing problems of under-detection, under-treatment and the progressive population ageing increase the challenges and complexity of matter. Gender difference is identified, while social support, social relationships and socioeconomic status were shown to be highly correlated with elderly depression in both the East and the West.

Conclusions: Elderly depression is a global threat causing increasing public health burden to healthcare systems and societies worldwide. Over the decades, public health sector is facing numerous challenges intackling it, including the practice-related challenges complicated by characteristics of elderly, policy-related challenges explained by the clinical iceberg concept, and societal related challenges. By understanding the older population and challenges in the community control of depression, it is the time to action and turn public health over a new leaf.