Detection is complicated but critical in saving lives

Whether black or white, older people who are homebound suffer equally from major depression, researchers from Cornell University have found.

Earlier studies of depression and racial disparities among senior citizens yielded conflicting results. Some found higher rates of depression among whites; other studies found just the opposite.

The latest study "may reflect a true 'shared burden' among black and white home-care patients," the researchers said.

But perhaps more importantly, they also found that even though depression is a common affliction, neither group receives adequate treatment for it.

Depression isn't just "feeling blue" for a day or two. It's a medical illness characterized by sadness, discouragement and loss of self-worth. These feelings can be accompanied by a lack of energy, an inability to concentrate or sleep, a decreased appetite and weight loss. In the elderly, it also frequently comes with excessive concerns about aches and pains.

Detecting depression in the elderly can be complicated because fatigue, loss of appetite and sleeping difficulties are associated with getting older and other medical problems rather than just depression. Depression also may be complicated by Alzheimer's disease.

Depression in the elderly often is not diagnosed because many older people won't admit to symptoms of depression for fear of being seen as weak or crazy. Untreated depression in the elderly, however, is associated with a high suicide rate.

An elderly person may be depressed, according to the National Library of Medicine, if any of the following symptoms occur daily for more than two weeks:

•  A depressed or irritable mood

•  Feelings of worthlessness or sadness

•  Loss of interest or pleasure in daily activities

•  Temper outbursts or agitation

•  Loss of appetite

•  Unintentional weight loss

•  Difficulty sleeping, including daytime sleepiness, difficulty falling asleep, multiple awakenings through the night or early morning awakening

•  Fatigue

•  Difficulty concentrating

•  Memory loss

•  Abnormal thoughts, excessive or inappropriate guilt

•  Excessively irresponsible behavior

•  Abnormal thoughts about death

•  Thoughts about suicide, plans to commit suicide or suicide attempts

But help is available for older people suffering from depression. Sometimes symptoms can be eased by group outings, volunteering or regular visits from friends or loved ones to ease feelings of isolation or loneliness.

Identifying and treating medical conditions also can help. Antidepressant drug therapy has been proven effective among elderly people. Doses usually are lower and increased more slowly than in younger people. Neuroleptic, or tranquilizing, medications may help treat agitation in some people, and electroconvulsive therapy could be an option in cases of severe depression that has not responded to other measures.