Determinants of Depression 
In the Elderly
Researchers have indicated that increased occurrence of depression in the elderly has been associated with "age, female gender, family history of mental illness, physical illness or disability, change in living patterns, lack of support systems, loneliness, financial and educational status" (Minardi & Blanchard, 2004, p. 24). Additionally, Lapid and Rummans (2003) believe that there are psychological stressors, usually in a form of transitions, which affect the development of depression in the elderly. These transitions can be from active working life to retirement, death or deteriorating health of loved ones and friends, or other unexpected life events that causes stress to the elderly, which induces loneliness and develops to depression. It is evident that there are many determinants of depression in the elderly; however, among the ones mentioned above, there are five determinants that are prevalent due to repitition in research: gender, physical illness or disability, loneliness and isolation, ineffective grieving in relation to loss, and lack of support systems.
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Gender
Another determinant of depression that was prevalent in researches is the existence of any form of physical illness or disability among the elderly. Minardi and Blanchard (2004) indicated that there have been studies done on the affects of physical illness or disability in the mental health of the older population. They found that "increased impairment, disability and handicap resulted in older people experiencing more depressive symptoms and higher level of isolation" (Minardi & Blanchard, 2004, p. 24). Similarly, Zullo (2004) agrees that loss of physical functioning and independence is associated with depression. He believes that disability restricts activity due to impairment and restricted activity means reduced “social interaction, reduced sense of impact and value as a person, and increased dependence.As a result, the elderly will need help with the activities of daily living (ADL's) such as feeding oneself, dressing, bathing, toileting, and mobility. When this happens, sense of independence is lost and the elderly has the tendency to feel insignificant, which can make them give up and this is when their chances of acquiring depression is high.
Loneliness and Isolation
The prevalence of loss is important to address in the elderly population. According to Marshall and Atkinson (2005), ineffective grieving after a loss is common and sometimes difficult to detect among the elderly. However, grieving becomes a problem, when an individual has difficultly in coping or returning to his/her daily activities and usually acquires depression. Statistics indicates “33% of bereaved people have a depressive illness one month after the loss, and 15% are still depressed a year later” (Marshall & Atkinson, 2005). Miller, Prigerson, Reynolds, and Rosenzweig (1999) conducted a study on complications of grief and depression among the elderly and found that depression and suicide are symptoms of ineffective grieving displayed through spousal bereavement.
Lack of Support Systems
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In regards to depression, researchers recognize a difference between male and female genders, which can be applied to the elderly population. Price (2004), states that women experience depression about twice as often as men due to hormonal factors and additional stressors in life such as responsibilities as a wife, mother, or domestic household chores. Additionally, Price also mentions that men usually mask their depression through alcohol, drugs, or the acceptable habit of working late hours, which makes it difficult for others to detect whether or not they are just busy or depressed. Among the elderly, it is important to note that the suicide rate of men rises, reaching a peak after the age of 85. Researchers like Hall and Havens (2002), regarding identifying the link between gender and depression, state that "women's advantage over men in life expectancy means that they are more likely to outlive their spouse." Due to this, women are found to be disadvantaged because they are more likely to be widowed and to live alone, which makes them vulnerable to depression
Physical Illness or Disability
Researches have indicated that there is a connection between loneliness and isolation to depression. Hall and Havens (2002) identified underlying factors that are related to loneliness and found that “individuals who had recently experienced the death of a spouse had the highest levels of loneliness and those who lived with a partner, husband or wife expressed the lowest levels of loneliness”. In addition, they also found that loneliness following widowhood was intensified by the length of the marriage, with those married 50 or more years being the most likely to experience loneliness following the death of their spouse. Furthermore, in the case of living arrangements, Hall and Havens (2002) found that elderly who live at home with family have a greater sense of well-being and happiness than those who live in nursing homes, who feel alone and isolated. In agreement, Minardi and Blanchard (2003) indicate that level of loneliness experienced among elderly living in nursing homes can be due to the lack of intimate relationship, increased dependency, and loss of self-identity.
Ineffective Grieving
Related to Loss
Bosworth, Flint, George, Hays, and Steffens (2001) conducted a study on the effects of social support on extremely depressed elderly individuals and found that social support acts as a buffer to the effects of depression among elderly individuals and are at risk of functional impairment. They also found that the more social support was provided, the more the depressed elderly wanted to preserve and improve their performance in doing basic ADLs. Similarly, Minardi and Blanchard (2004) emphasize that adequate emotional support and a strong social network are connected to reduction in depression. Likewise, Donnelly, Lockhart, and MacCourt (2002) elaborates the significance of a comprehensive system of services, such as self/family care, family physicians, home support, community senior groups, and assisted nursing programs that need to be implemented as support networks for the elderly in order to prevent depression and high morbidity.
Elderly Depression: A Public Health Issue
Role of a Nurse Caring for the Depressed Elderly
Created by: Thea Janice Gutianjo
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