The epidemiology of affective disorders in the elderly: a review.

It has been suggested that elderly people are predisposed to depression by age-related structural and biochemical changes that may increase their vulnerability to depression and by the fact that risk factors such as bereavement and other psychological losses, somatic diseases and institutionalization become more common with increasing age. The elderly also have a disproportionately high rate of suicide. Whether the prevalence of depression increases or decreases with age is, however, debatable. There may be a peak in the prevalence during the years before retirement, a low prevalence during the first 10-15 years thereafter, and an increase after the age of 75 years. Among the consequences of depression are social deprivation, loneliness, poor quality of life, increased use of health and home-care services, cognitive decline, impairments in activities of daily living, chronicity, suicide and increased non-suicide mortality. However, most studies report that few depressives in the community are treated with antidepressants. During recent years new antidepressants have been introduced, which are better tolerated by the elderly. At the same time, the prescription of anti-depressants has increased in the community. It remains to be seen whether these changes have led to a higher rate of treatment of depression in the elderly.