Depression affects 5% to 7% of community-dwelling older adults and approximately 10% of older men and 18% of older women, but is often undiagnosed, untreated, or undertreated. Prevalence rises in those with multiple comorbidities and hospitalizations. Screening for the general adult population, with services in place for diagnosis, treatment, and follow-up, is now recommended by the USPSTF (2015) and requires only one or two questions.
The single screening question, "Do you often feel sad or depressed?" has a sensitivity of 69% and specificity of 90%. The two screening questions below are 100% sensitive and 77% specific.
■ "Over the past 2 weeks, have you felt down, depressed, or hopeless?" (screens for depressed mood)
■ "Over the past 2 weeks, have you felt little interest or pleasure in doing things?" (screens for anhedonia)
Positive responses should prompt further investigation with scales such as the Geriatric Depression Scale or the 9-item Patient Health Questionnaire (PHQ-9). Depressed men over age 65 years are at increased risk for suicide and require particularly careful evaluation. Effective treatment for older adults both reduces morbidity and extends life, and includes exercise, supportive and group therapy, and medication.
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