"We must be cautious in eliminating all somatic symptoms when assessing for depression in older adults because several studies, in addition to the present one, suggest that some somatic symptoms are reliable indices of depression," she says.
Norris, who with colleague Michelle D. Woehr examined how three widely used depression tests diagnosed symptoms of the elderly, says the prevailing practice has been to exclude bodily symptoms in order to keep from overestimating depression - something not supported by her decade of research.
Norris examined how the Geriatric Depression Scale, the Beck Depression Inventory and the Center for Epidemiological Studies-Depression Scale assessed depression in patients 56 - 88 years old.
Patients were at varying levels of medical treatment, including outpatients living in the community, outpatients receiving partial hospitalization services and inpatients of a medical rehabilitation unit.
Her examination found that a set of physical maladies could be considered reliable symptoms of depression, more severe in depressed individuals and accurate for classifying the presence or absence of depression.
These maladies, she says, are not simply a result of the aging process and include diminished energy, sleep disturbances and health worries.
And while these symptoms of the elderly shouldn't be automatically dismissed, others that may signal depression in younger people don't necessarily mean the same thing for older adults, Norris notes.
"Work inhibition, weight loss and loss of sex drive are consistently poor discriminators of depression in the elderly, regardless of whether these symptoms are assessed using a variety of depression scales," she says.
These may be the result of factors other than depression such as physical changes and decline that occurs from the aging process or ill health, Norris notes.
Physical and psychological items were examined individually to determine which items are most strongly associated with total scores on depression measures and which items appear to confound the assessment of depression in the elderly.
She says, further work is needed that examines physical effects in older adults who vary in their health status, degree of depression, functional impairment and self-perceived health. Such studies would shed more light on the direct and indirect effects of ill health and depression on physical symptoms.
Contact: Ryan A. Garcia, 979-845-4680, via e-mail: rag@univrel.tamu.edu or Margaret P. Norris, 979-845-2507, via e-mail: mpn@psyc.tamu.edu.
Journal
Journal of Mental Health and Aging