This likely to experience symptoms of dysphoria or anhedonia,

This background article reviews the epidemiology, presentation, etiology, risk factors, protective factors, suicide relevance, and treatments of depression. No participants were studied throughout this article, rather, background information about depression and useful interventions were discussed. Results of interventions were given, but statistical information wasn’t mentioned. The background article indicated that “depressive symptoms are existent in 15% of community-dwelling older adults” (Fiske, Loeback, & Gatz, 2009). In addition, rates of depression are higher in older women than older men and Hispanic women are more likely to experience depressive symptoms in comparison to non-Hispanic women. Older individuals reside in several different settings including in their own home or in a specific care facility. Of these different settings, rates of major depression are highest (14%-42%) in long-term care facilities (Fiske, Loeback, & Gatz, 2009). It should be noted that presentation of Depression is different among the older (65+) and younger population in terms of symptoms. For instance, older individuals appear to have more symptoms related to lack of sleep, fatigue, loss of interest of living, hopelessness about the future, poor memory and concentration, and lack of appetite. On the other hand, younger adults appear to have more cognitive-somatic symptoms in relevance to depression. It should be noted that there are gender differences among the older population. Women present more with a lack of appetite, while older men present with more agitation. Other presentation differences include neurological illnesses associated with depression which include stroke, Parkinson’s Disease, and Alzheimer’s Disease. This consists of individuals with a stroke being less likely to experience symptoms of dysphoria, individuals with Parkinson’s being less likely to experience symptoms of dysphoria or anhedonia, and individuals with Alzheimer’s disease presenting with more non-somatic symptoms, such as irritability and social withdraw. In terms of etiology of depression, occurrence of older individuals could be due to long-standing vulnerabilities, stressful life events and loss of social roles, and changes in health, physical ability and/or cognitive ability. These factors have an influence and lead to limitation of activities among the older population which in turn is associated with lower positive outcomes, overall resulting in depression. This onset of depression results in self-critical cognitions which further the decline in participation in activities. Risk factors identified in this article are separated between early-onset depression and late-onset depression. Risk factors for older adults include biological risks, risks from medical illnesses, medication use, cardiovascular disease, dementia, anxiety, sleep disturbance, higher scores on personality scales measuring neuroticism, sleep disturbance, number of stressful events, socioeconomic status, and problems with social support. Among early-onset depression risk factors include problems with social support, genetics, stressful life events, socioeconomic factors, anxiety, avoidance and rumination. It is important to note that suicide is a big factor in relevance to depression among older adults. Fiske et al., (2009) report that 85% of older adults with depression die as a result of suicide. In addition, there are differences in gender, ethnicity, and methods of suicide among older adults in comparison to younger adults. This includes a higher risk of suicide in men and a higher risk among Caucasian, Native American, and African Americans. In terms of methods of suicide, older adults are more likely to use lethal methods, have a higher level of intent and planning method, are more likely to not verbalize their suicidal thoughts, and are more likely to visit their primary care physician prior to completion of suicide in comparison to younger adults. Protective factors for older adults include identifying how resources, such as health cognitive function and economic status are important, life experiences that lead to adaption of strategies and support, identifying the importance of engagement, strong interpersonal characteristics, being able to utilizing cognitive strategies, and physical exercise. Prevention efforts for decreased rates of depression in the older population include targeting those who are presenting risk factors of depression, utilizing programs to reduce social isolation, and reducing symptoms of depression for individuals who do not meet the full criteria for depression. Information in the article indicated that evidence-based interventions, such as behavioral, cognitive-behavioral, cognitive bibliotherapy, problem-solving, brief psychodynamic, and life review therapy are useful in decreasing symptoms of depression in older adults. Results indicated that these interventions have a moderate to large effect sizes among randomized controlled trials. It should be noted that older adults initially seek mental health treatment through their primary care provider in comparison to other mental health professionals. Therefore, the use of interventions focused on collaborative care and psychotherapy and/or pharmacotherapy in settings, such as primary or home care settings have also shown a reduction in depressive symptoms. In addition, pharmacological and exercise interventions were also shown to influence the decrease in depressive symptoms. A limitation to this study is that it only compared early onset and late onset for some factors associated with depression, but not all of them. Therefore, it was difficult to identify if there were potential difference or if both age groups overlapped in some factors. However, the study outlined late-onset in detail, including an array of risk, preventive, protective factors. This is beneficial when identifying different techniques and strategies to utilize with older individuals. In conclusion, this study provided an array of background information on depression in older adults.