Depression Among Older Adults with Diabetes Mellitus

Abstract

Synopsis Depression is among the leading causes of decreased disability-adjusted life years in the world1 and a serious public health problem.2 Older adults with DM experience greater risk for comorbid depression compared to those who do not have DM.3 Having DM increases the risk of subsequent development or recurrence of depression. Conversely, history of depression increases the risk for new onset DM.4 As an unwanted co-traveler of DM, undetected, untreated or undertreated depression impinges an individual’s ability to manage their DM successfully, hindering their adherence to treatment regime.5 It also undermines the effectiveness of provider-patient communication and decays therapeutic relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. Moreover, recent studies have suggested that co-occurring depression and DM may accelerate cognitive decline, highlighting the importance of treating depression and DM. Several treatment modalities are available, which can be used to treat and manage depression in primary care settings: pharmaceutical, brief psychotherapeutic, behavioral and life style interventions, and combination therapies. An evidence-based health care delivery model is also available for treating depression in primary care settings. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.

Diabetes type 2 diabetes in the elderly – solved and unsolved questions

“…Депрессивное состояние пожилых пациентов может привести к ухудшению контроля уровня глюкозы крови, несоблюдению лечебного режима, функциональным расстройствам, снижению качества жизни и смертно-сти [18].…”

The Psychosocial Challenges and Care of Older Adults with Diabetes: “Can’t Do What I Used To Do; Can’t Be Who I Once Was”

“…More research on the effects of antidepressant medication and psychotherapy is recommended to advance current treatment strategies for depression in older adults[58, 59]. The present clinical approach is comprehensive and includes patient education, individualized and patient-centered management, quality integrative care for comorbid conditions, attention to the development of adverse effects of medications, and frequent regular follow-up assessments.…”

“…The present clinical approach is comprehensive and includes patient education, individualized and patient-centered management, quality integrative care for comorbid conditions, attention to the development of adverse effects of medications, and frequent regular follow-up assessments. The depression diagnosis is made using the DSM-V criteria and all medical conditions and medication side effects that mimic depression should be ruled out before a depression diagnosis is finalized[58]. Suicidal or homicidal ideation will necessitate prompt psychiatric referral and intervention[58, 60].…”

“…The depression diagnosis is made using the DSM-V criteria and all medical conditions and medication side effects that mimic depression should be ruled out before a depression diagnosis is finalized[58]. Suicidal or homicidal ideation will necessitate prompt psychiatric referral and intervention[58, 60]. Treatment options for depression in older adults may include psychotherapy, medications, electroconvulsive therapy (ECT), and lifestyle modifications such as exercise.…”

“…Treatment options for depression in older adults may include psychotherapy, medications, electroconvulsive therapy (ECT), and lifestyle modifications such as exercise. The characterizing features of the patient’s depression as well as the patient’s preference, family history, past medical history, treatment contraindications, financial state, and access to resources should be taken in consideration when forming a management plan for late-life depression[58, 61]. …”