Academic journal article Hong Kong Journal of Psychiatry

The Judicial Use of Rating Instruments in the Clinical Assessment of Geriatric Depression

Academic journal article Hong Kong Journal of Psychiatry

The Judicial Use of Rating Instruments in the Clinical Assessment of Geriatric Depression

Article excerpt

SUMMARY

Many rating scales for depression are popular in use but few of there are suitable far use in Chinese elderly populations in view of the general emphasis on physical symptoms in the scales and the tendency of the Chinese to somatise their psychological discomfort. Geriatric Depression kale, which is currently available, may mitigate the psychometric disadvantages and be utilised to screen Chinese elderly communities far prevalence of depressive illness, on account of its ease, simplicity, validity and reliability.

INTRODUCTION

DEPRESSION IN OLD AGE

Depressive illnesses, as epidemiological studies have consistently shown, are among the most frequent mental disorders encountered in hospital or everyday practice. In modern society, the rapidly changing psychosocial environment of man often gives rise to situations of acute and/or prologed environmental stress, which may then bring about depressive reactions. At iN time when more and more individuals are suffering from the unsettling effects of uprooting, family disintegration, and social isolation, for instance, it is hardly surprising that the prevalence of psychiatric disorders, which will often be of a depressive nature, will be certain to spiral upwards.

The current risk in morbidity from chronic diseases is also likely to contribute to the number of those with depression. Cardiovascular diseases, collagen diseases such as rheumatism, gastroenterological diseases, and cerebro-vascular and other neurological diseases have been shown to be associated with depressive illness in as many as 20 per cent of all cases.

In this context, it is, therefore. common sense that with increasing age and infirmity individuals must be more vulnerable to depression, and in fact it is now widely recognised that depression is the most common psychiatric problem from which an aging individual is liable to suffer (Verwoerdt, 1981; Thompson, 1984; Comi, Davison & Webster, 1984; Martin Gambrill, 1986).

Nevertheless, these depressed elderly are generally unwilling to seek treatment for mental disorders and are particularly reluctant to initiate contact with mental health professionals (Butler, 1969, Gaitz, 1974; Waxman, Carner & Klein, 1984). On the other hand, evidence indicates that physicians often fail to recognise, diagnose and treat, or refer their elderly patents who are depressed (Waxman & Camer, 1984), although their clinical manifestations are not radically different from those observed in younger people. In spite of this, there remain a number of characteristics or problems which are specific to old-age depression. Cognitive symptoms, for instance, though observed in adult depressive states- may become sa prominent in the elderly thar they induce a "pseudodementia" (Kiloh, 1961).

Another problem in the assessment of geriatric depression is that elderly individuals are typically more resistant to psychiatric evaluation than younger patients (Salzman & Shader, 1978; Wells, 1979). Somatic symptoms, that are usually a key to the diagnosis of depression in the young individual, lose their specificity as they become "normal" or common accompaniments of aging. For instance, sleep disturbances, decline of sexual function, constipation, ache and pains are common symptoms of endogenous depression, but are also common in nondepressed elderly individuals (e.g., Coleman et al, 1981). Questions appropriate for use with the young patient may not be appropriate for the old. For example, questions about Sexuality often make the elderly defensive, and yet they are included on many existing psychiatric rating scales. Other questions may pose problems of patient acceptance and may also lead to problems of interpretation (Blumenthal, 1975). Far example, questions about suicidal intent, whether life is worth living or whether one is hopeful about the future, may measure very different things in persons near the beginning and those reaching the end of the life span. …

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