As limitations of the study, first we highlight the low number of cases and the fact that only those elderly took part in the assessments, who signed the ICF, and whose mental and physical condition was good enough to be able to consent and complete the questionnaires and screening tests. However, our results can be considered representative of this population living independently in their own apartments and has contact with the elderly club. Furthermore, the primary purpose of using clinical screening tools was to assess depressive or cognitive symptoms. These tools cannot be used to clinically diagnose depression or dementia. Therefore, the finding of significant proportion of depressive symptoms does not necessarily mean that these elderly suffered from clinical major depressive disorder (MDD). However, it is important to highlight that although elderly were in regular contact with health care systems due to their physical illnesses, depressive symptoms were mostly unrecognized, thus specific psychiatric assessment and adequate treatment could not be performed. Lastly, the use of structured clinical interview may be of limited value in elderly because of the frequent occurrence of cognitive decline. Therefore, extensive review of medical records was also completed.
About half of the elderly took some psychotropic medications, and the same proportion had cognitive impairment reaching the level of dementia (mainly mild, according to the MMSE), and a little less (but more than 40%) found to be depressed by the GDS depression screening tool (Table 1.). Although it was somewhat more common to take antidepressant medications, there was a greater proportion of current depressive symptoms among males. No other major differences were found between genders.
In the elderly sample, out of the 11 patients taking antidepressants 6 patients received adequate antidepressant therapy and were without current depressive symptoms, which may indicate the efficacy of the antidepressant treatment in this elderly population (Table 2.). 26 elderly had current depressive symptoms, but only 9 of them contacted with a psychiatrist, and 7 of them had a clinical diagnosis of depression. Furthermore, only 5 of them received antidepressant medication (which also means that 21 elderly was found to have depressive symptoms, but their depression was not treated), but still they had some depressive symptoms. On the other hand, these patients with current depressive symptoms were more likely to receive antipsychotic medications. This indicates that only certain symptoms of the depressive disorder (sleep disturbance, anxiety, agitation) have been observed and treated (with antipsychotics), while the underlying mood disorder was not considered, and therefore the adequate treatment (antidepressant) was lacking. Theoretically, antipsychotics, especially first-generation ones may be associated with the occurrence of depressive symptoms, but it is unlikely, as all the patients treated with antipsychotics were treated with a second-generation antipsychotic, which rarely induce depressive symptoms. Moreover, as it is known from the literature and clinical practice, some second-generation antipsychotics may even improve depressive symptoms or can work as antidepressants . So, these antipsychotics might be prescribed to treat depression in the elderly. Although, for many patients there was only partial response to these antipsychotic or antidepressant medications, as – at least some of the – depressive symptoms were still present.
Based on our analysis, among elderly with current depression (according to the GDS) cognitive decline (assessed with the MMSE) was significantly more frequent and more pronounced, but this was not recognized and treated. In line with previous literature data, the results of this study showed that depressed (according to the GDS) elderly had lower cognitive levels and their QoL was also significantly poorer than that of the non-depressed (Table 2, 3.). Our results confirm close correlation between depression and cognitive impairment, as well as the key role of depression in the background of QoL decline [3, 20, 21]. On the other hand, it is well-known that reversible depression-related cognitive decline (also known as depressive pseudo-dementia) is often considered as true dementia and these patients do not receive adequate treatment for their mood disorder . However, the depressive pseudo-dementia in old age seems to be a long-term predictor of true dementia [5, 23].