Case Scenario

A 93-year-old woman has mild cognitive impairment and lives in an assisted-living facility. Before the COVID-19 pandemic, her daughter, a medical social worker, and son-in-law visited her weekly. The patient has severe sensorineural hearing loss but chooses to not wear hearing aids. Her facility prohibited visitors during the pandemic, allowing her daughter to communicate by phone, FaceTime, or standing outside her mother's window. The patient was often unable to hear what her daughter was saying. She rarely left her room because of COVID-19 protocols, lost weight, and slept poorly despite taking mirtazapine (Remeron) and sertraline (Zoloft) for chronic depression. She continued to recognize her daughter and son-in-law throughout the pandemic; however, she was often unsure why they had not visited her in person. Because of her insomnia, the patient wandered around her apartment at night, occasionally falling. She also refused to wear an alert device designed to call for help.

Clinical Commentary

Up to 88% of people 65 years and older have at least one chronic medical condition, and 25% have more than four chronic diseases.¹ Major depression occurs in 1% to 3% of older adults in the general population (8% to 16% in those with dysthymia).² However, fewer than 20% of cases are diagnosed or adequately treated because the symptoms of depression are likely to be attributed to comorbid conditions instead of sadness.² In a 2020 national survey, participants 65 years and older reported significantly lower percentages of an anxiety disorder (6.2%), depressive disorder (5.8%), or trauma-or stress-related disorder (9.2%) compared with younger participants.¹ However, family physicians need to consider or screen for depression in older adults and treat it when present.