brand logo

Am Fam Physician. 2022;106(3):318-320

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

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.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.