Contrary to popular belief, depression is not a normal part of aging.  Rather, depression is a medical disorder that causes suffering for patients and their families, interferes with a person's ability to function, exacerbates coexisting medical illnesses, and increases use of health services (Lebowitz, 1996).  Despite the efficacious treatments available for late-life depression, many older adults lack access to adequate resources; barriers in the health care reimbursement system are particular challenges for low income and ethnic minority older adults (Charney et al., 2003).  In a comprehensive review of research on the prevalence of depression in later life, Hybels and Blazer (2003) found that although major depressive disorders are not prevalent in late life (1%-5%), the prevalence of clincially significant depressive symptoms is high (3%-30%).  What is more, these depressive symptoms are associated with higher morbidity and mortality rates in older adults than in younger adults (Bagulho, 2002; Lyness et al., 2007). 

Late-life depression often occurs within a context of medical illnesses, disability, cognitive dysfunction, and psychosocial adversity, frequently impeding timely recognition and treatment of depression, with subsequent unnecessary morbidity and death (Bagulho, 2002; Lyness et al., 2007).  A substantial number of older patients encountered by nurses will have clinically relevant depressive symptoms.  Nurses remain at the frontline in the early recognition of depression and the facilitation of older patient's access to mental health care.  

Nursing Standard of Practice Protocol: Depression in Older Adults



Evidence-Based Content - Updated August 2012


Assessment Parameters
Care Parameters
Evaluation of Expected Outcomes
Follow-Up to Monitor Condition










Assessment Parameters

A. Identify risk factors/high risk groups




4. Widow/widowers (Ref 6)

5. Caregivers (Ref 7)




Try This Issue 4 - The Geriatric Depression Scale (GDS)


1. Depressive symptoms

2. Depressed or irritable mood, frequent crying


4. Weight loss or gain (especially loss)

5. Sleep disturbance (especially insomnia)

6. Fatigue/loss of energy

7. Psychomotor slowing/agitation

8. Diminished concentration

9. Feelings of worthlessness/guilt

10. Suicidal thoughts or attempts, hopelessness







G. Assess for cognitive dysfunction.

H. Assess level of functional ability.

Care Parameters





2. Remove or control etiologic agents:

a. Avoid/remove/change depressogenic medications.

b. Correct/treat metabolic/systemic disturbances.





7. Identify and reinforce strengths and capabilities.



10. Provide practical assistance; assist with problem solving.



13. Educate about the importance of adherence to prescribed treatment regimen for depression (especially medication) to prevent recurrence; educate aboutspecific antidepressant side effects due to personal inadequacies.


Evaluation of Expected Outcomes

A. Patient

1. Patient safety will be maintained.



4. Patient’s daily functioning will improve.

B. Health care provider


C. Institution

1. The number of patients identified with depression will increase.





Follow-Up to Monitor Condition



C. Educate caregivers to continue assessment processes.

For Definition of Levels of Quantitative Evidence Click Here


















Last updated - August 2012

Journal Articles

Bruce, ML, Ten Have, TR, Reynolds, CF 3rd, Katz , II, Schulberg, HC, et al.(Mar 3, 2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291(9), pp. 1081-91.

Cronin-Stubbs D, Mendes de Leon CF, Becket LA et al. .( 2000).Six-year effect of depressive symptoms on the course of physical disability in community-living older adults. Arch Intern Med;160, pp. 3074-3080.

Hall, R, Hall, R, Chapman M. (2003). Identifying Geriatric Patients at Risk for Suicide and Depression. Clinical Geriatrics, 11(10). pp 36-44.

Lebowitz, B. D., Pearson, J. L., Schneider, L. S., Reynolds, C. F., Alexopoulos, et al. (1997). Diagnosis and treatment of depression in late life: Consensus statement update. JAMA, 278(14), pp. 1186-1190. Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, et al. (Nov 12; 2003). Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA, 290(18), pp. 2428-9.

Unutzer J, Katon W, Callahan CM et al. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA, 28, pp. 2836-2845.

Last updated - January 2005