Understanding the differences between the clinical presentation of depression

 
Understanding the differences between the clinical presentation of depression in older and younger adults is essential when attempting to identify the exact cause of its manifestation. In the older population, for example, depression is commonly mistaken for dementia due to similar characteristics that are displayed between both conditions. More importantly, as practitioners, we must remember that the treatment approach is different for depression and dementia, making it a priority to perform an in-depth assessment for each client. Tetsuka (2021) lists the signs and symptoms of geriatric depression as increased anxiety and irritability, somatic and psychological complaints, sleep disturbance, and sometimes suicide attempts. Interestingly enough, the feature of a depressed mood and psychomotor retardation is not always seen; however, a decrease in interest and pleasure appears to be prominent (Tetsuka, 2021). With all this being said, an important term to familiarize ourselves with is that of pseudodementia or depression-related cognitive dysfunction. Although it is not considered a diagnosis, pseudodementia helps us understand that the cognitive decline in older adults is not merely a direct result of neurodegenerative diseases but that underlying psychiatric etiology very well can be the dominant cause of their change in behavior and or personality (Brodaty & Connors, 2020).
            Younger adults seem to display depressive symptoms in other ways. It usually stems from the transition to adulthood, struggles with identity, stress from both social and occupational areas, and the increase in their responsibilities and obligations in everyday life (Othman & Jaafar, 2020). However, they may also present with similar complaints as how older patients who have depression do, and therefore consideration should be placed on the biopsychosocial factors that have a significant impact on an individual’s overall physical, mental, and emotional health. Symptomology of depression includes anhedonia, feeling sad, empty, or hopeless, sleep disturbances, difficulty concentrating, and feelings of guilt and worthlessness (American Psychiatric Association, [APA], 2013). Looking at it from a biopsychosocial perspective, one can understand the interconnectedness present from frameworks dealing with genetics, neurology, immunology, psychology, and sociology (Remes, Mendes, & Templeton, 2021). When comparing the different etiologies and clinical presentation of depression between older and younger adults, the undeniable truth is found at the core of their internal and external environments. In this case, emotional responses to specific life events and stressors will be presented in various ways, requiring the clinician to assess their clients and provide the best treatment options on a case-by-case basis.
            In reference to the question regarding a person’s right to drive when they have dementia, I find that it depends on the severity of their cognitive impairment. Nevertheless, I would still lean towards that it would be a huge risk not just to the individual driving but other people on the road. Personal and public safety should take precedence while attempting to preserve a person’s independence, connection to the outside world, and quality of life (Stasiulis et al., 2020). While researching this topic, I came upon a study that utilized an assessment strategy to assess/predict the fitness to drive in patients with Alzheimer’s disease, vascular dementia, frontotemporal dementia, and dementia with Lewy bodies. Each type of dementia involves different cognitive and functional impairments within memory, language, behavior, and visuospatial contexts (Piersma et al., 2018). The assessment strategies in the study were split into three categories: a clinical interview, a neuropsychological assessment, and driving simulator rides. Results showed that about half of the individuals failed the on-road driving assessment making more errors and are at higher risk for unsafe driving. Furthermore, although the neuropsychological assessment was deemed useful in predicting their fitness to drive, initial clinical interviews displayed limited use, possibly due to the lack of the individual’s insight into their own abilities.