Clinical cases and integration of learning

The study of depression in older adults requires not only theoretical knowledge but also the ability to apply it to real clinical situations. Effective learning is achieved when the exploration of clinical cases is combined with an appropriate geriatric interview and the relevant use of diagnostic tools.

Analysis and discussion of real clinical cases

Clinical cases allow us to observe how depressive symptoms in older adults can present atypically or be masked by physical conditions.

Older adults often do not directly verbalize feelings of sadness, but rather express nonspecific physical discomfort, irritability, social withdrawal, or loss of interest in usual activities. Cognitive complaints may also appear, confusing the differential diagnosis between depression and dementia.

Analyzing specific cases helps to understand the multiple factors involved in the onset and maintenance of depressive disorders in this population, including recent emotional losses, social isolation, chronic diseases, and polypharmacy. It also allows for the practice of clinical reasoning, empathy, and the ability to propose therapeutic interventions tailored to each patient's context.

How to structure an effective geriatric interview

The clinical interview with an older adult requires certain adaptations. It is essential to foster an atmosphere of attentive and respectful listening, to speak clearly and patiently, and to use understandable language.

Exploring the patient's mood should go beyond asking if they are sad; you should also inquire about loss of interest, sleep quality, changes in appetite, cognitive difficulties, feelings of uselessness or hopelessness, and thoughts related to death.

The interview should also include important contextual aspects: who cares for the patient, who they live with, whether they have a pension or financial support, whether they have experienced recent bereavements, or whether they are functionally dependent. The use of open-ended questions, along with more structured ones, allows relevant information to be gathered in a respectful and effective manner.

Integrating scales, interviews, and diagnostic tests

The diagnosis of geriatric mental health is enriched when different sources of information are integrated. Psychometric scales, such as the Yesavage scale for detecting depression in older adults, offer useful initial screening.

These tools should be used to complement the clinical interview, not as a substitute. In addition, the diagnosis should consider possible organic causes that may explain or exacerbate depressive symptoms.

Therefore, it is advisable to request laboratory tests that include thyroid function, vitamin B12 and D levels, complete blood count, and metabolic profile. In the presence of cognitive complaints, neuropsychological testing or neuroimaging may also be useful to rule out cognitive impairment or concomitant neurological pathologies.

The combination of the interview, clinical scales, and medical studies provides a more complete picture of the patient, improves diagnostic accuracy, and facilitates an individualized treatment plan that responds to the particular needs of this stage of life.