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Health & Medicine for Senior Citizens

Older Women with Diabetes and Depression Have Twice the Risk of Death

Both problems linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle

Jan. 3, 2011 – Older women suffering with diabetes and depression have a significantly increased risk of death from heart disease, as well as an increased death risk from all causes, over a six-year period, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Depression affects almost 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to the report. About 20 to 25 percent of patients with diabetes also have depression – nearly twice as many as those without diabetes. Diabetes and its complications are leading causes of death around the world.

A study of 78,282 older women – aged 54 to 79 – was conducted in 2000 by An Pan, Ph.D., of the Harvard School of Public Health, Boston, and her colleagues. The women were participants in the Nurses Health Study.

The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of type 2 diabetes were confirmed using a supplementary questionnaire.

During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease.

Compared with women who did not have either condition, the results were:
   ● those with depression had a 44 percent increased risk of death,
   ● those with diabetes had a 35 percent increased risk of death and
   ● those with both conditions had approximately twice the risk of death.

When considering only deaths from cardiovascular disease,
   ● women with diabetes had a 67 percent increased risk,
   ● women with depression had a 37 percent increased risk and
   ● women with both had a 2.7-fold increased risk.


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"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write.

"It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network."

In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.

"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.

This study was supported by a National Institutes of Health grant.

Read below to learn more about Diabetes, Depression and Depression in the Elderly

About Diabetes (MedlinePlus NIH)

Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With Type 1 diabetes, your body does not make insulin. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Symptoms of Type 2 diabetes may include fatigue, thirst, weight loss, blurred vision and frequent urination. Some people have no symptoms. A blood test can show if you have diabetes. Exercise, weight control and sticking to your meal plan can help control your diabetes. You should also monitor your glucose level and take medicine if prescribed.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

>> More about diabetes at MedlinePlus

About Depression (MedlinePlus NIH)

Depression is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days. If you are one of the more than 20 million people in the United States who have depression, the feelings do not go away. They persist and interfere with your everyday life. Symptoms can include

   ● Sadness
   ● Loss of interest or pleasure in activities you used to enjoy
   ● Change in weight
   ● Difficulty sleeping or oversleeping
   ● Energy loss
   ● Feelings of worthlessness
   ● Thoughts of death or suicide

Depression can run in families, and usually starts between the ages of 15 and 30. It is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder.

There are effective treatments for depression, including antidepressants and talk therapy. Most people do best by using both.

NIH: National Institute of Mental Health

>> More about Depression at MedlinePlus

About Depression in Elderly (MedlinePlus Encyclopedia)

Depression is a medical illness in which a person has persistent feelings of sadness,often with discouragement and a lack of self-worth.

Depression in the elderly is a widespread problem, but is often not recognized or treated.

About Depression and Senior Citizens

Of the 35 million Americans age 65 and older, about 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.

Everyone feels blue or sad now and then, but these feelings don't usually last long and pass within a couple of days. When a person has depression, it interferes with daily life and normal functioning, and causes pain for both the person with depression and those who care about him or her. Doctors call this condition "depressive disorder," or "clinical depression."

Important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness. For instance, the death of a loved one, moving from work into retirement, or dealing with a serious illness can leave people feeling sad or anxious. After a period of adjustment, many older adults can regain their emotional balance, but others do not and may develop depression.

Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more physical ailments. However, when older adults do suffer from depression, it may be overlooked because they may be less willing to talk about feelings of sadness or grief, and doctors may be less likely to suspect or spot it.

If left untreated, depression can lead to suicide.

>> Read more from the National Institutes of Health Website for Seniors


In the elderly, a number of life changes can increase the risk for depression, or make existing depression worse. Some of these changes are:

Adapting to a move from home to an apartment or retirement facility

Chronic pain

Feelings of isolation or loneliness as children move away and their spouse and close friends die

Loss of independence (problems getting around, caring for themselves, or driving)

Multiple illnesses

Struggles with memory loss and problems thinking clearly

Elderly people often use alcohol to self-treat depression, but this may make symptoms worse.

Depression can be a sign of a physical illness. It can be a psychological reaction to the illness, or directly caused by the physical illness.

Physical illnesses that increase the risk for depression include: thyroid disorders, Parkinson's disease, heart disease, cancer, and stroke.

Symptoms of depression may occur as part of dementia ( Alzheimer's disease).

Symptoms of depression are also a side effect of many drugs commonly prescribed for the elderly.

Many older people will not admit to feeling depressed, for fear that they will be seen as "weak" or "crazy." Some older people will not report their depression because they believe that feeling sad is "normal," or that nothing can be done about it.


Many of the usual symptoms of depression may be present in the elderly. See: Depression - major for more details.

Depression in the elderly may be hard to detect. Common symptoms such as fatigue, appetite loss, and trouble sleeping can be part of the aging process or a physical illness. As a result, early depression may be ignored, or confused with other conditions that are common in the elderly.

Clues to depression in the elderly may include:
   ● Being more confused or forgetful.
   ● Eating less. The refrigerator may be empty or contain spoiled food.
   ● Not bathing or shaving as often. Visitors may notice smells of urine or stool. Clothes may be dirty and wrinkled.
   ● Not taking care of the home.
   ● Stopping medicines or not taking them correctly.
   ● Withdrawing from others. Not talking as much, and not answering the phone or returning phone calls.

Exams and Tests

A discussion of your symptoms, physical exam, and blood and urine tests will help determine if a physical illness is causing the depression.

Sometimes your primary care doctor will send you to an expert in depression, such as a psychiatrist, to help with diagnosis and treatment. This may be especially useful for telling the difference between depression and normal grieving, which occurs more often in this age group.


See: Depression - major for more information about medications and other therapies used to treat depression.

The first step is to address any physical illnesses and stop taking any medications that may be making your symptoms worse.

If these steps do not relieve the depression, antidepressant medications and talking through problems (psychotherapy) with a psychologist, psychiatrist, or other therapist is usually helpful.

Antidepressant drug therapy should be carefully monitored for side effects, which can be more common in the elderly. Doctors usually prescribe lower doses of antidepressants for older people, and increase the dose more slowly than in younger adults.

To better manage depression at home, elderly people should:
   ● Exercise regularly, seek out pleasurable activities, and maintain good sleep habits.
   ● Learn to watch for the early signs of depression, and know how to react if it gets worse.
   ● Minimize alcohol use and avoid illegal drugs. These substances can make depression worse over time, and they may also impair judgment about suicide.
   ● Surround themselves with people who are caring and positive.
   ● Talk about their feelings to someone they trust.
   ● Take medications correctly and learn how to manage side effects.

Outlook (Prognosis)

Depression usually responds to treatment. If it is not detected, depression can lead to complications. The outcome is usually better for people who have access to social services, family, and friends who can help them stay active and engaged.

Possible Complications

The most worrisome complication of depression is suicide. Depression and older age are both risk factors for suicide. Men account for most suicides among the elderly, and divorced or widowed men are at the highest risk. Families should pay special attention to elderly relatives who live alone.

Other complications include reduced functioning at work and in social relationships.

When to Contact a Medical Professional

Call your health care provider if you feel persistently sad, worthless, or hopeless, or if you cry often. Also call if you are having trouble coping with stresses in your life and want to be referred for talk therapy.

Go to the nearest emergency room or call your local emergency number (such as 911) if you are thinking about suicide (taking your own life).

If you are caring for an aging family member and think they may have depression, contact their health care provider.


Staying physically, mentally, and socially active may help reduce the risk of depression in older age.


Cassano P, Fava M. Mood disorders: major depressive disorder and dysthymic disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008:chap 29.

Unutzer J. Clinical practice: late-life depression. N Engl J Med. 2007;357:2269-2276.

Update Date: 8/15/2010

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