Aging; It is a process that occurs over time in various parts of the organism, never recovers, causes functional and structural changes and affects the physiological and biological structure. (Turaman 2001). Aging is not a process that works the same for everyone. Each person has their own unique way and time of aging. The last process of aging is described as old age. (Aslan, Hocaoğlu 2014). According to the World Health Organization (WHO) report covering the elderly and old age in 1998, old age; It is defined as people who are increasingly unable to be self-sufficient and need help from others, and the old age limit is determined as sixty-five years old (Turaman 2001).
Nowadays, with the development of technology and health standards, the lifespan of the environment has also been extended (OK, Öner 2001). As a result, the proportion of people considered elderly (65 years and over) in the entire society has increased to 15% in developed countries (Alexopoulos 2000, Chong et al. 2001). In 2000, this rate increased to 6.9% (Akgün, Budakoğlu 2004). As people's life expectancy increases in the coming years, the population rate of the elderly will continue to increase rapidly. For this reason, it is predicted that the number of elderly individuals will increase, especially in developed societies (Aslan, Hocaoğlu 2014). The negative consequences of the increase in life expectancy are the decrease in the strength of the elderly, their inability to be self-sufficient, chronic diseases, decrease in their roles in society and negative changes in these social roles, their inability to be economically self-sufficient and their increasing dependence on the environment (Jeste, 2009).
Depression is the most common mental disorder in the elderly (Özmenler 2001). Different types of depression are seen with an average frequency of 15% in people aged 65 and over (Livingston 1990). The chronic type of depression called dysthymia is very common in old age. Dysthymia type is long-lasting, progresses slowly, and the depressive state without very severe symptoms is often seen as the nature of old age. But this is a wrong perspective (Özmenler 2001). In a study conducted in our country, 20 (21.7%) of 92 elderly patients with physical illnesses were diagnosed according to ICD-10. A diagnosis of depression was made (Sağduyu 1997). In another study, major depression was detected in 30.7% of patients admitted to a geriatric clinic for outpatient treatment and in 35% of inpatients (Ertan et al. 1998). In depression in older ages, the mood symptoms of unhappiness, grief, and low mood may not be prominent. General anxiety, feeling of irritability, restless mood, childish behavior, stubbornness, constant physical complaints, whining, and excessive demandingness are also masked manifestations of depression (Shulman 1989). In depression seen in the elderly, physical complaints and concerns are more prominent. Deterioration in body functioning or disease-related, meaningless-bizarre delusions, agitation, and memory disorders are known features of late-life depression (Kaya 1999). Patients often have complaints such as loss of energy, difficulty concentrating, reluctance, sleep problems, pain, loss of appetite, and weight loss. The number of elderly people who commit suicide due to depression is very high. In a study conducted on the elderly in many centers around the world, it was determined that 71% of elderly suicides were caused by psychiatric diseases. It was determined that more than half of them were psychologically depressed during their suicide attempt. (Conwell, Raby, Caine 1995).
RISK FACTORS
Physical Diseases
With aging, people experience changes in their biological structures. There are some changes in the heart, vascular and endocrine glands, a decrease in the number of neurons in the brain, functional deficiencies in the musculoskeletal, circulatory, digestive system and other systems, loss of reproductive ability, functional losses in sensory organs and a decrease in general body resistance (Aslan, Hocaoğlu 2014). This condition causes disability in the elderly. Since disability directly affects the independence of the individual, it can cause the individual to feel dependent on others, useless, have low self-esteem, and cause depression (Boult, Kane, Louis, Boult, and McCaffrey 1994; Meerding, Bonneux, Polder, Koopmanschap, and Van der Maas 1998). In addition, depressive symptoms caused by chronic diseases further affect the quality of life of the elderly, increasing the effects of the disease. It hurts. This can create a vicious circle, increasing people's level of depression and making them completely dependent on others (NIH 1992). It should not be forgotten that diseases such as Parkinson's disease, adrenal and thyroid dysfunction, strokes, and cancer directly cause depression (OK, Öner 2001). The first symptom of diseases such as pancreatic and lung cancer is usually depression (Oral 1999). The relationship between physical health and depressive temperament in the elderly is two-way. The presence of both negatively affects the prognosis of the other (Özmenler 2001).
Neurobiological Factors
Especially with aging, there is a decrease in the brain structure of serotonin, noradrenaline, dopamine and GABA. This has been seen as one of the most important reasons that increase the elderly's susceptibility to depression (Oyun, Öner 2001). In addition, much emphasis has been placed on the possibility that MAO levels may be an early precursor of dementia in the elderly who have developed depression, and it has been concluded that research on this subject is insufficient (Alexopolous 2000). With the aging process, a decrease in cerebral blood flow, the number of neurons and synapses, an increase in glial cells, thickening of the myelin sheath, atherosclerosis in blood vessels, and capillary fibrosis occur (Long 1985). In addition, these degenerative changes in brain structures negatively affect cognitive functions such as "memory, attention, perception" and psychomotor activity. This may initially manifest itself with symptoms such as emotional fluctuation and violence (Yesavage 1993).
Psychosocial Factors
There is no consensus on the idea that there are definitely factors that cause depression in the elderly. The most agreed upon reason was loss of privacy for men. Factors such as widowhood and divorce are also factors that trigger depression. For this reason, being married plays a protective role for men (Wilson 1999). In addition, many negative events experienced by depressed elderly people throughout their lives have a great impact on the formation of this situation. The most important of these is the unexpected death of the spouse. However, if the spouse has an illness that has been going on for many years and his death is not real due to this illness. If it is severe, it is not considered a triggering reason for depression (Özmenler 2001). In the patient's history, the patient's past psychiatric diagnoses, the patient's family history of mental illness, personality structure, chronic biological disorders, the development process of disease symptoms, and the psychological and non-psychological treatments received should be questioned in detail (Ceylan and Göka 1998, Örnek et al. 1992). The patient's family and close circle should be questioned, especially about the possible presence of cognitive impairment, affective disorder and schizophrenia in the patient (OK, Öner 2001). As people get older, they enter the retirement period. During this period, people lose many of their social and personal roles, such as being individuals who can contribute economically, being in a position of authority, and being respected by the environment. Retirement is a negative situation for individuals who index their social identity to their work, like competition, have high expectations of success, do not spend much time with their family outside of their profession, have few social relationships, or do not feel satisfied when ending their career, and retirement is perceived as the end of life by these people (Karay 2012). ). Moving the children they live with to another place, the death of people in the same age group, acquaintances and spouses lead to the experience of loss. For the elderly person whose life is full of difficulties, these situations are more painful and much more difficult to accept (Yılmaz, Sayıl 1996).
CONCLUSION
Depression and death in the elderly. It is a factor that increases the rate. However, it cannot be said that this rate is due only to depression. The share of physical discomfort that accompanies depression cannot be ignored. Research has shown that the course of the disease progresses much worse in biological diseases that occur in addition to depression. (Williamson 1992). In addition, one of the most painful consequences of depression in the elderly is suicide (Aydemir 1999, Pearson et al. 1997). The elderly are the age group most likely to commit suicide. Among the most important risk factors for suicide in the elderly are;
Being male
Having a biological disorder that has a high level of pain and will affect the self-sufficiency of the elderly.
Only Having a history of suicide
Previous suicide attempt
Suicide attempt in the family
Alcohol and drug abuse
Having made a plan for suicide
As the depression begins to regain its former strength during the recovery phase. We can list situations such as finding the strength to commit suicide together.
. (OK, Öner 2001).
CONCLUSION
Depression, which can be seen at any age, is also seen in old age, and this disease negatively affects their lives. The cause of depression is multifactorial. Among these, we can list physical diseases, neurobiological factors and psychosocial factors. Other biological disorders that occur in addition to depression worsen the prognosis.
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