This is the final article in a series about the elderly in America today.

Q: What are the trends in mental disorders, addictions and abuse of prescription medications in the elderly?

A: Mental Health America, formerly the National Mental Health Association, released the following facts about depression in the elderly, dated 2009. More than 2 million Americans of the 34 million who are 65 years and older suffer from depression. Many chronic diseases in older adults trigger depressive reactions. These include Alzheimer's disease, Parkinson's disease, cancer, arthritis and heart disease.

A third of older person who lose spouses are depressed in the first month after their losses. Half of this number of widows and widowers still are depressed after a year.

Older adults with depression have approximately 50 percent higher health costs than the non-depressed elderly. Suicide is a risk for the depressed older population. Persons 65 years and older comprise 13 percent of the population and account for 20 percent of all suicides.

The majority of depressed elderly who receive treatment seek treatment from primary care physicians. Less than 3 percent are treated by mental health professionals. The majority of adults 65 years and older believe depression is a normal process of aging.

Rita L. Colderson, a clinical social worker in New York City, documents that untreated depression can lead to hypertension, diabetes and general physical debilitation related to inactivity. She also enumerates risk factors for elderly depression. These include death of a significant other, medical illness, social isolation and loneliness, divorce and abusive relationships, poverty, caring for ill spouses or children, loss of former abilities and moving. Retirement also can trigger depression in the elderly if they feel they have no goals or purposes in life.

The elderly are more likely than younger adults to have negative stigmas against seeking help. Depression affects all economic and ethnic groups, and the stigma essentially appears in all these groups in the elderly population.

There are barriers to identifying depression in the elderly. Dr. Jonathan Segal from the Palo Alto Medical Foundation points out that depression in the elderly is hard to diagnose because the symptoms overlap with many physical illnesses common in older persons. A second barrier is that depressive symptoms in the elderly do not present as the classic symptoms of depression. Elderly patients might never mention depression but might instead recite long lists of minor physical problems such as constipation or fears that are not realistic.

The classic symptoms of depression that might not be obvious in the elderly include melancholy, lethargy, loss of interest in hobbies and activities, negativism, irritability, indecisiveness, poor concentration and suicidal thoughts. Loss of appetite and disturbances in sleep also commonly are occurring classic symptoms.

An ever-shrinking circle of family and friends in combination with feelings of loneliness and isolation predispose older persons toward depression. A study at the University of Chicago of 3,000 people ages 57 to 85 in 2005 and 2006 concluded those who adapted better to losses and did not feel isolated had much better mental and physical health.

According to an article in the Christian Science Monitor in 2002, the most commonly occurring addiction in the elderly is alcoholism. The use of illegal drugs is expected to increase significantly when baby boomers join the elderly population because their lifetime illegal drug use is higher than those who aged before them.

Drug abuse in the elderly is hard to identify. Most of the elderly are retired or semi-retired and are not visible in the criminal justice system, so they are hard to track. Alcoholism and other drug abuse are more likely to be seen as moral shortcomings by the elderly and thus less likely to be revealed because of shame and guilt. Family members also might be reluctant to confront their elderly relatives.

Dr. William L. Smith, a psychotherapist who works with addictions, states that diagnosing alcoholism is difficult because many of the symptoms mimic either processes of aging or side effects of medication. These symptoms include aches and pains, depression, anxiety, insomnia, decreased sexual drive, loss of memory and chronic gastritis.

There are two types of alcoholism, that which develops before age 65 years and that which develops after 65 years of age. Late onset alcoholism might not be easily recognized, but, if diagnosed, has the better chance for recovery because those older adults have past histories of successful coping skills.

The abuse of prescription medication is an enormous problem for the elderly. Longer life expectancy not only has increased the years the elderly will live, but also has multiplied the number of chronic conditions that require medication. According to the American Heart Association Web site (2006), about 65 percent of those post-retirement have medication compliance rates of 60 percent or less.

Elderly persons with faulty memories might take too much or not enough medication. Older patients might not realize they are experiencing side effects or toxic effects from their medications. Since the majority of the elderly can remain in their homes longer because of the proliferation of home-based services, there might be no one in their homes often enough to perceive misuse of medications.

Since the elderly need less medication than younger patients to get the same results, they are more of a risk for adverse effects. Older persons also understate their problems, or give incomplete data to physicians, not necessarily intentionally.

Family members can be helpful to older relatives by encouraging them to write down information for physicians, by attending appointments with elderly persons and by monitoring their medication use. Besides physicians, concerned family members also can consult pharmacists, who are knowledgeable resources regarding side effects and misuse of medications.

Judy Caprez is associate professor and director of social work at Fort Hays State University. Send your questions to her in care of the department of sociology and social work, Rarick Hall, FHSU.