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Distinguishing Distress in the Context of Aging: Demoralization vs. Depression

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Abstract

Purpose of Review

Older adults face unique age-related challenges that evoke existential themes. Demoralization and depression are clinical concerns at the interface of the physiological and psychosocial worlds. This review highlights the utility of demoralization as a clinical construct distinct from depression, as well as common tools for measuring it; discusses the prevalence of demoralization in the clinical context and related sociodemographic factors; and outlines potential treatment approaches for restoring morale in demoralized patients.

Recent Findings

Demoralization is characterized by a sense of hopelessness, helplessness and persistent inability to cope due to a loss of meaning and purpose in life. In contrast, depression is better differentiated by anhedonia and apathy. Demoralization is highly prevalent across clinical settings, and often occurs independently of a mood or anxiety disorder. Demoralization is a stronger predictor of suicidal ideation than depression. Social isolation, unemployment, physical symptom burden, and inadequately treated mood and anxiety disorders may increase risk for demoralization. Family support, higher income, and secure interpersonal attachments are potential protective factors. Psychotherapeutic interventions aimed at resilience-building and meaning-making may be helpful treatment modalities for demoralization.

Summary

Demoralization and depression are two distinct psychological conditions that can exist independently and in comorbidity. It is imperative that clinicians appropriately screen, evaluate and address symptoms of demoralization given that older adults are disproportionately affected by stressors, such as chronic medical illness, that evoke existential conflicts and impact physical, mental, and functional health. Further research is needed to reach better consensus on the boundaries of the demoralization construct, how to reliably measure it, and in what way to integrate it within our current classification system. This can ultimately help improve quality of care by allowing clinicians to better tailor treatment towards restoring morale in older adults.

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    1. Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA

      Shriya Kaneriya & Kirsten M. Wilkins

    2. Department of Psychiatry, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA, USA

      Chelsea Mendonca

    3. Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA

      Erawadi Singh

    4. VA Connecticut Healthcare System, West Haven, CT, USA

      Kirsten M. Wilkins

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    Kaneriya, S., Mendonca, C., Singh, E. et al. Distinguishing Distress in the Context of Aging: Demoralization vs. Depression. Curr Geri Rep 12, 128–137 (2023). https://doi.org/10.1007/s13670-023-00390-8

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