Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit?

OBJECTIVES:The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5.METHODS:In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX.RESULTS:Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue.CONCLUSIONS:This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues.CLINICAL IMPLICATIONS:Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.