ETIOLOGY
Biological, psychological, and social factors contribute to
the etiology of depression in nursing home patients. Biological
factors include a strong association with medical illnesses such
as cardiovascular disease, Parkinson’s disease, hip fractures,
pain, and urinary incontinence. “Vascular depression” is a
term used to describe late-life depression associated with vascular
changes in the brain, and characterized by executive
dysfunction.31 Changes in the brains of depressed older patients
seen on imaging include structural abnormalities in
areas related to the cortical–striatal–pallidal–thalamus–
cortical pathway,32 smaller size of the orbital frontal cortex in
late-life depression,33 and smaller left hippocampal volumes
in depressed patients who go on to develop dementia.34