1 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
The most important psychosocial factors that play a role in
the development of depression include the losses inherent in
old age, such as those of health or significant others, as well as
loneliness experienced by patients in nursing homes. Patients
who identify religion as the most important factor in coping,
termed “religious coping,” show improved emotional and
physical health,35 suggesting that religion may be a protective
factor in development of depressive symptoms.