Late-life depression, religiosity, cerebrovascular disease, cognitive impairment and attitudes towards death in the elderly: interpreting the data.

Geriatric depression is considered to be a major health problem in the elderly. Passing the age, the speed of mental process is decreasing and personality obtains more mature functioning (better coping) while most of its traits remain stable. Empirical studies have shown that fear of death is most prominent during midlife and not late-life. Neuroimaging studies led to the "vascular depression" hypothesis. Depression was found to be a strong predictive factor leading to stroke, while religiosity seemed to be a 'protective' factor. A possible interpretation of these reports could consider late-life depression to be an early symptomatology of an undergoing vascular disease. Religiosity could be interpreted as absence of depression, and therefore, mainly as absence of vascular lesions. The above have profound implications in the understanding of late-life depression and to the therapeutic design, especially in the primary care setting.