Depression in the Eldery Handout Package

Transcription

1 Depression in the Eldery Handout Package

2 Depression in the Elderly 1 Learning Objectives Upon completion of this module, you should be able to: 1. State the prevalence and describe the consequences of depression in the elderly. 2. Give examples of common causes of depression in the elderly. 3. Describe the basic types of depression. 4. Identify signs and symptoms that may indicate depression. 5. Explain and justify common therapies and treatments for depression. 6. Describe the role of the health care worker in caring for the elderly clients living with depression. 2 Depression is a mood disorder that falls along a continuum from Major to Minor depression. 3 1

3 Depression in older adults is a common illness associated with increased morbidity and mortality but frequently is unrecognized and untreated 4 Facts & Figures In 1990, the World Health Organization identified major depression as the 4 th leading cause of worldwide disease burden. Elderly women are roughly twice as likely as elderly men to become depressed. 5 Major depression, according to the DSM-IV, is a mood disorder characterized by five (or more) of the following symptoms that have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is (a) depressed mood or (b) loss of interest or pleasure. a. Depressed mood most of the day, almost every day, for at least two weeks. b. Diminished interest or pleasure in almost all activities most of the day, almost every day, for at least two weeks. 6 2

4 Major Depression Continued c. Significant weight loss or gain; change in appetite. d. Sleep disturbances (e.g., insomnia, waking early, hypersomnia). e. Psychomotor agitation/retardation; feeling restless, wired or irritable. f. Fatigue; energy loss. g. Feeling of worthlessness, guilt or hopelessness. h. Impaired concentration; indecisiveness. i. Recurring thoughts of death/suicide. 7 Other Types of Depression A. Psychotic Depression Major depression with delusions and/or hallucinations B. Dysthymic Disorder Chronic depressed mood most of the day, most days, for at least two years 8 Other Types of Depression C. Minor Depressive Disorder Shorter term, episodic lowered mood D. Others: SAD Adjustment disorder Depression secondary to medical condition Bipolar disorder Delirium and dementia 9 3

5 It is critical to note that presentation of depressive disorders is often atypical in the elderly. a. Depressed mood is not always evident. b. Memory loss or difficulty with concentration. c. Anxiety of several weeks/months duration. d. Physical manifestations. e. Psychotic features. f. Functional decline. g. Apathy, withdrawal and loss of self-esteem. h. Suicide attempts. 11 Depression: Risk Factors Physical Medical conditions Sensory decline Functional decline Medications Gender History 12 Depression: Risk Factors Psychosocial Significant losses Alcohol/substance abuse History of physical or sexual abuse Loneliness or sense of abandonment Difficult interpersonal relationships 13 4

6 Depression: Risk Factors Spiritual Loss of faith Disappointed with God Disappointed with level of support from church family Lack of purpose in life 14 Depression: Risk Factors Cognitive Realization that cognition is declining Diagnosis of dementia Memory loss 15 Consequences of Depression Physical Fatigue Decreased appetite Increased susceptibility to infections Somatic complaints 16 5

7 Consequences of Depression Psychosocial/Societal Social deprivation Loneliness Alcohol/substance abuse Increased use of health care 17 Consequences of Depression Behavioural Aggressiveness Agitation Withdrawal Over-dependency 18 SIG E CAPS S Sleep is disturbed. I Interest and capacity for joy are decreased. G Guilt of lowered self-esteem are common. E Energy and participation are lower than previously. C Concentration is poor; memory problems may appear. A Appetite is disturbed, usually with a loss of weight. P Psychomotor retardation or agitation may be present. S Suicidal ideation and thoughts of death are common. 19 6

8 Common Depression Screens Geriatric Depression Scale Brief Assessment Schedule Depression Cards (BASDEC) Cornell Scale for Depression 20 Depression in the elderly is often undiagnosed, under-diagnosed, or misdiagnosed. Tendency to diagnose and prescribe for anxiety rather than depression Ageism Many older adults find it very difficult to even identify their own feelings Stigma attached to psychological/psychiatric illness Somatic symptoms are often misattributed to physical illness 21 Treatment of Depression Psychotherapy Drug Therapy Electroconvulsive Therapy (ECT) 22 7

9 Psychotherapy The therapeutic relationship is critical. Psychotherapy becomes particularly important in the rehabilitative and maintenance phase of the patient s disorder. Some common applications of psychotherapy: Cognitive-Behavioural Therapy Group Therapy 23 Drug Therapy It is advisable to begin drug therapy at relatively low doses, and to increase dosage levels slowly. Often the first drug tried will not have the desired effect. Other cautions: Observe for side effects Monitor for desired effects Be aware of the dangers of polypharmacy 24 Electroconvulsive Therapy The most effective treatment modality for major depression, especially for those with delusions or suicidal ideation Has an 80% success rate in all age groups Very safe, with rare complications and adverse effects 25 8

10 There is great potential for effective treatment of depression to contribute to the improvement of quality of life 26 Role of the Health Care Worker Be educated about depression. Be alert for signs of depression. Respond to comfort needs. Report observations. Be aware of and follow the treatment plan. Provide opportunity to reminisce, review life. Listen to and respect the client s views. 27 Role of the Health Care Worker Support the highest level of functioning. Ensure nutritional needs are met. Encourage self-decision making. Identify strengths. Display a positive attitude. Enhance sense of belonging and mattering. KNOW THE CLIENT WELL! 28 9

11 Depression is one of the most common and most treatable of all mental disorders in older adults 29 10