Term
| Where will you find major depression in the elderly |
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Definition
3% community dwelling
14% two years after spouse dies
15% medically ill
25% long-term-care settings |
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Term
| Where will you find depressive symptoms in the elderly? |
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Definition
17-37% in primary care settings
42% in long-term-care settings |
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Term
| How is depression different in the elderly? |
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Definition
Less verbalization of emotions or guilt
Minimize or deny depressed mood (“masked depression”)
Preoccupied with somatic symptoms
Cognitive impairment can be marked
Hopelessness appears to be persistent
Depressive ideation, anxiety, psychomotor retardation, and weight loss have high assoc. with disability
More anxiety, agitation and psychosis
esp. delusions with themes of guilt, nihilism, persecution, jealousy
Medical Conditions can mask or cause depression |
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Term
| How does subsyndromal depression present? |
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Definition
new medical complaints
exacerbation of GI sx’s or arthritic pain
cardiovascular sx’s
preoccupation with health
diminished interest, fatigue, poor concentration |
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Term
| What medical conditions can cause or mask depression? |
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Definition
Autoimmune
Cerebrovascular
Chronic pain
Degenerative Disease
Endocrine
Metabolic
Neoplasms
Infections |
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Term
| What percentage of Parkinson's patients develop depression? |
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Definition
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Term
| How are depression and Alzheimers alike? |
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Definition
insomnia
fatigue
agitation
psychomotor retardation
decreased interest & energy
concentration problems |
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Term
| Can cerebrovascular dx precipitate or perpetuate depression? |
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Definition
| yes, ischemia, apathy, psychomoter retardation, cognitive decline. |
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Term
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Definition
| dementia of the depressed, cognitive decline that clears if depression is treated |
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Term
| What does suicide among the elderly look like? |
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Definition
25% of all completed suicides are > 65
Suicide rate for depressed men over 65 is 5 times higher than for younger men
20% of older people who committed suicide saw a physician that day
Increased risk: financial problems, physical illness, recent loss, EtOH, abuse, isolation |
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Term
| What are the depression interventions? |
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Definition
Seek out medical illness
Recognize medical side effects
Rehab services to maximize remaining function and retrain impaired iADL’s
Involve family and caretakers
Counsel re: role transitions, grief, dependency |
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Term
| Things to do for mild to moderate depression: |
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Definition
| sun exposure, melatonin (for insomnia), exercise, acupuncture, vitamins, fish oil, St. johns wort |
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Term
| What are the prescribing principles? |
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Definition
| C (caution, compliance), A (adjust dose for age), R (review, remove, reduce), E (educate); start low and go slow |
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Term
| What is the medical therapy? |
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Definition
Select based on symptoms, prior response, concurrent illness, side effect profile
Reassess after 4-6 weeks:
Increase dose, augment with second agent, add psychotherapy
Consider psychiatric consult/referral |
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Term
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Definition
| works well for psychotic depression, high suicide risk, Parkinson's-related depression, failed drug treatment |
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Term
| What are the take home point? |
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Definition
Depression Often Presents Atypically in Old Age.
Use validated Screening tools, don’t rely on “Are you depressed” question
Rule out medical causes in severe cases.
In Mild to Moderate Depression – try non pharmacological methods first.
Get community, family involved as much as possible.
Watch out for Polypharmacy and if need to start Antidepressant START LOW and GO SLOW – geriatric mantra. |
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