late-onset depression differs from early onset
- worse prognosis
- more chronic course
- higher relapse rate
- higher levels of medical comorbidity, cognitive impairment, and mortality
Consequences of Depression
- more likely to be fatal in older patients – especially older men
- depression is linked to poor health outcomes
- increases progression of chronic illness
Preventitive treatment for depression includes
- increasing social interactions in the elderly to reduce lonliness.
- increase/start exercise
- instilling hope (get them to see that there is a future. Hope doesn’t exist with one person)
Signs of depression are often overlooked
- assume it is just normal part of aging
- symptoms of depression are often incorrectly attributed to physical (e.g. neuro) illnesses.
- The elderly usually do not present satating “I feel depressed
- Clinical sympoms are less obvious in the aging propulation
depression and anxiety are recognized in older adults equally as often as other age groups? T/F
False
Common symptoms of depression in elderly
- Cognitive changes
–Worse memory - Decreased appetite
- Early morning wakening (changes in sleep patterns)
- Isolation (not interacting, going to church/activities, selective mutism)
- Excessive focus on health concerns (pain, somatic complaints)
- Excessive worry
Name 2 assessment tools for depression
PHQ-2 – a quick initial screening tool.
PHQ-9- first self-report 9 item questionnaire specific to depression for use in primary care.
Cornell Scale for Depression in Dementia pg. 155
Are older adults more or less prone to suicide?
Older adults are a higher risk group for suicide- especially older men. They don’t tend to tell anyone and choose lethal means – assessment can be challenging and building rapport is essential.
What are 3 common treatments for elderly depression? Non=pharmacological approches
1) Non-pharmacological approches (environmental/behavioral strategies)…this is the first time treatment
2) Drugs
3) Other like ECT (harder due to cardiac issues)
What are 2 main goals for improving with depressive elderly?
Enhance physical function + enhance social support
Common Med plan for depression treatment
- SSRI in combination with psychotherapy- first line trt.
- Adequate trial- 6 to 12 weeks with close monitoring
- SSRI’s and venlafaxine – stimulating so give in AM
- Venlafaxine (Effexor) – caution with persons with hypertension- monitor vitals when dose is increased.
