Depression

Question 1

comparison of depression
– young vs older adults

Answer 1

Depression in YA
* More emotional symptoms
* Sense of hopelessness, uselessness, and helplessness
* Negative feelings towards self
* Insomnia
* Eating disorders
* More verbal expression of suicidal ideation than successful attempts; more passive means of suicide

Older Adults
* More cognitive & physical symptoms (somatic presentation)
* Apathy; exaggeration of personal helplessness
* Sense of emptiness; withdrawal from social activities
* Hypersomnia; early-morning awakening
* Anorexia; weight loss
* Less talk about suicide; more successful attempts and more violent means

Question 2

risk factors for depression in older adults

Answer 2

demographic factors and psychosocial influences:
* female gender
* Personal or familial history
* Bereavement/ loss of significant relationships
* Loneliness
* Recent social stressors
* Stressful social environment
* Loss of meaningful social interaction
* Lack of social supports
* Loss of significant roles
* abuse and neglect
* Being a caregiver

Question 3

risk factors cont.
– Medical Conditions and Functional Impairments

Answer 3

conditions with an increased risk for depression
ex. cancer, dementia, Parkinson’s, MS/ALS
- disability can lead to depression
- depression can lead to other medical problems
- depression worsens pain and pain worsens
depression
- nutritional deficiencies

Question 4

risk factors cont.
– effects of meds and alcohol

Answer 4

• meds can mimic depression/episodes
• meds can simulate a depressive syndrome by causing lethargy, insomnia and irritability
• withdrawal of certain meds can cause a
  depressive episode
• older adults are more sensitive to adverse
  medication effects due to age-related changes
• alcohol and depression have a circular relationship
• cognitive impairments and Dementia

Question 5

functional consequences
- physical

Answer 5

• change of appetite
• weight change
• GI symptoms
• insomnia, hypersomnia
• early awakening
• fatigue
• loss of energy
• loss of libido
• change of psychomotor activities

Question 6

functional consequences
- psychosocial

Answer 6

• sad/low/flat affect
• absence of feelings
• diminished life satisfaction
• low self-esteem, passivity
• inattention to personal look
• slowed thinking, poor memory
• exaggeration of any mental deficits
• rumination about past/present problems
• hopelessness
• unworthiness
• uselessness

Question 7

nursing assessment using geriatric depression scale (GDS)

Answer 7

5-7 min
used for adults w/ cognitive impairment
30 languages

Question 8

nursing interventions
– alleviating risk factors

Answer 8

• adverse meds effects are a risk > encourage client to speak to health provider about alternatives
• alcohol use > referral to AA or other counselling
• any intervention to improve functioning
  > ex. continence products, sensory aids, mobility assists, etc.

Question 9

nursing interventions
– improving psychosocial function

Answer 9

• promote autonomy, self-efficacy, decision-making about daily care
• promote socialization
  » seniors group, day programs
• refer to support groups for life events
  » caregiving, widowhood, loss of children

Question 10

nursing intervention
– promoting health through physical activity and nutrition

Answer 10

• encourage engagement in group individually-tailored exercise programs
  hospital setting:
  » facilitate referrals to physical, occupational, and recreational therapies
• nutrition interventions

Question 11

tool

Answer 11

well-researched and evidence based
- easy and widely used

Question 12

nursing interventions
– providing education and counselling

Answer 12

• help older adults identify fears, provide reality-based info to help them evaluate fear
• assist in verbalizing emotions
• encourage story-telling
  » acknowledge their strengths and weaknesses
• active listening and expressing empathy
  » addressing sadness about losses

Question 13

nursing intervention
– psychosocial therapies

Answer 13

• suggest/directly facilitate referrals to interprofessional geriatric mental health and/or geriatric assessment services for treatment of major depression

Question 14

nursing intervention
– teaching about alternative interventions

Answer 14

• herbs and other natural remedies for depression
• St Johns wort
• light therapy
• stress reduction interventions
  » yoga, relaxation, exercise

Question 15

nursing intervention
– teaching about electroconvulsive therapy (ECT)

Answer 15

• major depression

guidelines recommend considering ECT for
older adults when:
> antidepressants are ineffective, not
tolerated or pose significant medical risks
> when the patient’s health is significantly compromised due to depression

Question 16

SSRIs

Answer 16

Selective Serotonin Reuptake Inhibitors
- a group of meds that treat depression
- the first go-to
- safe, efficient, broad, treat all types of symptoms
- not as many side effects

Question 17

Cyclic/ tricyclic antidepressants

Answer 17

connected to depression
Amitriptyline, Desipramine