5. Depression

Question 1

Depression in Older adults

Answer 1

• more cog and physical symptoms (more 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

Answer 2

• female
• family hx
• loneliness
• loss of sig. relationship
• lack of role
• recent social stressor
• being a caregiver
• current or past abuse or neglect
• lack of social supports

medical conditions ex cancer, dementia, stroke, Parkinson’s, chronic pain

• nutritional deficiencies
• disability
• effects of medications and alcohol
• withdrawal from medications
• cog. impairments

Question 3

Functional consequences

Answer 3

Physical:

• loss of appetite
• weight loss
• GI symptoms
• insomnia
• hypersomnia
• fatigue
• loss of energy
• pain
• loss of libido
• slowed or increased psychomotor activities

Psychosocial:

• sad affect
• absence of feelings
• diminished life satisfaction
• low self esteem
• inattention to personal appearance
• slowed thinking, poor memory
• guilt
• hopelessness
• unworthiness
• uselessness

Question 4

Assessment

Answer 4

Geriatric Depression Scale
(GDS)
-to detect depression in pts with cog. impairment
-high score=depression

Question 5

Interventions

Answer 5

Alleviate risk factors

Improve psychosocial function

Encourage PA and nutrition

Provide education and counseling

Refer to therapy

*Teach about and manage antidepressant meds:

1. Selective Serotonin Reuptake Inhibitors SSRI
   (safe, broad spectrum)
2. SNRI -serotonin and norepinephrine reuptake inhibitors
3. MOAI - monoamine oxidase inhibitors
   (can cause fatal reactions)
4. Cyclic/tricyclic
   (lots of side effects so not first choice)

Teach about other interventions

Teach about electroconvulsive therapy