Affective disorders and other common disorders in old age Flashcards
What characterises the increase in ageing population?
> Population aged +60 years worldwide
- 2015: 12%
- 2020: 22%
> Old age population growth is 3.5 times more rapidly than general population
What is the impact of the ageing population on society?
> Increasing socio-economic burden
> Increases demands on
- social care
- healthcare
- pension
> Need for
- larger and better trained workforce
- more age-friendly environments
=> old age psychiatry gains significant relevance
What are the valuable contributions of the ageing population to society?
- Carers for families’ grandchildren
- Volunteers in their local community
What does the demographic transition model proposed in 1929 by Warren Thompson consist of?
Observed changes in birth and death rates in industrialised societies over previous 200 years:
> Stage 1: high birth rate, high death rate
- stable or slow increase of population
> Stage 2: high birth rate, rapid fall of death rate
- very rapid increase of population
> Stage 3: falling birth rate, slower fall of death rate
- slowing increase
> Stage 4: low birth rate, low death rate
- stable or slow increase
> Stage 5: very low birth rate, low death rate
- stable or slow decrease
What is observed between developed countries (HICs) and developing countries (LMICs) in the demographic transition model of Warren Thomspon?
- Most developed countries (HICs) are either in late stages or have completed the transition
- most developing countries (LMICs) are still in process of transition
In the demographic transition model, what were the historical events and associated population growth between the 18th and 21st century?
> Stage 1: 18th century
- infectious diseases, periodic epidemics (plague, cholera) -> high death rates
- high fertility + high mortality = slow population growth
> Stage 2: 19th century
- improvements in medicine, nutrition and sanitation -> lower death rates
- high fertility + lower mortality = higher population growth
> Stage 3: 20th century
- social changes (e.g. increased access to contraception) -> low fertility rates
- low fertility + low mortality = imbalance of births over deaths -> rapid increase of pop. growth
> Stage 4: 21st century
- extended lifespan and low fertility rates -> older population
- low fertility + low mortality = increase of adult population
> Stage 5: 21st century and future
- birth rate drops below replacement levels
- very low fertility + very low mortality = reduction of overall population
What is epidemiology, as defined by WHO (2010)?
Study of the distribution and determinants of health-related states or events (including disease),
AND the application of this study to the control of diseases and other health problems
Why is further epidemiological research needed in old age psychiatry?
Cognitive and non-cognitive disorders represent a burden for health, social and economic systems
What is the worldwide prevalence of adults over 60 that suffer from a mental disorder?
15%
What is are two main factors explaining why mental health problems in old age continue to be under-identified by healthcare professionals and old people themselves?
> Cognitive and non-cognitive problems considered normal in old age
> Stigma
- limits help-seeking behaviour
What is the most frequent affective disorder in old age population?
Depression
- approx. 15-25% of general population experience mild depressive symptoms
- > distress and loss of functioning
- unipolar major depression occurs in 7% of general older population
- > 5.7% of YLDs in people aged +60
What is depression associated with in old age?
- Functional disabilities
- Cognitive impairment
- Lower self-related QoL
- Increased mortality
- Poorer functioning compared to those with physical chronic conditions
- Increased self-perception of poor health and use of health care services
In which cases do we commonly see depression in older age?
In older adults recovering from major medical conditions
What characterises late-onset depression in terms of recurrence and persistence?
Late-onset depression shows higher rates of recurrence and/or persistence
Which types of symptoms are frequently observed in depression in old age?
- Somatic and psychotic symptoms
- Suicide is common
What are the available treatment options for depression in old age?
> Psychotropic medication (e.g. antidepressants) and psychotherapy (e.g. CBT, interpersonal psychotherapy)
> Antipsychotics
> Electroconvulsive therapy (ECT), reserved exclusively for very severe psychotic or life-threatening depression
What is the first-line treatment for mild depression in old age?
Psychotherapy, not antidepressants
What is subsyndromal depression?
2 or more symptoms of depression that last for at least 2 weeks
BUT aren’t severe enough for a depression diagnosis
- more common than MDD in older age population
What is the prevalence of subsyndromal depression in older adults in primary and long-term care settings?
> 6-10% of older adults in primary care settings
> 30% in medical and long-term care settings
What is associated to increased age and depression severity?
Greater cognitive impairment
What could explain the complex relationship between depression and dementia?
- Depressive symptoms as prodromal to dementia
- Depression as causative factor in dementia
- Potential shared risk factors
- Cerebral white matter hyperintensities may increase risk of cognitive impairment in depression
- Cardiovascular risk factors (e.g. smoking, hypertension) increase risk for dementia and depression
- Several cognitive domains may be affected in depression
- Cognitive impairment often persists even after remission of depression (40% of affected individuals develop dementia)
What is a prodrome?
Premonitory symptom of a disease
What is the role antidepressants in cognitive impairment?
- May improve cognitive symptoms BUT cognitive impairment may hinder the effectiveness of certain psychotherapies for depression in older adults
- Antidepressants with anticholinergic side effects should be avoided
What is old age bipolar disorder (OABD)?
> Bipolar disorder in individuals aged 60+
> Similar presentation to early-onset bipolar disorder (EOBD)but usually with less severe manic symptoms
> Good response to most mood-stabilisers