Depression

Question 1

late-onset depression differs from early onset

Answer 1

• worse prognosis
• more chronic course
• higher relapse rate
• higher levels of medical comorbidity, cognitive impairment, and mortality

Question 2

Consequences of Depression

Answer 2

• more likely to be fatal in older patients – especially older men
• depression is linked to poor health outcomes
• increases progression of chronic illness

Question 3

Preventitive treatment for depression includes

Answer 3

• 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)

Question 4

Signs of depression are often overlooked

Answer 4

• 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

Question 5

depression and anxiety are recognized in older adults equally as often as other age groups? T/F

Answer 5

False

Question 6

Common symptoms of depression in elderly

Answer 6

• 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

Question 7

Name 2 assessment tools for depression

Answer 7

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

Question 8

Are older adults more or less prone to suicide?

Answer 8

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.

Question 9

What are 3 common treatments for elderly depression? Non=pharmacological approches

Answer 9

1) Non-pharmacological approches (environmental/behavioral strategies)…this is the first time treatment
2) Drugs
3) Other like ECT (harder due to cardiac issues)

Question 10

What are 2 main goals for improving with depressive elderly?

Answer 10

Enhance physical function + enhance social support

Question 11

Common Med plan for depression treatment

Answer 11

• 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.