Depression Flashcards
comparison of depression
– young vs older adults
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
risk factors for depression in older adults
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
risk factors cont.
– Medical Conditions and Functional Impairments
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
risk factors cont.
– effects of meds and alcohol
- 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
functional consequences
- physical
- change of appetite
- weight change
- GI symptoms
- insomnia, hypersomnia
- early awakening
- fatigue
- loss of energy
- loss of libido
- change of psychomotor activities
functional consequences
- psychosocial
- 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
nursing assessment using geriatric depression scale (GDS)
5-7 min
used for adults w/ cognitive impairment
30 languages
nursing interventions
– alleviating risk factors
- 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.
nursing interventions
– improving psychosocial function
- 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
nursing intervention
– promoting health through physical activity and nutrition
- encourage engagement in group individually-tailored exercise programs
hospital setting:
» facilitate referrals to physical, occupational, and recreational therapies - nutrition interventions
tool
well-researched and evidence based
- easy and widely used
nursing interventions
– providing education and counselling
- 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
nursing intervention
– psychosocial therapies
- suggest/directly facilitate referrals to interprofessional geriatric mental health and/or geriatric assessment services for treatment of major depression
nursing intervention
– teaching about alternative interventions
- herbs and other natural remedies for depression
- St Johns wort
- light therapy
- stress reduction interventions
» yoga, relaxation, exercise
nursing intervention
– teaching about electroconvulsive therapy (ECT)
- 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
