Depression in Older Adults Flashcards
what is the global prevalence of depression in older adults?
28.4% (Hu et al. 2022)
what are some physical factors that can cause depression? (6)
- chronic disease
- acute myocardial infarction
- organic brain diseases
- endocrine/metabolic disorders
- malignancy
- chronic pain and/or disability
These can lead to lower rates of exercise, stress, lack of sleep, sensory/cognitive/motor impairment and polypharmacy
(Rodda et al 2011)
what are some psychosocial factors of depression? (8)
- social isolation
- change in financial circumstances (retirement)
- being a carer (for spouse?)
- bereavement
- difficulty adapting to illnesses/pain
- anxiety about death
- history of depression
- being in institutional care
(Rodda et al 2011)
what are the risks associated with social isolation?
- increased blood pressure
- infection
- impaired cognitive function
- depression
- mortality
Social relationships often encourage older adults to seek appropriate medical treatment, better medication/treatment concordance, and less participation in negative health behaviours
(Coyle & Duggan 2012)
what factors increase risk of suicide? (7)
- major life changes (loss)
- financial stress
- chronic pain
- serious health concerns
- medications that alter brain chemistry
- hx of attempts/self harm
- access to methods (particularly for socially isolated persons)
(Kay et al. 2017)
how can depression generally present in older adults? (8)
- somatic complaints
- report of loneliness
- early mornings
- appetite change
- fatigue
- hopelessness about future
- poor memory and concentration
- slower cognitive processing and executive functioning
(NIA 2021)
what are key points about delirium that distinguishes it from depression and dementia? (6)
- sudden onset within hours/days
- worse at night
- impaired recent memory
- fluctuates between rational/disorganized thinking
- distorted perception (hallucinations/difficulty distinguishing between reality and misperceptions)
- diagnosed based on rapid onset of fluctuating symptoms
test for infection before query depression/dementia
what are the key points about dementia that differentiate it from depression/delirium?
- gradual and progressive decline over months/years
- impaired recent and remote memory
- difficulty with abstract thinking, poor decision making, difficulty finding words
- may include delusions surrounding persecution/theft (psychotic symptoms possible in Lewy Bodies)
- wandering and confusion at night
- must rule out other causes (delirium/depression) before diagnosis
what are the key points that distinguish depression from dementia/delirium?
- onset over weeks/months (coincide with life event)
- often worse in the morning
- generally intact/minimally impaired memory
- reduced concentration/indecisive/low self esteem/hopelessness
- perception surrounds feelings of guilt and self loathe (possible delusions/hallucinations in severe/psychotic depression)
- flat mood, withdrawn, changes in appetite, no interest in usual activities
what assessment tool should be used?
geriatric depression scale
what are causes of delayed intervention?
- misconceptions about psychopathy
- poor mental health literacy
- cost of care
- misconceptions about treatment
- stigma
(Pywell et al 2020)
what are some psychosocial interventions?
- art therapy
- music therapy
- CBT
- mindfulness
- life story work
what are physiological interventions?
- ECT (not common)
- medications
Strong evidence shows efficacy of combined antidepressant and cognitive behaviour therapy over antidepressant alone in moderate to severe depression and in chronic depression. (Timonen et al. 2008)
what are the reasons for increased risk of adverse drug reactions in older adults?
- polypharmacy
- altered homeostasis and immunity
- altered pharmacokinetics and pharmacodynamics
- sensitivity to sedatives
- compliance problems (try use blister packs if they live alone)
what are the key components of recovery focused care plan?
- early intervention
- person centered (include family/carers)
- psychoeducation
- hope inspiring care
- connectedness (social groups)
Meaningful social activities have shown to improve low mood and mental health outcomes for older adults with depression
(Foresman et al 2011)
