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Semester 3 FS Exam 4 > Depression in the Elderly > Flashcards

Depression in the Elderly Flashcards

1
Q

Depression is more common in which patient - community, hospital, long term care

A

Long term care

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2
Q

Why is depression more common in long term care patient

A

Relocation
Social factors
Co-morbidity
Medication side effects

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3
Q

Relocation

A

Lack of ind. and stimulation
Deteriorating sense of integrity
Deficiencies in care
Lack of pos. reinforcement

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4
Q

Social Factors

A

Loss of social support
Bereavement
Retirement
Loss of autonomy, status and independence

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5
Q

Co-Morbidity

A

Chronic disease associated with high prevalence of depression

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6
Q

Co-morbidity - stroke association with depression

A

30-60%

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7
Q

Co-morbidity - Coronary artery disease prevalence with depression

A

8-44%

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8
Q

Co morbidity - Cancer prevalence with depression

A

1-4%

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9
Q

Co-morbidity - Parkinsons prevalence with depression

A

40%

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10
Q

Co-morbidity - Dementia prevalence with dementia

A

20-40%

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11
Q

Medication side effects - in general older adults take an average of how many medications
What about in LTC?

A

4

8 in LTC setting

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12
Q

Medication side effects - Depressant effects

A

1/4 of those medications may have a depressant effect

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13
Q

2 main barriers of depression in older adults

A

Under recognition

Under treatment

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14
Q

Consequences of undertreated depression

A

Diminished functioning
Slower recovery
Inc mortality
Suicide

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15
Q

Suicide - adults over age of 65 comprise what percentage of population and what percent of suicide deaths

A

13% of US pop

nearly 18% of suicide deaths

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16
Q

Highest rate of suicide in US

A

White men age 85 or older

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17
Q

Risk factors for suicide

A 
Recent losses
Major medical issues
Social isolation
Being widowed 
(w attempt more, m are more effective)
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18
Q

Sx of depression

A 
Inc somatic complaints
Sleep issues
Loss of appetite
Feelings of worthlessness
Paranoia
Pseudodementia
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19
Q

DSM IV criteria

A

at least 5 sx present in a 2 week period and can’t be due to other things

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20
Q

Diagnosing Depression

A

DSM criteria
Mini mental scale
Geriatric depression scale
Hamilton depression rating scale

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21
Q

Two question screener

A

During past month have you been bothered by feeling down, depressed or hopeless
During the past month, have you been bothered by little interest or pleasure in doing things

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22
Q

Geriatric Depression Scale

A

Long form and short form
Screening tool
Self administered
Yes/no responses
Sensitive (85) and specific (95) at score of 11
Not reliable in those with cog impairment

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23
Q

Hamilton Depression Rating Scale

A

Commonly used
Administered by HCP
Score of 18 is cutoff for depression
Validity not well tested

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24
Q

Dementia vs. Depression - what is the relationship

A

50% of patients with dementia are depressed

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25
Q

Dementia vs. Depression - cognition

A

Patients with depression do not lost intellectual capacity - executive function

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26
Q

Barriers to seeking treatment

A

Stigma with depression
Pts may not realize they are showing signs of depression
They may think it is normal part of aging
Might think it is due to their illness
Denial
Financial barrier

27
Q

Treatments for depression

A

Nonpharacologic
Medications
Herbal medications
Electroconclusive therapy

28
Q

Non-pharmacological Interventions

A 
Socialization
Spirituality 
Exercise
Regular outdoor activity
Positive thinking
Daily pleasureable activity
29
Q

Pscyhotherapy - what percentage of residents in LTC facility

A

20-30%

30
Q

Benefits of psychotherapy

A

Improved outcomes

Combination of psychotherapy and antidepressants - best treatment outcomes

31
Q

Electroconclusive Therapy

A

Indicated for older pts who are unresponsive to tx

Several studies have shown safety and effectiveness in older adults

32
Q

Side effects for ECT

A

Short term confusion and memory impairment

33
Q

Medications

A

SSRI
Other antidepressants
Tri-cyclic antidepressants
Monoamine oxidase inhibitors

34
Q

Rule of thumb with antidepressants

A

Start low, go slow

Taper slow

35
Q

How do antidepressants work?

A

Etiology of depression is certain NT deficiencies

Antidepressants work on different NTs

36
Q

SSRI - mechanism of action

A

Inc level of serotonin

37
Q

Commonly used SSRIs

A 
Prozac
Paxil
Zoloft
Celexa
Lexapro
38
Q

SSRI

A

1st line of therapy for older adults

Better tolerated but more $

39
Q

SSRI can also be used for

A

General axiety disorder
Panic disorder
OCD

40
Q

SSRI Side effects

A 
GI sx
Anxiety
Hyponatremia
Sexual dysfunction
Weight gain
Fatigue or insomnia
41
Q

Duloxetine

A

Also indicated for diabetic neuropathy

Side effects - nausea, insomnia, somnolence

42
Q

Venlaxafine

A

Act as SSRI at low dose
Inhibits uptake of NE at higher doses
Effective for depression, GAD
Side effects - nausea, hypertension, sexual dysfunction

43
Q

Wellbutrin

A

Generally safe and well tolerated
Inc activity of Dop and NE
Also used for smoking cessation
Side effects - insomnia, anxiety, tremor, seizures

44
Q

Mirtazapine

A

Inc Ser and NE
Associated with weight gain, inc appetite
May be used in older adults who are having failure to thrive
Very sedating

45
Q

TCAs mechanism of action

A

Blocks the reuptake of NE and serotonin

46
Q

Appropriate TCAs for older adults

A

Nortriptyline

Desipramine

47
Q

TCAs to avoid in older adults

A

Amitriptyline
Doxepin
Imipramine
Maprotiline

48
Q

Side effects of TCAs

A 
Anticholinergic properties
- Orthostatic hypertension
- Constipation
- Urinary retention
- Blury vision/dry mouth
- Cardiac conduction problems
Sedation
Weight gain
Lower seizure threshold
49
Q

MAOIs

A

Phenelzine

Tranylcypromine

50
Q

MAOI side effects

A

Life threatening hypertensive crisis can occur if dont watch diet
Orthostatic hypertension
Use of SSRI and MAOI together leads to serotonin syndrome

51
Q

Serotonin Syndrome

A

Caused by use, overdose, or combined use of medications like SSRI and MAOI

52
Q

Cognitive sx of serotonin syndrome

A

Confusion, agitation, anxiety, irritability, and drowsiness

53
Q

Autonomic NS overactive - Serotonin Syndrome

A

Hyperthermia, diaphoresis, tachycardic, tachypnea, hypertension, dilated or unreactive pupils, GI symptoms

54
Q

Neuromuscular signs with serotonin syndrome

A

Hyperreflexia, tremor, muscular rigidity, ataxia, clonus, nystagmus

55
Q

Antianxiety medications

A

Might be first type of drug given to patients exhibiting jittery, nervous type of behavior

56
Q

Ex of antianxiety medications

A

Diazepam (20-100 hrs)
Lorazepam (10-20 hrs)
Chloridiazepoxide (5-20 hrs)

57
Q

Antianxiety medications also used as

Side effects include

A

muscle relaxants

Side effects include sedation

58
Q

Sedative-hypnotic agents

A

Benzodiazepines with greater sedation rate

Barbituate

59
Q

Ex of benzodiazapine

A

Triazolam (2 hr)

Temazapam (8-22 hr)

60
Q

Ex of barbituate

A

Secobarbital (15-40 hr)

61
Q

Side effects of sedative-hypnotic agents

A

Motor problems, confusion, anxiety, headache, hypotension

Tend to have addictive effeccts particularly the seconal

62
Q

Antipsychotics

A

Several major drug classifications
Impair synaptic transmission of dopamine pathways
Anticholinergic effects

63
Q

Ex of antipsychotics

A 
Chloropromazine hydrochloride
Prochlorperazine
Thioridazine hydrochloride
Haloperidol
Triflupromazine HCl
Risperidone

Semester 3 FS Exam 4 (11 decks)

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