Geratric Depression

Question 1

When do you screen for geriatric depression

Answer 1

low threshold to screen since its pretty common

Patient presents with

• social isolation
• persistent grief
• cognitive impairment/functional impairment
• chronic pain
• substance abuse
• chronic comorbidities

Question 2

Epidemiology and risk factors for geriatric depression

Answer 2

15% in the adult community residents

Risks

• female
• social isolation
• recent death of a spouse or divorces
• medical comorbid
• insomnia
• delirium
• chronic pain

Question 3

How does depression usually look like in geriatric depression?
(Most common symptoms/signs)

Answer 3

Low energy

Decreased appetite

Weight loss

Sleep disruption (early AM awakening)

Somatic complaints/hypochondriasis

Question 4

Differential diagnosis for geriatric depression

Answer 4

Delirium

Hypothyroidism and diabetes

Dementia

Medication side effects

Substance abuse

Complicated grief

Question 5

Complicated grief vs depression

Answer 5

Complicated grief = there is an obvious reason for the depression/grief
- also all signs/symptoms are related to the reason for grief

Depression = there usually is not an obvious reason for the depression/grief
- signs/symptoms are not always tied to an event (usually aren’t, only get worse because of the event, but was there before/not caused directly by it).

Question 6

Pseudo dementia

Dementia syndrome of depression

Answer 6

Pattern of cognitive impairment that is associated with depression in the elderly
- predominantly psychomotor slowing and prominent a motivation

A lot of questions are responded to as “I dont know”

No memory impairment usually (or mild if parent)

very highly tied to depression (patient usually has both)

Question 7

Prognosis of geriatric depression

Answer 7

Suicide risk is significant

• especially elderly caucasian males
• make up 25% of all completed suicides

if on antidepressants and properly therapy, the prognosis is pretty good

Question 8

Considerations with Medications for elderly

Answer 8

WHEN IN DOUBT, USE BEERS CRITERIA

Start low dose and go slow
- be alert for hyponatermia with SSRIs

Always administer with CBT/therapies

can use ECT if fails multiple trials of antidepressants (is not contraindicated just because they are old)