geriatric Flashcards
major depression criteria
-Depressed Mood or Anhedonia (must have one)
-4 or more additional symptoms
-Change in Appetite/Weight
-Change in Sleep Pattern
-Psychomotor Agitation/Retardation
-Fatigue/Loss of Energy
-Poor Concentration
-Thoughts of death or suicide
-Feelings of worthlessness, guilt, shame, helplessness, hopelessness
-Symptoms present for 2 weeks, and are not attributable to a medical condition, medication or substance abuse
geriatric specific symptoms
-Loss of pleasure in all, or almost all, activities
-Depression tinged with anxiety
-Depression regularly worse in the morning
-Early morning awakening
-Marked psychomotor agitation/retardation
-Significant anorexia or weight loss
-Excessive or inappropriate guilt
presentation
-Feel down, sad, unhappy, empty, miserable, anxious, don’t care, defeated, hopeless, helpless, what’s the use.
-Ruminative, angry, moody, irritable, serious, lost sense of humor, grim demeanor, negative, cynical
-Somatic: Insomnia, headaches, backaches, fatigue, dizziness, muscle tension, palpitations, limbs feel heavy, sexual difficulty, gastrointestinal problems
geriatric presentation
-Somatic Complaints Emphasized
-Memory Failure Emphasized
-Anxious and Irritable
-Feel Overwhelmed
-Symptoms often wrongly attributed to medical condition or early dementia
-Irritability and withdrawal of interest most specific geriatric symptoms!!!!
geriatric depression facts
-Affects 6 million, at least 1 in 6 office patients
-NOT a normal fact of aging
-Associated with functional disability and suicide
-Can alter risk and course of general medical conditions
-A recurrent illness
-Depression is the second leading cause of disability in the USA
epidemiology of depression in the elderly
-Depressive symptoms are present in 15% of regular population > 65 years of age
-Rates of depression: 5% in primary care clinics, 20% of nursing home residents
-Increased risk if admitted in nursing homes
-Medical co-morbidity increases risk
-High risk conditions: ischemic heart disease, stroke, cancer, arthritis, chronic lung disease, and Parkinson’s disease
-Dementia: almost 45% have signs/symptoms of depression
typical course: elderly pts
-Rule of 3rd’s regarding treatment
-36% responded well
-34% responded but relapsed
-30% poor response and chronic
-Positive outcome associated with rapid initial screening, onset of appropriate treatment, depressive symptoms being milder, no associated cognitive impairment or severe co-morbid illnesses, robust social network, positive family support
depression and cognitive disorders
-Depression masquerades as dementia: Pseudodementia syndrome.
-30-40% of patients with Alzheimer’s disease exhibit depressive syndromes
-Catatonic like state, impaired quality of life, Poor ADL’s, frequent emergency room visits, inpatient hospital admissions, assisted living and/or nursing home placement
pseudo-dementia
-A syndrome of cognitive impairment that mimics dementia but is actually depression
-Marked psychomotor retardation
-Selective mutism and poor appetite
-Poor attention and concentration
-Symptoms resolve as the depression is treated effectively
-If considerable cognitive impairment remains, an underlying dementia is suspected
-Highest risk over age 65
geriatric depression screening process
-History (medical and psychiatric)
-Medication review
-Physical examination
-Psychiatric interview
-Mental Status Exam
-Labs and Imaging studies
-Family collateral information
assessment strategies
-Family/Friends interview
-Detail medical problems
-Bring in medications on initial visit
-Rule out underlying medical causes
-Conduct neuropsychological assessment for cognitively-impaired patients
-Ask open ended questions
-LISTEN!!
rating scales
-Geriatric Depression Scale (GDS): A self-rated scale that focuses on internal experience and is valid and reliable in mild dementia
-Beck Depression Inventory (BDI): most widely used self rating scale with focus on emotional/somatic symptoms
-Zung Self Rating Depression Scale (SDS): 20 question self rating scale; screening tool in general practice offices
-Hamilton Depression Scale (HDRS): A interview that focuses on somatic and vegetative symptoms
-Cornell Scale for Depression in Dementia: sensitive for superimposed depression
-Median sensitivity (true positive rate) of the most common depression screening scales: 85%
evaluation of geriatric depression
-Assess for pain, insomnia, GI problems and optimize treatment
-Assess thyroid status, B12 level and medications
-Assess environmental stressors. Make environmental changes ( e.g. room change ) and enhance patient control over environment
-Up to 10% of patients with major depressive disorder severe enough to require hospitalization eventually commit suicide
-Individuals 65 years and older account for 20% of all suicide deaths; highest in elderly white men
assessing suicide risk
-Plan or intent
-Pervasiveness
-Means
-Lack of support
-Determine appropriate treatment setting and the need for psychiatric hospitalization voluntarily or involuntarily
-Indications for involuntary admission: suicidal patient, homicidal patient, gravely disabled
-Assess need for police intervention if in the community
elder reluctance to seek tx
-Symptoms inappropriately attributed to declining physical health
-Embarrassed to complain of psychological ailments
-Assume depression is a normal part of aging
-Trouble distinguishing between grief and depression
-Inadequate assessment of elderly in the community
