Geriatrics Psychosocial, Depression, Suicide Flashcards
What falls under the Psychosocial Issues of Loss
- Retirement from long time job
- Loss of spouse
- Dismissed or loss of income
- Loss of home, car or ability to drive
- Loss of hearing
- Loss of independence
What are some factors that can influence an older person from sexual activity?
- Low intrinsic drive dating back to youth
- Physical disability
- Poor marital relationship
- Death of spouse
What are some reproductive changes that happen in elderly women?
- Atrophy and fibrosis of cervical and uterine walls
- Decreased vaginal elasticity
- Decreased hormones (no menses)
- Suspension ligaments relax
Is sexual interest changed in elderly women?
NO
What are some reproductive changes in elderly men?
- Reaction more dependent on tactile stimulation
- Penis decreases in size
- Testicles drop lower in scrotum
- Proliferation of prostate epithelial and stromal tissue
What are some cormorbidites impacting elderly sexuality
- Medical problems
- Surgery
- Drugs
For elderly what is a big part about their sexuality?
Not always about sex more about intimacy and companionship
What substance related disorder is more common among the elderly?
Tobacco dependence
What can light alcohol consumption lead to?
Better health
*6-8OZ
What are some health consequences of alcoholism?
- malnutrition
- Cirrhosis
- Osteomalacia
*lack of vitamin D metabolism
Is the use of illegal drugs common in the elderly?
NO
What is the most common drugs used in the elderly population?
- Benzodiazepines
*More risk of falls and hip fx - Opiates
What are the most common driving violations that the elderly commit?
- Failure to yield the right of way
- Obey traffic signs
*involve multiple vehicles
When assessing an elderly patients ability to drive what must a PA consider?
Consider
1. Public safety
2. Patients independence
3. Functional ability
4. Medications that could impact ability to drive
What are some things a PA should tell an elderly patient who is capable of driving?
- Inform about certain medications
- Inform about an impairment that the elderly patient has and how that can impact their driving capability
What is the definition of foreseeability?
- The ability to predict a risk or threat to public safety and health
How to differentiate depression vs sadness
Sadness from a loss should not last >6months
Where is depression most common in the elderly population?
Nursing homes
*Males 65+ greater risk for suicide
How to asses if an elderly patient is depressed?
Ask directly
*Patients usually will not voice their concern
What is Major depression or persistent depressive disorder defined as?
Clinically significant distress or impairment in social, occupation or other important areas of life
*lasts more than 2 weeks
What are some factors predisposing to depression?
- Biological
- Physical
- Psychological
- Social
What are some sensory impairments seen with the elderly?
- Hearing
- Vision
- Smell
- Taste
*Patient appears withdraw and disinterested bc they can’t see or hear you
Is sensory impairment that same things as depression?
NO
What are some geriatric clinical presentations of depression?
- Constipation
- Apathy and withdrawal
- Loss of self-esteem
What is the two question screener for elderly depression?
- “During the past 2 weeks, have you been bothered by feeling down depressed…..”
*Depressed mood - “During the past 2 weeks, have you been bothered by little interest or pleasure……”
*Loss of interest
If the geriatric patient has a positive result to the Two Question Screener what happens next?
Geriatric Depression Scale
*>5 is suggestive of depression
>10 always suggest depression
What are some nonpharmacological options for battling depression?
- Psychotherapy
*first-line used in combination with medications - More invasive, prescribed by specialist
*ECT
*deep brain stimulation
*magnetic seizure therapy
When should pharmacological therapy be used?
- When patient meets criteria for depression
- Depression is causing a functional disability or interfering with recovery from other illnesses
- Patient not responding to non pharmacological interventions
What are some pharmacological options for depression?
Choose the one with the fewest side effects
1. SSRI *Better tolerated
2. SNRI
3. Atypical antidepressants
4. Serotonin modulators
5. Tricyclic antidepressants
6. MAOIs
What is the first line for pharmacological therapy?
SSRI or venlafaxine XR
*along with psychotherapy
*No overdose effects
*treat anxiety
How to start pharmacological therapy?
Start treatment at sub therapeutic dosages
*use half doses and up the dose very slowly, 2-4 week intervals
What is bupropion used for/
Depression and reduce smoking
What are the Selective serotonin reuptake inhibitors?
- Citalopram (celexa)
- Escitalopram (lexapro)
- Sertraline (zoloft)
*safest - Fluoxetine (Prozac)
- Flovoxamine (Luvox)
*never approved as antidepressant
What are the most common side effects of SSRI?
- Sexual side effects
- Hyponatremia
- Weight gain
What are some of the adverse reactions of serotonin syndrome?
- Mental status change
- Agitation
- Hyperreflexia
- Tachycardia
- Sweating
- Death
What are some common SNRI?
- Duloxetine (Cymbalta)
*depression, neuropathic pain from DM - Venlafaxine (Effexor)
*depression, anxiety - Desvenlafaxine (Pristiq)
What are some side effects of SNRI?
- Increase blood pressure
- Nausea
- Dry mouth
- Overdose can be dangerous or fatal
What are some atypical antidepressants?
- Mirtazapine (Remeron)
*SE: weight gain and drowsiness - Bupropion (wellbutrin)
*Smoking cessation
*depression - Trazodone
*helpful with insomnia - Vilazodone
What used to be the first-line antidepressant?
Tricyclic antidepressants
1. Amitriptyline (Elavi)
2. Desipramine (Norpramin)
3. Nortriptyline (pamelor)
What is the most common sleep related problem that causes insomnia?
OSA
