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    Depression in The Elderly

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    lovelots1234
    1. Depression in the elderly can present in three main ways: as a reaction to loss, as a failure to thrive without clear mood symptoms, or with new psychotic or disruptive behaviors. 2. Major depression is more prevalent in long-term care facilities and hospitals than in community-dwelling elderly. Risk factors include medical illness, medications, loss of independence and social support. 3. Treatment involves managing any underlying medical conditions, antidepressant medication, psychotherapy, social support and lifestyle changes like exercise. Careful monitoring is needed due to risks of relapse and interaction with other illnesses.

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    Depression in The Elderly

    Uploaded by

    lovelots1234
    93 views23 pages
    1. Depression in the elderly can present in three main ways: as a reaction to loss, as a failure to thrive without clear mood symptoms, or with new psychotic or disruptive behaviors. 2. Major depression is more prevalent in long-term care facilities and hospitals than in community-dwelling elderly. Risk factors include medical illness, medications, loss of independence and social support. 3. Treatment involves managing any underlying medical conditions, antidepressant medication, psychotherapy, social support and lifestyle changes like exercise. Careful monitoring is needed due to risks of relapse and interaction with other illnesses.

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    Depression in the Elderly

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    1. Depression in the elderly can present in three main ways: as a reaction to loss, as a failure to thrive without clear mood symptoms, or with new psychotic or disruptive behaviors. 2. Major depression is more prevalent in long-term care facilities and hospitals than in community-dwelling elderly. Risk factors include medical illness, medications, loss of independence and social support. 3. Treatment involves managing any underlying medical conditions, antidepressant medication, psychotherapy, social support and lifestyle changes like exercise. Careful monitoring is needed due to risks of relapse and interaction with other illnesses.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    93 views23 pages

    Depression in The Elderly

    Uploaded by

    lovelots1234
    1. Depression in the elderly can present in three main ways: as a reaction to loss, as a failure to thrive without clear mood symptoms, or with new psychotic or disruptive behaviors. 2. Major depression is more prevalent in long-term care facilities and hospitals than in community-dwelling elderly. Risk factors include medical illness, medications, loss of independence and social support. 3. Treatment involves managing any underlying medical conditions, antidepressant medication, psychotherapy, social support and lifestyle changes like exercise. Careful monitoring is needed due to risks of relapse and interaction with other illnesses.

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    © All Rights Reserved
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    of 23

    Depression in the Elderly

    Noel H. Ponce, M.D.

    Definition
    A disorder of mood, a syndrome that includes a
    cluster of sx
    Vegetative: sleep, appetite, wgt, sex
    Cognitive:
    attention span, frustration
    tolerance, memory, negative
    distortions
    Impulse:
    suicide, homicide
    Behavior:
    motivation, pleasure, interest,
    fatigability
    Somatic:
    HA, abdl pain, muscle tension

    3 Major Clinical Presentations


    Associated with Depression in Older
    Patients
    1. Community-dwelling persons who
    have recently experienced a
    significant loss. The initial
    presentation is one of
    depressed mood
    loss of pleasure
    vegetative sx

    2. Those recently ill whose initial


    presentation is primarily a failure-tothrive or vegetative state without clear
    sx of depressed mood.
    Best identified by a decline in physical
    and cognitive function (out of
    proportion to or unexplained by recent
    episode of illness)

    3. Recent onset of delusions,


    hallucinations or disruptive behavior
    might present an initial presentation
    of depressed mood and or a FTT
    syndrome

    Epidemiology
    Prevalence of Major depressive disorder
    Community: 3%
    LTC facilities: 12%
    Hospital: 11%

    Prevalence of Depressive symptoms


    Community: 15%
    Nursing home: 30%

    Etiology
    Conglomeration of factors
    Biological
    Family history / prior hx
    in serotonin, dopamine and noradrenaline

    Physical
    Chronic medical condition
    Treatment

    Etiology
    Psychological
    Low self-esteem, memory loss, childhood sexual /
    physical abuse

    Social
    Losses of family and friends, isolation, loss
    of job and income

    Neurological and Medical


    Causes

    Parkinsons disease
    Alzheimer's disease
    Cerebrovascular disease
    Multiple sclerosis
    Hypothyroidism
    SLE
    Rheumatoid arthritis
    Carcinoma
    Vitamin deficiencies

    Pharmacologic causes

    Propanolol, Digitalis
    Benzodiazepines
    Corticosteroids
    Phenytoin
    Ibuprofen, indomethacin
    Ampicillin, Tetracycline, Metronidazole
    Meclizine
    Pizotifen
    Cimetidine

    Significance in Medical Care


    Depression promotes loss of physical, cognitive,
    social function and prevents them from regaining
    function after tx of acute medical illness
    Despite appropriate tx of medical and surgical
    diseases, undiagnosed and or untreated
    depression leads to poor patient outcomes

    Consequences of Failure in
    Recognition

    Social isolation
    Reduced quality-of-life
    Burden to family, society, economy
    Increased M/M
    Suicide risk

    Symptoms
    DSM-IV-TR lists the ffg sx as diagnostic
    criteria for major depression in older persons
    1. Depressed mood and or loss of interest
    or pleasure PLUS 4 additional criteria
    2. Additional criteria

    Weight loss or weight gain


    Insomnia or hypersomnia
    Psychomotor retardation or agitation
    Loss of energy
    Feelings of worthlessness
    Difficulty concentrating
    Recurrent thoughts of death or suicide

    Suicide
    More frequent in the elderly than in any other
    population
    Up to 70% of elderly who completed suicide
    visited their MD within the previous 4 weeks
    Suicidal attempts and ideation decrease with
    aging

    Assessment
    History and PE including neurologic and
    mental status assessment
    Review of drug use
    Rating scales
    Geriatric Depression Scale
    Hamilton Rating Scale

    Laboratory tests

    Geriatric Depression Scale


    1. Are you basically satisfied with your life?
    2. Do you feel that your life is empty?
    3. Are you afraid that something bad is going to
    happen to you?
    4. Do you feel happy most of the time?
    Answers: 1-N, 2-Y, 3-Y, 4-N
    0 - No depression
    1 - Uncertain
    2-4 - Probably depression present

    Treatment
    Treatment Issues
    Any loss incurred major depressive Disorder
    Unstable medical illness must be treated in
    parallel with the major depression for optimal
    outcome
    Exacerbation or relapse are typically resistant to
    Tx as a result of multiple co-morbid illness ergo
    maintenance therapy should be continued
    indefinitely

    Treatment
    Treatment issues
    Common mistakes made in
    pharmacotherapy
    Dose too low
    Treatment too short
    Settling for a partial response to tx
    instead of complete remission of sx.
    Careful and frequent ff-up important

    Treatment
    Non-pharmacologic
    Social support to reduce isolation
    Psychotherapy
    Family counseling
    Substance-abuse intervention as indicated
    Bereavement counseling
    Health promotion and maintenance

    Good nutrition
    Light physical exercise
    Attention to chronic medical conditions
    Regular daily routine

    Treatment
    Pharmacologic treatment
    Antidepressant

    SSRI- Sertraline, Escitalopram, Paroxetine, Fluoxetine


    SNRI- Venlafaxine, Duloxetine
    NDRI- Bupropione
    SSRI/ SNRI- Mirtazapine
    TCA- Nortriptyline, Desipramine
    SARI- Trazodone, Nefazodone

    Psychostimulants
    Methyphenidate
    Modafinil

    Treatment
    Antipsychotics
    Treats agitation, delirium, psychosis

    Haloperidol
    Olanzapine
    Quetiapine
    Risperidone

    Treatment
    Cognitive impairment
    Cholinesterase inhibitors
    Donepezil
    Galantamine
    Rivastigmine

    NMDA receptor antagonist


    Memantine

    Electroconvulsive Therapy
    Indications
    Severely depressed patients
    Those who demonstrate significant
    psychotic symptoms and self-destructive
    behavior
    Those who do not tolerate or respond to
    antidepressants

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