Depression in Older Adults

Short Form Geriatric Depression Scale (SGDS)

-14 items -screen with MMSE first need to score abve 23 to be considered cognivetly intact -if patient scores 6 or greater on scale they need to be referred due to increased risk for depression

Common S/Sx's of Depression

-PERSISTENT sad or anxious -loss of interset/pleasure in activities, including sex -restlessness, irritability, excesive crying -feelings of guilt, worthlessness, and pessimism -changes in appetite, weight gain/loss -decreased energy, fatigue, feeling slowed down -thoughts of death, suicide or suicide attempts -difficulty concentrating or remembering -difficulty making decisions -persistent physical symptoms that do no need to respond to treatment (HA, chronic pain)

Additional potential S/Sx's of depression

-appears to accept suggestions by health professionals but does not "follow through" with recommendations -seems disoriented -unable to focus or loses track during conversations -appears disengaged -dramatic changes in mood/affect -less animated or seems to have withdrawn

Additional important risk factors for depression

-certain meds or combos of meds -medical conditions -living alone, social isolation, home bound -presence of chronic or severe pain -female, unmarried -caregivers, especially of people with dementia -damage to body image (cancer or heart surgeries) -fear of death -past suicide attempts -substance abuse -low income -minorities, especially hispanics

Many misconceptions about depression exist in society and are held by both patients and providers such as:

-depression is a response to the loss of a loved one -depressoin is the result of increased physical limitation -changing in societal toles as a result of aging increases the risk for depression -suicidal thoughts, a potential symptom of clinical depression, is sometimes considered a normal facet of old age *these mistake beliefs can lead to underreporting of symptoms by patients and a decreased focus on treatment by providers

Depression frequently co-occurs with serious medical conditions such as:

-heart disease -stroke -DM -Parkinson's disease -dementia *can make conditions worse or vice versa *meds that are taken for the above may cause SE's that may contribute to depression

Cornell Scale for Depression and Dementia (CSDD)

-patient with dementia -CDSS uses the caregiver as well as the paient to complete the scale ***Informant must be someone who has frequent contact with patient -screen with MMSE if patient scores below 12 on MMSE CDSS is administer (if patient scores above 23 use GDS, if patient. Scores between 15-23 use SGDS -11 or greater on CDSS = (+) for depression

Patient Health Questionnaire (PHQ-9)

-shortest -used most commonly BUT not necessarily made for older adults -can use first 2 questions as initial screen = "over the past 2 weeks have you ever felt down, depressed or hopeless? Over the past two weeks have you felt little interest or pleasure in doing things?" -9 items scored as = not at all, several days, more than half the days, nearly every day

What are the risk factors for depression

-there is no ONE cause, multiple factors can contribute to the onset -family hx -life experiences -environment -loss of loved one -difficult relationship with family and friends -financial problems -depressoin also may be related to changes that occur in the brain and body as a person ages

Why are members of the health care team possibly in the best position to recognize the S/Sx's and screen for depression in older adults

-they see the older person daily at a senior center or adult day care facility -they may be the only team member treating the patient in a practice setting such as home care or outpatient care -they take care of the patient daily in a long term care facility ***BUT they may avoid the subject

Providers concerns about the following may also work to reduce the likelihood of considering the presence of depression:

-uncertainty about optimal treatment -conerns about medication interactions or access to psychiatric care -concerns about the cost and/or reimbursement issues of treatment interventions

3 instruments commonly used to screen for depression in the older adult

1. Geriatric Depression Scale (GDS) 2. Cornell Scale for Depression and Dementia (CSDD) 3. Patient Health Questionnaire (PHQ-9); 2 question subset of PHQ-9

Barriers to recognizing and screening for depression (3)

1. Patient related 2. Provider related 3. Influenced by long held social beliefs about depression

A mean of _____ was spent on mental health issues during visits from PCP in older adults

2 minutes -- lack of time to discuss mental health issues

Depressive symptoms that persist for _________ are considered by doctors to be "depressive disorders" or "clinical depression"

2 weeks or more

Geriatric Depression Scale (GDS)

30 yes/no self-administered questionnaire -good psychometric properties -screen first with MMSE

Only _____% of adults aged 65 and over believe that depression is a "health' problem

38%

What is the number one goal for us a health care providers when it come to addressing depression in older adults

Advocate for the patient

What is depression

Characterized by the presence of specific symptoms and it interferes with daily life and functioning

T/F: Psychotherapy and non-pharm interventions are often well reimbursed for older adults

False

T/F: Depression is a normal part of the aging process

False; depression is NOT a normal part of aging,and is a treatment medical condition like HTN or DM. For those older individuals diagnosed with depression treatment works in a large %age of the cases

S/Sx's of depression are more/less frequently mentioned by people under 65 than people over

More

What is depression commonly associated with?

Multiple medical conditions

T/F: Depression can interfere with the managment of an older adult's other health conditions

True

T/F: Depression is a treatable medical condition and older adults should be screen for

True

T/F: If suffering from depression, older adults are more likely than any other group to handle it themselves

True

T/F: Screeing tools lead to positive outcomes

True

T/F: Screening for depression should be a routine part of the initial interview

True

T/F: Depression is when someone occasionally feels sad or blue

false

T/F: Persistent depression is an acceptable response to the serious illnesses and the social and financial hardships that often accompany aging

false; health professionals may mistakenly believe that is an older aduly has a serious illness or is dealing with financial hardships that persistent depression is normal

What is the first step in helping someone with depression get the help they need

screening

T/F: Depressive symptoms are far more common among older adults than major depression

true

T/F: With depression somatic symptoms tend to be the primary focus

true; back, shoulder, arthritis = primary focus Sx's

T/F: Older Adult tend to be more private about reporting depression symptoms

true; common for this group to underreport having a sad mood