Depression Depression among Older among Older Adults Adults Pre va - PowerPoint PPT Presentation

Depression Depression among Older among Older Adults Adults Pre va le nc e & I nte rve ntio n Stra te g ie s

Definition Definition De pre ssio n is a c o mple x syndro me c o mple x c ha ra c te rize d b y mo o d disturb a nc e plus va rie ty o f c o g nitive , psyc ho lo g ic a l, a nd ve g e ta tive disturb a nc e s

Epidemiology of Depression Epidemiology of Depression • Me n: 5-12% • Wo me n: 10-25% • Pre va le nc e 1-2% in e lde rly 6-10% in Prima ry Ca re se tting o 12-20% in Nursing ho me se tting o 11-45% in I npa tie nt se tting o >40% of outpt. Psyc hiatr y c linic and inpt. o psyc hiatr y • Pe a k a g e o f o nse t 3rd de c a de • L a te -life de pre ssio n: se c o nda ry to va sc ula r e tio lo g y

Depression – – the physical presentation the physical presentation Depression In primary care, physical symptoms are often the chief complaint in depressed patients In a New England Journal of Medicine study, 69% of diagnosed depressed patients reported unexplained physical symptoms as their chief compliant 1 N = 1146 Primary care patients with major depression Simon GE, et al. N Engl J Med . 1999;341(18):1329-1335.

Depression in Elderly Depression in Elderly • NOT a no rma l pa rt o f a g ing • 2 millio n Ame ric a ns o ve r a g e 65 ha ve de pre ssive illne ss • Sub -syndro ma l de pre ssio n inc re a se s the risk o f de ve lo ping de pre ssio n L e a ds to e a rly re la pse a nd o c hro nic ity • Ofte n c o -o c c urs with o the r se rio us illne sse s • Unde r-dia g no se d a nd unde r- tre a te d • Suic ide ra te s in the e lde rly a re the hig he st o f a ny a g e g ro up.

Facts in Elderly Facts in Elderly • Only 11 pe rc e nt in c o mmunity re c e ive a de q ua te a ntide pre ssa nt tre a tme nt • T he dire c t a nd indire c t c o sts – $43 b illio n e a c h ye a r • L a te life de pre ssio n is pa rtic ula rly c o stly b e c a use o f the e xc e ss disa b ility tha t it c a use s a nd its de le te rio us inte ra c tio n with physic a l he a lth

Etiology Etiology • Bio lo g ic a l fa c to rs • So c ia l fa c to rs • Psyc ho lo g ic a l fa c to rs

Biological factors Biological factors • Ge ne tic Hig h pre va le nc e in first de g re e re la tive s o Hig h c o nc o rda nc e with mo no zyg o tic twins o Sho rt a lle le o f se ro to nin tra nspo rte d g e ne o • Me dic a l I llne ss: Pa rkinso n's, Alzhe ime r's, c a nc e r, dia b e te s o r o stro ke • Va sc ula r c ha ng e s in the b ra in • Chro nic o r se ve re pa in • Pre vio us histo ry o f de pre ssio n • Sub sta nc e a b use

Social factors Social factors • L o ne line ss, iso la tio n • Re c e nt b e re a ve me nt • L a c k o f a suppo rtive so c ia l ne two rk • De c re a se d mo b ility Due to illne ss o r lo ss o f driving privile g e s o

Psychological factors Psychological factors • T ra uma tic e xpe rie nc e s o Ab use • Da ma g e to b o dy ima g e • F e a r o f de a th • F rustra tio n with me mo ry lo ss • Ro le tra nsitio ns

Common precipitants Common precipitants • Arg ume nts with frie nds/ re la tive s • Re je c tio n o r a b a ndo nme nt • De a th o r ma jo r illne ss o f lo ve d o ne • L o ss o f pe t • Annive rsa ry o f a (-) e ve nt • Ma jo r me dic a l illne ss o r a g e -re la te d de te rio ra tio n • Stre ssful e ve nt a t wo rk • Me dic a tio n No nc o mplia nc e • Sub sta nc e use

Assessment Assessment

Clinical Features Clinical Features • DSM I V-T R c rite ria o Multiple c rite ria (>=5) sho uld b e pre se nt fo r a t le a st two we e ks o Must b e a c ha ng e fro m pre vio us func tio ning o Pre se nc e o f de c re a se d inte re st o r lo w/ de pre sse d mo o d is a must fe a ture

Diagnostic Criteria Diagnostic Criteria • S le e p disturb a nc e : de c re a se d o r inc re a se d • I nte re st o r ple a sure *: de c re a se d • G uilt o r fe e ling wo rthle ss • M o o d* : susta ine d lo w o r de pre sse d • E ne rg y lo ss o r fa tig ue • C o nc e ntra tio n pro b le ms o r pro b le ms with me mo ry • A ppe tite disturb a nc e , we ig ht lo ss o r g a in • P syc ho mo to r a g ita tio n o r re ta rda tio n • S uic ida l ide a tio n, tho ug hts o f de a th

Considerations in Elder Depression Considerations in Elder Depression • Une xpla ine d o r a g g ra va te d a c he s a nd pa ins • Ho pe le ssne ss • He lple ssne ss • Anxie ty a nd wo rrie s • Me mo ry pro b le ms • L o ss o f fe e ling o f ple a sure • Slo we d mo ve me nt • I rrita b ility • L a c k o f inte re st in pe rso na l c a re (skipping me a ls, fo rg e tting me dic a tio ns, ne g le c ting pe rso na l hyg ie ne ) • So c ia l Withdra wa l • I nc re a se d use o f a lc o ho l o r o the r drug s

MINOR Depression MINOR Depression • Also kno wn a s • Asso c ia te d with: o sub syndro ma l de pre ssio n o sub se q ue nt ma jo r de pre ssio n o sub c linic a l de pre ssio n o g re a te r use o f he a lth se rvic e s o mild de pre ssio n o re duc e d physic a l, so c ia l • 2 - 4 time s mo re func tio ning c o mmo n tha n ma jo r o lo ss o f q ua lity o f life de pre ssio n • Re spo nds to same tre atme nts!

SUICIDE: DON’ ’T FORGET T FORGET SUICIDE: DON • Ask a b o ut suic ida l ide a tio n o inte nt o

Suicide risk in elderly Suicide risk in elderly • Ve ry I mpo rta nt, E a sy to miss • Alwa ys a sk • F ire a rms a t ho me • Ma ny o lde r a dults who c o mmit suic ide ha ve visite d a prima ry c a re physic ia n ve ry c lo se to the time o f the suic ide o 20 pe rc e nt o n the sa me da y o 40 pe rc e nt within o ne we e k – o f the suic ide

Suicide risk in elderly Suicide risk in elderly • Suic ide s twic e a s c o mmo n a s ho mic ide s • 12% o f the po pula tio n is e lde rly, the y a c c o unt fo r 20% o f the 30,000 suic ide s/ yr • Olde r pa tie nts ma ke 2 to 4 a tte mpts pe r c o mple te d suic ide , yo ung e r pa tie nts ma ke 100 to 200 a tte mpts pe r c o mple tio n • Whe n the y de c ide - the y a re se rio us

Los Angeles County Attempted Los Angeles County Attempted and Completed Suicides, 2008 and Completed Suicides, 2008 (rates per 100,000) (rates per 100,000) LA Co Dept of Public Health, Injury & Violence Prevention Program (Ma

Assessment for suicide risk: Assessment for suicide risk: S - Ma le Se x A - Ag e (yo ung / e lde rly) D - De pre ssio n P - Pre vio us a tte mpts E - E T OH R - Re a lity te sting (I mpa ire d) S - So c ia l suppo rt (la c k o f) O - Org a nize d pla n N - No spo use S - Sic kne ss

Geriatric Depression Scale Geriatric Depression Scale Cho o se the b e st a nswe r fo r ho w yo u ha ve fe lt o ve r the pa st we e k: 1. Are yo u b a sic a lly sa tisfie d with yo ur life ? YE S / NO 2. Ha ve yo u dro ppe d ma ny o f yo ur a c tivitie s a nd inte re sts? YE S / NO 3. Do yo u fe e l tha t yo ur life is e mpty ? YE S / NO 4. Do yo u o fte n g e t b o re d? YE S / NO 5. Are yo u in g o o d spirits mo st o f the time ? YE S / NO 6. Are yo u a fra id tha t so me thing b a d is g o ing to ha ppe n to yo u? YE S / NO 7. Do yo u fe e l ha ppy mo st o f the time ? YE S / NO 8. Do yo u o fte n fe e l he lple ss? YE S / NO 9. Do yo u pre fe r to sta y ho me , ra the r tha n g o ing o ut, do ing ne w thing s? S / NO YE 10. Do yo u fe e l yo u ha ve mo re pro b le ms with me mo ry tha n mo st? S / NO YE 11. Do yo u think it is wo nde rful to b e a live no w? YE S / NO 12. Do yo u fe e l pre tty wo rthle ss the wa y yo u a re no w? YE S / NO 13. Do yo u fe e l full o f e ne rg y? YE S / NO 14. Do yo u fe e l tha t yo ur situa tio n is ho pe le ss? YE S / NO 15. Do yo u think tha t mo st pe o ple a re b e tte r o ff tha n yo u a re ? YE S / NO *Unde rline d ite ms c o nstitute the fo ur ite m sc a le

Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms • I nto xic a tio n a nd/ o r withdra wa l fro m c e rta in sub sta nc e s c a n le a d to de pre ssive sympto ms. • I f sympto ms a re sig nific a nt e no ug h, the y ma y b e c ha ra c te rize d a s a sub sta nc e -induc e d mo o d diso rde r. • Drug -induc e d sympto ms c a n la st a s lo ng a s sub sta nc e s a re use d a nd ma y o r ma y no t impro ve with a b stine nc e . • De pre ssive sympto ms c a n ling e r fo r 3 to 6 mo nths a fte r a b stine nc e a nd must b e tre a te d in c o unse ling .

Substance Use & Depressive Symptoms Substance Use & Depressive Symptoms • Sub sta nc e use , a b use , o r de pe nde nc e c a n c a use de pre ssive sympto ms to wo rse n a nd c o mplic a te re c o ve ry fro m a de pre ssive illne ss. • T he se e ffe c ts ma y a lso inte rfe re with a c lie nt's re spo nse to me dic a tio ns o r o the r the ra pe utic inte rve ntio ns. • De pre ssio n a nd ho pe le ssne ss, c o mb ine d with a lc o ho l a nd/ o r drug use , ma y a lso inc re a se the risk fo r thinking a b o ut, pla nning , o r a c ting o n suic ida l tho ug hts.