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Depression in the Elderly

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Juniper Moore

on 11 December 2013

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Transcript of Depression in the Elderly

Depression in the Elderly
Statistics
15 out of every 100 adults over the age of 65 in the United States experience persistent sadness (Of the more than 40 million people in this age group, more than 6 million are affected)

The prevalence of depression in elderly women is almost double that of elderly men

Affects approximately 25% of those with chronic illness

It is estimated that 30-50% of those living in long-term care facilities live with depression (depending on the facility)

Affects approximately 3% of healthy elderly living in the community

78% of depressed elderly do not receive any treatment for their depression

The rate of suicide is higher among people over 75 than any other age group
Types of Depression
Causes
Life Changes


Physical Illness


Prescription Medications
Symptoms
Depression in the elderly may be hard to detect and is often not recognized or treated. This is because the common symptoms can be part of the normal aging process.

These symptoms include:
Fatigue
Appetite loss
Trouble sleeping
Restlessness
Sadness, discouragement
Anxiety
Panic attacks
Irritability

Depression is a chronic disease
Getting well is the beginning of the challenge
Staying well is the goal
Depression is highly responsive to treatment
Often not recognized
under treated
What happens if depression is unrecognized or left untreated?
Once recognized up to 80% can be treated effectively
Initial Management
Evaluation of patient’s medication regimen
Treatment of underlying medical conditions that may produce depressive symptoms
Treatment
Knowledge & Education
How Nurses Can Help
Symptoms of Depression cont…
Behavioral changes
Increased or decreases body movements
Pulling or rubbing their hair, body or clothing
Sleep disturbances
Changes in appetite
Weight loss or occasional weight gain
Decreased energy
Slowed speech
Constipation
Thoughts of suicide or suicide attempts
References:
http://www.gmhfonline.org/gmhf/consumer/factsheets/depression_factsheet.html
http://www.healthline.com/health/depression/elderly-and-aging?toptoctest=expand
http://www.helpguide.org/mental/depression_elderly.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001521.htm
http://www.grantedwishes.org
http://www.youtube.com/watch?v=jyFFQ0xRWsM&feature=youtu.be
Bare, B.G., Cheever, K.H., Hinkle, J.L. & Smeltzer, S.C. (2010). BRUNNER & SUDDARTH’S Textbook of Medical-Surgical Nursing (12th ed.) Philadelphia, PA: Lippincott Williams & Wilkins.
Duckworth, K. (2009, October). Depression in Older Persons Fact Sheet. Retrieved from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/Cont entDisplay.cfm&ContentID=7515.
Lehne, R. (2013). PHARMACOLOGY for Nursing Care (8th ed.). St. Louis, MO: Elsevier.
Perry, A.G., & Potter, P.A. (2009). Fundamentals of Nursing (7th ed.). St. Louis, MO: Mosby.
http://consultgerirn.org/topics/depression/want_to_know_more
Pinquart, M. & Sorensen, S.(2004). Associations of Caregiving Stressors and Uplifts with subjective well-being and depressive mood: A Meta-analytic
comparison. Aging and Mental Health, 8(5), 438-449. Evidence Level I
http://youtube/jyffqoxrwsm
Depression due to life changes
A move from home, such as to a retirement facility or nursing home
Chronic illness or pain
Death of a spouse or close friend
Feeling disconnected due to a loved one’s death
Loss of independence, related to the inability to perform activities of daily living
Inability to function at one’s own usual level
May lead to persistent feelings of worthlessness
Children moving away
Empty nest

Common medications that cause or worsen depression…
Blood pressure medication (Clonidine)
Beta-blockers (eg. Lopressor, Inderal)
Sleeping aids
Tranquilizers (eg. Valium, Xanax, Halcion)
CCBs
Ulcer Meds (eg. Zantac, Tagamet)
Steroids (eg. Cortisone, Prednisone)
Painkillers
High-cholesterol drugs (eg. Lipitor, Mevacor, Zocor)
In the event of losing a loved one, symptoms of depression are often a normal reaction. They may cry and feel sad, lost and lonely.
However, if grief triggers severe feelings of worthlessness, psychotic symptoms, or impairment in their ability to function, it is critical to seek professional help.
A thorough assessment is very important in order to decide whether the elderly patient is going through the normal aging process or experiencing something more severe.

Symptoms of Depression cont…
Provide information about the physical effects and treatment of depression
Educate Pt. about importance of adherence to treatment regain
Drugs side effects (weight gain/loss, suicidal thoughts, restlessness, drug interactions ect.)
DO NOT STOP SUDDENLY
Nursing Responsibilities
Follow up and monitor condition
Continue to track prevalence and documentation in at risk groups
Ongoing education on recognition, assessment and interventions
Early recognition/referrals for patients at risk
INDIVIDUALIZE Plan of care
Exercise
Bright lighting
Increasing interpersonal interactions
Cognitive therapy
Reminiscence therapy
Assess for alcohol/drug abuse
Non-Pharmacological
(Best treatment for mild to moderate depression)
Selective-Serotonin Re-uptake Inhibitors (SSRIs)
Serotonin and Norepinepherine Re-uptake Inhibitors (SNRIs)
Tricylic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Atypical Antidepressants
Antidepressants
(Best for major depression)
Electroconvulsive Therapy (ECT)
Proven effective in severe depression
Provides faster results than other methods of treatment
Can impact memory
Treatment Cont.
A combination of two or more of the treatments is typical
Be aware of
Antidepressants with anticholinergic, cardiac, and orthostatic adverse effects
Drug-Drug interactions
Medication toxicity
Hypotensive events
Falls
May take 4-6 weeks for symptoms to diminish
Quiz Questions
Many HC providers or family members mistake the symptoms of depression as signs of:
Misdiagnosed
Thyroid Disease
Dementia
Alzheimer's Disease
Arthritis
Cancer
Heart Disease
Parkinson's Disease
Stroke

Non Melancholic Depression (Major or Clinical)
Minor Depression Disorder
Dysthymic Disorder (Chronic Depression)
Depressive Reaction
Bipolar or Manic Depression

Which of the following is a nursing responsibility when caring for an elderly patient with depression?

A. Providing the patient with warm milk before bed
B. Ensure ongoing education, recognition, assessment and interventions.
C. Reassure the patient that depression is a normal part of aging
D. Separate patients experiencing depression from other patients so they don't bring them down.

Which of the following symptoms of depression in the elderly is subjective?

A. Trouble sleeping
B. Changes in appetite
C. Irritability
D. Constipation
When treating severe depression in the elderly, which treatment has been proven effective?

A) Exercise
B) Selective-Serotonin Reuptake Inhibitors
C) Electroconvulsive Therapy
D) Cognitive Therapy
A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle dies just 2 months ago. He is most likely experiencing:

A) dementia
B) depression
C) delirium
D) disengagement

Undiagnosed
More likely to seek tx for other ailments
Increases risk for heart disease and immune suppression
Certain illnesses may "hide" symptoms: stroke, heart disease or GI problems.
Depression is NOT a character flaw/weakness
Patients must seek treatment
A common side effect of many prescribed drugs is depression.
Older adults are more sensitive because their bodies have become less efficient at metabolizing and processing drugs.
Prescription Medications
Cancer
Stroke
Dementia
Alzheimer’s disease
Parkinson’s disease
Diabetes
Lupus
Multiple sclerosis
Depression due to physical illness
Institute safety precautions for suicide risk groups
Remove/control etiologic agents
Suggest Add, remove, change medication
Monitor and promote nutrition, elimination, sleep/rest patterns, and physical comfort
Pain control, daily schedules
Enhance physical function
Exercise, recreational activities, daily activities
Enhance social support/provide emotions support
Community outreach/ sr. volunteering programs
Maximize autonomy/personal control
Include pt. planning and treatment process, improve ADLs
Monitor and Document response to medication and other therapies
Nursing Interventions
Brooke Lindly
Curtis McKinzie
Carla Garcia
Adanna Nwagbara
Roger Levin
Tika Jackson
Full transcript