Depression in Later Life

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Depression in Later Life

• Vicki L. Schmall, PhD
• Gerontology Specialist / President
• Aging Concerns
• West Linn, Oregon

2
Prevalence of Depression

• 12-20 of community residents 65 suffer
  depressive symptoms of some type
• 3-6 of older adults experience major depression
• Rates of major or minor depression range from 4
  in primary care clinics to 15-30 in nursing
  homes

3
How the Medical Illness of Depression Differs
from Normal Depression

• Pervasive
• Persistent
• Intense
• Interferes with a persons functioning

4
Late-life Depression

• Family history is significant in early-onset, not
  late-onset depression
• Late onset is related to
• Biological changes in the brain
• Effects of drugs
• Medical illnesses
• Life stresses/losses
• Personality traits (low self-esteem, lack of
  resilience, pessimism)
• Social isolation

5
Types of Depression

• Major Depression
• Persistent mood disturbance interfering with a
  persons ability to function
• Person may have only one or two episodes in a
  lifetime or recurrent episodes
• Dysthymic disorder
• A chronic, low-grade depression for at least two
  years
• Periods of normal mood last only a few days or
  weeks

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Types of Depression(continued)

• Bipolar Depression (manic depression)
• Emotional rollercoaster
• Person cycles from deep depressive lows to
  frenetic bursts of energy
• Seasonal Affective Disorder (SAD)
• A seasonal pattern of depression, primarily
  experienced during the winter months
• Linked with light

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Bipolar Disorder

• Often diagnosed earlier in life
• Less common than unipolar depression
• Higher frequency of affective disorders among
  relatives
• Two times more common in women than men
• Higher rates for both attempted and completed
  suicides

8
Seasonal Affective Disorder (SAD)

• Clinical illness characterized by periods of
  depression, typically beginning in October and
  subsiding in April
• Most who suffer form SAD are women 30 years and
  over
• Prevalence rises with increasing latitude
• Storm patterns and cloud cover contribute to
  winter dreariness and exacerbate SAD

9
High Cost of Untreated Late-life Depression

• Decreased quality of life
• Increased visits to physicians
• Increased hospital costs
• Higher rates of institutionalization
• Higher rates of morbidity and mortality

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Early recognition, evaluation,and treatment can
shorten recovery time
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What to Look for

• Why Mrs. Murphy is vulnerable to depression
• Family role
• Personal traits
• Life changes
• Signs of depression in Mrs. Murphy
• Why her depression is not recognized

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What Were the Signs of Mrs. Murphys Depression?

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Depression Diagnosis

• To diagnose depression in a younger adult, ask
  them. They will tell you they are sad or
  depressed.
• To diagnose depression in an older adult, watch
  them. They lose interest in the world.

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Depression Is . . .

• a period of at least 2 weeks during which there
  is either depressed mood or the loss of interest
  or pleasure in nearly all activities (DSM-IV)
• Characterized by
• Affective distress
• Behavioral difficulties
• Cognitive complaints

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Signs of Depression What the Professional Looks
for

• Pervasive sadness, apathy, or empty mood
• Loss of interest in previously enjoyed activities
• Marked change in sleeping habits
• Marked change in appetite weight loss/gain
• Fatigue loss of energy
• Agitation or slowing of physical movement
• Feelings of worthlessness or guilt
• Indecisiveness impaired thinking and
  concentration
• Recurrent thoughts about death or suicide
  suicidal behavior

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Key Questions
Yes
No

• Has person changed dramatically?
• Has change persisted for two weeks or longer?
• Is the change interfering with relationships and
  functioning?

Get Medical Evaluation
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Encourage Medical Evaluation

• Highland Medical Center
• Patient Evaluation Form
• Patient Name
• Address
• City
  State
• Age
  Date of Birth
• Medical History

Office use only
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Individual Barriers to Recognizing and Treating
Depression

• Stigma of depression
• Beliefs and lack of knowledge about depression
• Not knowing when, how, and where to get help
• Debilitating nature of the disease

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Structural Barriers to Recognizing and Treating
Depression

• Ageist attitudes
• Primary care physicians are mental health
  gatekeepers
• Symptoms (e.g., fatigue, memory complaints)
  attributed to aging
• Symptom overlap
• Social isolation

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What to Talk About . . . When the Person Resists
Help

• Specific physical changes
• Specific problems
• Depression as a medical illness
• Fears and false beliefs

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How to Say It . . . When the Person Resists Help

• Use I statements
• Im concerned about you
• Avoid You statements
• You could just snap out of this
• Address concerns directly
• May I make an appointment for you?
• Avoid moralizing and giving pep talks

22
How to Get Participation . . . When the Person
Resists Help

• Ask what the person thinks is the problem
• Enlist the help of a trusted person
• Respect the persons autonomy

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Treatments for Depression

• Antidepressant medications
• Tricyclic medications
• Selective Serotonin Reuptake
• Heterocyclic or newer antidepressants
• Monoamine oxidase inhibitors (MAOIs)
• Psychotherapy
• Cognitive change negative thinking
• Behavioral increase positive events
• Interpersonal enhance relationships
• Psychodynamic improve current functioning
• Electroconvulsive therapy shock therapy
• Transcranial Magnetic Stimulation

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Electroconvulsive Therapy

• Effective for severe depression
• Prescribed when other treatments fail
• Life saving

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Depression Is . . .

• A medical Illness, not a character defect or
  weakness
• Chronic Risk of recurrence is significant
• Manageable
• Treatable Recovery is the rule, not the
  exception

26
Suicide
Depression
Alcohol
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PNW 347 Depression in Later Lifehttp//extensi
on.oregonstate.edu/catalog/pdf/pnw/pnw347.pdf
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End
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How a Person Becomes Depressed

• Depression is more likely when nerve cells or
  neurotransmitters malfunction
• Dopamine
• Norepinephrine
• Serotonin
• Changes with aging increase the biological risk
  for depression
• Interaction between environment, experiences and
  other biological functions