DEPRESSION IN THE ELDERLY

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DEPRESSION IN THE ELDERLY

• HEALTH CARE PROVIDERS NEW ZEALAND
• INAUGURAL CONFERENCE
• LIFTING YOUR HORIZONS
• 10/8/05

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BETWEEN 1-10 OF OUR OLDER POPULATION ARE
CLINICALLY DEPRESSED AT ANY GIVEN TIME
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BY 2020 DEPRESSION WILL BE SECOND ONLY TO HEART
DISEASE AS A CAUSE OF DISABILITY
W.H.O. 2004
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DEPRESSION MAY BE AFFECTING AS MANY AS 80, 000
OLDER PEOPLE IN NEW ZEALAND, BY THE TIME WE
RETIRE.
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BARRIERS TO DIAGNOSIS

• DEPRESSION IS NORMAL IF YOU ARE ILL.
• MISINTERPRETING SYMPTOMS.
• NOT SCREENING.
• RELUCTANCE TO TREAT.

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MODELS OF DEPRESSION.

• MEDICAL/BIOLOGICAL MODEL.
• PSYCHODYNAMIC MODEL.
• SOCIAL MODEL
• MODELS HELP US UNDERSTAND, AND RESPOND.

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DSM IV CRITERIA

• DEPRESSED MOOD/LOSS OF PLEASURE
• PLUS 4 OF
• APPETITE OR SLEEP CHANGE
• SLEEP CHANGE
• PSYCHOMOTOR CHANGE
• WORTHLESSNESS/GUILT
• DIFFICULTY THINKING/ CONCENTRATING
• THOUGHTS OF DEATH/ DYING
• (INTENSE ENOUGH TO AFFECT FUNTIONING)

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IN OLDER PEOPLE THIS LOOKS LIKE

• SELF CARE NEGLECT
• AGGITATION/ ANXIETY, OR APATHY
• BEING A BURDEN.
• STOPPING ACTIVITIES
• PREOCCUPATION WITH HEALTH
• COGNITIVE IMPAIRMENT
• SUICIDAL THOUGHTS OR BEHAVIOUR
• FEELING EMPTY

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DEPRESSION OR DEMENTIA?

• RAPID ONSET
• MOOD CHANGES
• SUBJECTIVELY POOR MEMORY
• ENERGY DECREASED
• SLEEP/APPETITE CHANGE

• GRADUAL ONSET
• MOOD UNCHANGED
• SUBJECTIVELY OFTEN NO PROBLEM
• ENERGY UNCHANGED
• SLEEP/APPETITE UNCHANGED

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THE EXPERIENCE OF GRIEF

• SADNESS OR ANGER
• APPETITE AND ENERGY LOSS
• INSOMNIA
• GUILT AND WISHFUL THINKING
• VISIONS OF THE DECEASED PERSON

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LOSS CAN BE FOR SELF (HEALTH, FUNCTION) FOR
OTHER (POSSESSIONS, PEOPLE) FOR TANGIBLE OR
INTANGIBLE THINGS OR ANTICIPATION OF LOSS
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TELLING GRIEF FROM DEPRESSION
HOW LONG HAS IT GONE ON FOR? HOW PERSISTANT IS
IT? IS THERE PROLONGED FUNCTIONAL IMPAIRMANT? ARE
THERE THOUGHTS OF SELF HARM? ARE THERE OTHER
HALLUCINATIONS OR DELUSIONS?
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DEPRESSION IN REST HOME RESIDENTS
15 will experience Depression within the first
year. 30will have depressive symptoms.
(NZ Ministry Of Health 1997,
Kluiter at al 2004)
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SOCIAL RISK FACTORS

• Three of the four biggest risk factors for rest
  home residents developing Depression are social
  in origin-
• Functional impairment (disability/dependence)
• Loneliness
• Lack of social support
• (Physical illness, hospitalisation, pain, and
  adverse life effects not as important as
  expected.)
• Eisses
  et al, 2004.

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ALL RISK FACTORS
BIOLOGICAL/MEDICAL MODEL MEDICAL ILLNESS FAMILY
HISTORY PAST HISTORY DEMENTIA
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PSYCHOLOGICAL MALADAPTIVE GREIF DIFFICULTY
ADAPTING TO CHANGE AND LOSS CHANGES IN
INDEPENDENCE MALADAPTIVE COPING STRATEGIES
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SOCIAL ISOLATION LONELINESS MOVING TO
INSTITUTIONAL LIVING CHANGES IN LEVEL OF
COMMUNITY SUPPORT/INTEGRATION.
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GERIATRIC DEPRESSION SCALE
A SCREENING TOOL USED BY NURSES DESIGNED FOR
OLDER PEOPLE SELF-RATING THRESHOLD IS 7 FROM 15
QUESTIONS (PLEASE USE, WHEN DEPRESSION IS
SUSPECTED)
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INTERVENTIONS

• THE MEDICAL/BIOLOGICAL MODEL
• ANTIDEPRESSANTS
• MOOD STABILISERS
• ANTI ANXIETY DRUGS
• HERBAL REMEDIES
• ELECTROCONVULSIVE THERAPY

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PSYCHOLOGICAL TREATMENTS CHALLENGING DISTORTED
BELIEFS SUPPORTING NEW BEHAVIOURS ALLOWING
EXPRESSION OF FEELINGS
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• SOCIAL INTERVENTIONS
• ENCOURAGE RESIDENTS TO STAY CONNECTED TO THEIR
  COMMUNITIES
• ASSIST THE FORMATION OF NEW FRIENDSHIPS
• VALUE RESIDENTS CONTRIBUTIONS
• AJUSTMENT CAN TAKE UP TO 18 MONTHS
• SUPPORT INDEPENDENCE
• SUPPORT DIVERSIONAL THERAPY
• LISTEN TO YOUR RESIDENTS

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REFERANCES/ WEBSITES Eisses, Kluiter,
Jongelinis, Pot, Beekman and Ormel (2004). Risk
indicators for depression in residential homes.
In International Journal of Psychiatry. Vol
19634-640. Arthur, Jagger. Lindsay. (1999) Using
an annual over 75 health check to screen for
depression validation of the short geriatric
depression Scale within general practice. In
International Journal of Psychiatry. Vol 14,
431-439. Diagnostic and Statistical manual of
Mental Disorders Forth Ed, text revision. (2000).
American Psychiatric association. Public Health
Report Number 3. (1997) Mental Health In New
Zealand from a Public Health perspective.
Ministry of Heath.. Wellington, NZ.
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National Health Committee (1996). Guidelines for
the treatment and management of Depression by
Primary Healthcare Professionals.Ministry of
Health, Wellington. Smith (2000). Sharing the
load What to do when someone you love is
Depressed. Random House, NZ. Nolen and Zohar
(1995). Refractory Depression, current strategies
and future directions. Wiley Press,
Brisbane. Powell (1992).Mental Health Handbook
WP Press England www.stanford.edu/7Eyesavage/ACR
C.html Geriatric Depression Scale research,
Stanford University
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ww.mentalhealth.org.nz (Mental Health Foundation
of New Zealand) www.moh.govt.nz (Ministry of
health) www.mhc.gowvt.nz (mental Health
Commission) www.nzgg.org.nz (New Zealand
Clinical Guidelines Group) WilliamG_at_waikatodhb.go
vt.nz Gwyneth Williams Clinical Nurse
Specialist Mental Health Services Older
Person 214 Pembroke St Hamilton