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Depression Assessment Program for Seniors

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Title: Depression Assessment Program for Seniors


1
Depression Assessment Program for Seniors
  • Catherine R. Johnson, PsyD LP
  • Associated Clinic of Psychology
  • 2013 Minnesota Age Disabilities Odyssey
    June 17, 2013

2
Mood Disorders
  • Depressive disorder is not a normal part of
    aging.
  • Emotional experiences of sadness, grief, response
    to loss, and temporary blue moods are normal.
  • Persistent depression that interferes
    significantly with ability to function is not.

3
Prevalence of Depression Age 65 and Older
  • 1-5 Community older adults
  • 13.5 Requiring home healthcare
  • 11.5 Hospitalized
  • 65 Nursing home have mental-health issues
  • Major depression 12-22
  • Depressive symptoms 17-30
  • 5 Million with depressive symptoms

4
Suicide General Population 11
  • 14.3 of all suicides are age 65 or older
  • White male age 85 and older highest rate
  • 75 had visited a doctor within the last month

5
Suicide General Population 11
  • For every 100,000 people age 65 and older in each
    of the ethnic/racial groups below, the following
    number died by suicide in 2007
  • Non-Hispanic Whites 13.5 per 100,000
  • Am Indian and Alaskan 14.3 per 100,000
  • Asian and Pacific Islanders 6.2 per 100,000
  • Hispanics 6.0 per 100,000
  • Non-Hispanic Blacks 5.1 per 100,000

6
Common Types of Mood Disorder or Related Disorder
  • Major Depression
  • Dysthymic
  • Cyclothymic
  • Bipolar I
  • Manic/Major Depression
  • Bipolar II
  • Hypomanic/ Major
  • Depression
  • Other Disorders
  • Adjustment Disorder
  • Pseudodementia
  • Bereavement
  • Mood Disorder due to Medical Condition

7
Symptoms of Depression
  • Depressed or sad mood/irritable mood/agitated
  • Loss of interest in activities
  • Fatigue or loss of energy -Sleep Disorder
  • Psychomotor retardation slow moving
  • Weight change
  • Difficulty concentrating and/or memory
  • Feelings of worthlessness/guilt
  • Thoughts of death of dying

8
Depression in older adults
  • More physical symptoms -pain
  • More cognitive symptoms
  • Hypersomnia
  • Anorexia
  • Less crying/mood disturbances
  • Sense of personal helplessness
  • Apathy
  • Sense of emptiness/loss
  • Irritability/hostility
  • Withdrawal from activities

9
Depression in older adults
  • 50 personality disorder traits
  • Physical illness excess disability
  • Institutionalization
  • Loneliness

10
Risk Factors Medical Illness
  • Comorbidity with medical illness
  • Metabolic Hypothyroidism, Diabetes
  • Neurologic Dementias, MS, Parkinsons
  • Stroke, cancer
  • Rheumatoid Arthritis
  • Congestive heart failure and heart attack
  • Infections, Vitamin B 12 deficiency
  • Pain

11
Risk Factors Medications
  • Psychotropic Medications
  • Antiparkinsonian agents
  • Anticancer drugs
  • Hormonal preparations
  • Antihypertensives
  • Pain medications
  • Alcohol

12
Risk Factors
  • Female
  • Unmarried and/or widowed
  • Recent bereavement
  • Stressful live event
  • Lack of supportive social network
  • caregiver
  • Satisfaction with supportive services
  • Perceived empathy
  • Physical problems/pain
  • Education HS
  • Impaired functioning
  • Heavy alcohol use

13
Risk Factors
  • Demographic age, sex, race, ethnicity
  • Early Life education, childhood traumas
  • Late Life occupation, income, marital status
  • Current Event coping style and strategies
  • Social Integration religious affiliation,
    voluntary activities, neighborhood stability
  • Vulnerability chronic stressor, social support,
    isolation

14
Challenges of Recognition of and Treatment of
Depression
  • Often undiagnosed or misdiagnosed
  • Historical development of care which focus on
    the medical model of care
  • Insufficient mental-health services
  • Environment exacerbates
  • Comorbidity with medical illness
  • Cultural ageism/gerophobia/internalized ageism
  • Older adults attitudes about aging and death
  • Insufficient research

15
Untreated Depression
  • Increase decline in function
  • Increase disability and worsen symptoms
  • Complicates the course of dementia
  • Complicates nursing/medical care higher use of
    health care system
  • Increase costs
  • Diminishes quality of life for the family
  • Increase mortality

16
Assessment Parameters
  • Identify risk factors
  • Assess at-risk person with GDS-SF or PHQ-9
  • Note symptoms/onset severity/duration
  • Review medical record/history
  • Check for depressogenic meds
  • Check for systematic and metabolic processes
  • Assess cognitive function SLUMs
  • Assess functional disability - ACL

17
Care Parameter
  • If severe (GDS-SF 11 or higher) and 5-9 symptoms
    Refer for psychiatric evaluation
  • Treatment options anti-depressant meds and/or
    psychotherapy, hospitalization, ECT
  • If mild to moderate (GDS-SF 6-10) and lt5
    symptoms refer for mental-health evaluation
  • For all persons develop interdisciplinary
    individual plan, document, and monitor

18
Care Plan Content
  • Safe precaution
  • Remove/control depressogenic meds
  • Correct metabolic disturbance/pain
  • Promote wellness (nutrition, sleep, physical
    exercise)
  • Enhance physical function ACL test
  • Enhance social support
  • Maximize autonomy
  • Encourage relaxation and engagement in pleasant
    activities
  • Problem solve

19
Care Plan Content/Follow -Up
  • Provide information about physical/mental health
    illness
  • Stress the importance of adherence to prescribed
    regimen
  • Ensure mental health community linkup
  • Track info/outcome
  • Provide information to service provides to
    coordinate care
  • Educate caregivers to continue efforts
  • Education/Cord. all parties involved.

20
Effective Psychotherapies
  • Cognitive
  • Behavioral
  • Cognitive/Behavioral Therapy
  • Brief psychodynamic
  • Life review
  • Reminiscence
  • Problem Solving
  • Interpersonal Therapy

21
Antidepressant Medication
  • Most frequently prescribed to treat depression
  • Valuable when properly regulated and scrupulously
    supervised
  • Have consider side effects which limit use

22
Preferred Treatment
  • Preferred treatment for older adults residing is
    a combination of antidepressant medication and
    psychotherapy. However, for those who cannot
    tolerate medication, psychotherapy is the primary
    treatment alternative.

23
Advancing Mental-Health Services
  • Health care providers can mitigate depression
    experienced by older adults.
  • Employee mental-health training is available and
    effective to mitigate depression if a formal
    program is put in place.

24
Advancing Mental-Health Services
  • The Geriatric Depression Scale can be
    administered by health-care providers and is an
    effective at screening (vs. diagnosing) for
    depression in older adults with mild-to- moderate
    cognitive impairment.
  • PHQ-9

25
Personal Impact
  • Studies show that when persons trained to
    interact empathically with older adults visited
    older adult 2 times per week for one hour, those
    older adults showed significant decreases in
    depression and greater life satisfaction.

26
Conclusion
  • Psychologist, health-care providers, training and
    psychological instruments, and the evaluation
    processes all contribute to an effective
    mental-health program for older adults. When
    pulled together in a systematic way, the
    mitigation of depression among this population is
    amenable to success.

27
Resources
  • Senior LinkAge Line 1-800-333-2433
  • www.MinnesotaHelp.info
  • Try This Series www.ConsultGeriRN.org

28
The Depression Assessment Program for Seniors
(DAPS) is a screening and intervention program
for older adults based on the evidence based
program Healthy IDEAS (Identifying Depression,
Empowering Activities for Seniors). DAPS is
supported, in part, by a CS/SD grant from the
Minnesota Department of Human Services (DHS).
Viewpoints and opinions in this presentation do
not necessarily represent official DHS policy.
  • DAPS partners include
  • Jewish Family Service of St. Paul (project lead)
  • Highland Block Nurse Program Ramsey County
    Human Services
  • National Alliance on Mental Illness MN West 7th
    Community Center
  • Optage, Inc.

If you would like more information about DAPS,
contact
Marjorie Sigel, MSW, LICSW Mental Health Specialist 651-698-0767 MSigel_at_jfssp.org OR Steve Greenberg DAPS Coordinator 651-690-8938 SGreenberg_at_jfssp.org
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