Transcript Depression

3 D’s: Depression, Delirium
and Dementia
Francie Larsen, MS, LPCC, LNHA
Depression
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Is not a normal part of aging
Cognitive changes linked to mood
Runs in families
Organically affects the brain
With late onset in life is often
associated with brain abnormalities
Doubles the risk to develop heart
disease
Depression:
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Is a treatable medical illness, much like
heart disease or diabetes.
Is a serious illness affecting
approximately 15 out of every 100
adults over the age of 65
Is not a passing mood
Untreated Depression can:
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Lead to disability
Worsen symptoms of other illnesses
Lead to premature death
Result in suicide
Depression can increase
mortality
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One study of 454 patients newly
admitted to a nursing home with a
diagnosis of depression and followed for
one year were 59% more likely to die in
the course of that year than were nondepressed patients.
Rubin, Harold; Depression in the Elderly-Part II
Symptoms of Depression
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Increased irritability
Increased agitation
Feelings of worthlessness or sadness
Loss of interest in daily activities
Abnormal thoughts, excessive guilt
Change in appetite
Symptoms of Depression
continued
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Change in weight
Exacerbated physical complaints
Difficulty sleeping
Fatigue
Difficulty concentrating
Memory loss
Thoughts of death or suicide
Risk Factors for Depression in
the Elderly
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Certain medications or combination of
Other illnesses
Living alone, social isolation
Recent bereavement
Presence of chronic or severe pain
Life changes
Risk Factors (continued)
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Damage to body image (amputation,
cancer, etc.)
Previous history of depression
Family history of major depressive order
Past suicide attempt(s)
Substance abuse
Disease and Physical Problems
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Thyroid Disease
Diabetes
Parkinson’s Disease
Multiple Sclerosis
Strokes
Tumors
Some viral infections
Suicide and the Elderly
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In the United States, older adults make
up 12.5% of the population but account
for 15.7% of all suicides
Suicide is highest among 85 year old
white men and increases when they
lose a loved one, have a serious illness
or a history of substance abuse
According to Dr. Cleveland Kinney at the University of Alabama at
Birmingham
Suicide and the Elderly (cont.)
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In 2007, there was one elderly suicide
every 97 minutes and 16 suicides each
day among those 65 and older.
The rate of male suicides in late life was
7.3 times greater than female suicides.
70% of elderly suicide victims visited
their PCP within a month of their deaths
40% saw a physician within a week of
their death
Suicide Warning Signs
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Appearing depressed or sad most of the
time
Talking or writing about suicide
Withdrawing from family and friends
Feeling Hopeless
Feeling Helpless
Feeling strong anger or rage
Suicide Warning Signs (cont)
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Feeling trapped – like there is no way
out of a situation
Experiencing dramatic mood changes
Abusing drugs or alcohol
Exhibiting a change in personality
Acting impulsively
Losing interest in most activities
Suicide Warning Signs (cont)
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Giving away prized possessions
Feeling excessive guilt or shame
Stockpiling medications
Sudden interest in firearms
Suicide Misconceptions
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People who talk about suicide won’t really do
it
If a person is determined to kill him/herself,
nothing is going to stop them
People who commit suicide are people who
were unwilling to seek help
Talking about suicide may give someone the
idea
Helping or Not
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They will get angry with me
I might put the suicidal thoughts in
their heads
I won’t know what to say
I wouldn’t know what to do if they were
contemplating suicide
What you can say that helps:
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You are not alone in this, I’m here for you
You may not believe it, but the way you are
feeling now will change
I may not be able to understand exactly how
you feel, but I care about you and want to
help
When you want to give up, tell yourself you
will hold off for just one more day, hour,
minute
What not to do:
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Don’t argue with the person
Don’t act shocked or lecture
Don’t minimize the seriousness
Do not promise confidentiality
Don’t offer ways to fix the situation
Don’t blame yourself
Levels of Suicide Risk
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Low – Some suicidal thoughts, No
suicide plan and says he or she will not
commit suicide
Moderate – Suicidal thoughts, vague
plan that isn’t lethal, says he or she will
not commit suicide
Levels of Suicide Risk (cont.)
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High – Suicidal thoughts, specific plan
that is highly lethal, says he or she will
not commit suicide
Severe – Suicidal thoughts, specific plan
that is highly lethal, says that he or she
will commit suicide.
Diagnosis of Depression can
be overlooked because:
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Intervening medical issues
Stigma
Fear from the patient
Lack of understanding by patients and
the medical profession
Treatments for Depression
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Medications
Psychotherapy
ECT – Electroconvulsive Therapy
Delirium and the Elderly
Delirium
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A temporary state of confusion.
The most acute of the 3 D’s
Consider delirium an emergency that
requires immediate and aggressive
intervention to avoid any permanent
brain damage.
Accurate diagnosis includes at
least two of the following:
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Reduced or fluctuating levels of
consciousness
Perceptual disturbances: illusions,
misinterpretations, and hallucinations
Insomnia & disturbance of sleep/wake
Change in psychomotor activity
Symptoms of Delirium
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Memory Loss
Disorientation
Language disturbance
Develops quickly, over a matter of
hours or days
Delirium Symptoms (cont.)
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Restlessness with “plucking and
picking” gestures
Slurred speech
Dilated pupils
Increased agitation
May have a period of restlessness or
fearfulness preceding onset
Delirium Symptoms (cont.)
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Oriented to person but not time and
place
Symptoms tend to fluctuate throughout
the day, but are worse during the night
and upon waking
Alternate between agitation and
lethargy
Reversible causes of Delirium
in the Elderly
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D-drugs,
E – electrolyte disturbances
L – lack of drugs – stopping a drug
I – infection
R – Reduced sensory input
I – Intracranial problems
U – Urinary or Fecal problems
M – Myocardial problems (heart or lung)
Delirium
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In the frail elderly, delirium may occur
in 30% to 40% of those hospitalized
Clinicians should consider any acute
change in cognition or consciousness as
delirium unless determined otherwise
Unrecognized and untreated, the
mortality rate is high, particularly in
patients with existing dementia
Delirium
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A special emphasis should be directed
toward reviewing medications, both
prescribed and over-the-counter,
because they are responsible for 22%
to 39% of the deliriums in older adults.
(Bair, 2000)
Delirium and Hospitalization
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30% to 40% of hospitalized elderly
have delirium
Up to 80% in ICU
Patients experiencing delirium were
hospitalized 6 days longer and were
placed in nursing homes 75% of the
time
Delirium and Hospitalization
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Delirium is present in half of patients
admitted to a nursing home
Hospital care can contribute:
-Adverse effects of medications
-Complications of invasive procedures
-Immobilization
-Dehydration
-Malnutrition
Delirium
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Can be more dangerous than a fall
Described in charts as agitation and
confusion
Is often the sole manifestation of a
serious underlying disease
Rarely lasts more than a month
By that time a patient has full blown
dementia or has died
What to do - 
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Obtain a thorough medical examination
Evaluate the need for a one to one for
fall risk
Frequently tell patients who you are,
where they are and what time it is
Push fluids if possible
What to do - 
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Reduce or discontinue all psychotropic
drugs
The main goal of treatment is to
identify and correct the underlying
cause.
The best way to treat delirium is first to
prevent it.
Create a familiar, stable
environment . .
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Place photos of friends and family in
view
Play favorite music
Make sure they wear their glasses and
hearing aids
Be consistent with staffing
Dementia/Alzheimer’s Disease
Progressive cognitive decline.
Alzheimer’s Disease:
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Cited in 2001 as the 8th leading cause of
death in the United States
Afflicts up to 10% of adults ages 65 to
85 and 50% of adults over 85
Gradual onset that can not be dated
Diagnosis is based on at least 6
months of confusion
Alzheimer’s Disease Early Signs
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Changes in personality
Progressive memory loss
Difficulty finding the right words
Inability to perform familiar tasks
Cannot think abstractly
Sundown syndrome
Disoriented in familiar surroundings
How to tell the difference:
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Delirium and depression are reversible
Different from the delirious patient,
demented patients are typically alert
when waking
Demented patient’s consciousness not
clouded until terminal
A depressed patient may not want to
talk, but the language skills are intact
How to tell the difference:
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Delirium can be superimposed on
dementia, making the distinction less
clear
Psychotic patients typically hear voices
or sounds, while people with delirium
usually see things.
3 D’s Signs and symptoms
Delirium
Dementia
Depression
Onset
Acute, hrs and
days
Slowly, over
months & yrs
Relatively Rapid
– over weeks
and months
Acuity
Acute illness,
medical
emergency
Chronic
progressive
Episodic
Disabilities
New disabilities
appears, acute
May conceal
deficits
Recognizes
changes
Answers to
questions
May be
Offers response,
incoherent. acute but not correct
“Don’t know”
4th D -- Pseudodementias
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False Dementias
Causes of dementia-like symptoms
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Some drugs, such as sleeping pills,
tranquilizers and certain pain medications
Drug interactions or an overdose of a drug
Malnutrition caused by a poor diet or
problems absorbing nutrients
Alcohol or substance abuse