Transcript Depression

Depression Assessment
Program for Seniors
Catherine R. Johnson, PsyD LP
Associated Clinic of Psychology
2013 Minnesota Age & Disabilities Odyssey
June 17, 2013
Mood Disorders
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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.
Prevalence of Depression: Age 65
and Older
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1-5% Community older adults
13.5% Requiring home healthcare
11.5% Hospitalized
65% Nursing home have mental-health
issues
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Major depression – 12%-22%
Depressive symptoms – 17%-30%
5 Million with depressive symptoms
Suicide: General Population 11%
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14.3 % of all suicides are age 65 or older
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White male age 85 and older –highest rate
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75% had visited a doctor within the last
month
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
Common Types of Mood Disorder
or Related Disorder
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Major Depression
Dysthymic
Cyclothymic
Bipolar I
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Manic/Major
Depression
Bipolar II
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Hypomanic/ Major
Depression
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Other Disorders
Adjustment Disorder
Pseudodementia
Bereavement
Mood Disorder due to
Medical Condition
Symptoms of Depression
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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
Depression in older adults
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More physical
symptoms -pain
More cognitive
symptoms
Hypersomnia
Anorexia
Less crying/mood
disturbances
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Sense of personal
helplessness
Apathy
Sense of
emptiness/loss
Irritability/hostility
Withdrawal from
activities
Depression in older adults
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50% personality disorder traits
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Physical illness; excess disability
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Institutionalization
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Loneliness
Risk Factors – Medical Illness
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Comorbidity with medical illness
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Metabolic: Hypothyroidism, Diabetes
Neurologic: Dementias, MS, Parkinson’s
Stroke, cancer
Rheumatoid Arthritis
Congestive heart failure and heart attack
Infections, Vitamin B 12 deficiency
Pain
Risk Factors – Medications
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Psychotropic Medications
Antiparkinsonian agents
Anticancer drugs
Hormonal preparations
Antihypertensives
Pain medications
Alcohol
Risk Factors
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Female
Unmarried and/or
widowed
Recent bereavement
Stressful live event
Lack of supportive
social network
caregiver
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Satisfaction with
supportive services
Perceived empathy
Physical
problems/pain
Education HS
Impaired functioning
Heavy alcohol use
Risk Factors
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Demographic; age,
sex, race, ethnicity
Early Life; education,
childhood traumas
Late Life; occupation,
income, marital status
Current Event; coping
style and strategies
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Social Integration;
religious affiliation,
voluntary activities,
neighborhood
stability
Vulnerability; chronic
stressor, social
support, isolation
Challenges of Recognition of and
Treatment of Depression
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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
Untreated Depression
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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
Assessment Parameters
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Identify risk factors
Assess at-risk person
with GDS-SF or
PHQ-9
Note symptoms/onset
severity/duration
Review medical
record/history
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Check for
depressogenic meds
Check for systematic
and metabolic
processes
Assess cognitive
function – SLUMs
Assess functional
disability - ACL
Care Parameter
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If severe (GDS-SF 11 or
higher) and 5-9
symptoms: Refer for
psychiatric evaluation
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If mild to moderate
(GDS-SF 6-10) and <5
symptoms: refer for
mental-health evaluation
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Treatment options: antidepressant meds and/or
psychotherapy,
hospitalization, ECT
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For all persons develop
interdisciplinary
individual plan,
document, and monitor
Care Plan Content
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Safe precaution
Remove/control
depressogenic meds
Correct metabolic
disturbance/pain
Promote wellness
(nutrition, sleep,
physical exercise)
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Enhance physical
function –ACL test
Enhance social
support
Maximize autonomy
Encourage relaxation
and engagement in
pleasant activities
Problem solve
Care Plan Content/Follow -Up
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Provide information
about physical/mental
health illness
Stress the importance
of adherence to
prescribed regimen
Ensure mental health
community linkup
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Track info/outcome
Provide information
to service provides to
coordinate care
Educate caregivers to
continue efforts
Education/Cord. all
parties involved.
Effective Psychotherapies
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Cognitive
Behavioral
Cognitive/Behavioral
Therapy
Brief psychodynamic
Life review
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Reminiscence
Problem Solving
Interpersonal Therapy
Antidepressant Medication
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Most frequently prescribed to treat
depression
Valuable when properly regulated and
scrupulously supervised
Have consider side effects which limit use
Preferred Treatment
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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.
Advancing Mental-Health Services
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Health care providers can mitigate
depression experienced by older adults.
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Employee mental-health training is
available and effective to mitigate
depression if a formal program is put in
place.
Advancing Mental-Health Services
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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-tomoderate cognitive impairment.
PHQ-9
Personal Impact
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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.
Conclusion
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Psychologist, health-care providers, training and
psychological instruments, and the evaluation
processes all contribute to an effective mentalhealth program for older adults. When pulled
together in a systematic way, the mitigation of
depression among this population is amenable to
success.
Resources
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Senior LinkAge Line 1-800-333-2433
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www.MinnesotaHelp.info
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Try This Series: www.ConsultGeriRN.org
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
[email protected]
OR
Steve Greenberg
DAPS Coordinator
651-690-8938
[email protected]