used with medically ill older adults, and includes few somatic items that may be confounded with physical illness (Harvath & McKenzie, 2012). Screening tools such as the Patient Health Questionnaire (PHQ)-2 and PHQ-9 are also acceptable to use. See Table 2 for a list of symptoms of depression about which an older adult must be aware. Often an older adult does not wish to discuss depression because he or she may feel that depression is a sign of weakness, that there is nothing that can
be done to treat mood, or that he or she cannot afford to be treated. Family members may have the misunderstanding that a depressed person could “snap out of it” on his or her own if desired, and therefore do not encourage the depressed person to seek treatment. Some depressed older people may hold the misconception that they are too old to be helped. Healthcare professionals must counter these notions with education on treatment options.
Table 1: Factors Contributing to Depression • Medications that may cause depression: Some antihypertensive, hormonal, and neuroleptic agents; carbidopa/levodopa; beta-blockers; clonidine; benzodiazepines; barbiturates; anticonvulsants; histamine-2 blockers; calcium channel blockers; thiazide diuretics; digoxin; opioids; and polypharmacy defined as three or more medications per day. • Medical conditions associated with depression: Chronic illness: Late-life mental disorders are commonly detected in association with somatic illness. The prevalence of clinically significant depression in later life is estimated to be highest, approximately 25%, among those with chronic illness, especially with ischemic heart disease, stroke, cancer, coronary artery disease, diabetes, chronic lung disease, arthritis, and Alzheimer’s and Parkinson’s diseases. • Other physical conditions that contribute to depression: Persistent insomnia, impaired vision, impaired hearing, pain, posttraumatic stress disorder, or impaired physical functioning. • Psychological conditions: Educational attainment less than high school, female gender, low self-esteem, family history of depression, heavy alcohol consumption, social isolation, bereavement, and frustration with memory loss. • Losses: Correlations have been found between depression and various losses, including loss of family home, friends, social activities, volunteering, financial security, and marital harmony. Note. A dapted from National Institute of Mental Health. (2016a). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml Table 2: Signs of Depression If an older adult has several of these common signs of depression for more than 2 weeks, he or she should see a healthcare provider: • Aches and pains that do not respond to treatment. • Difficulty focusing, paying attention, making choices, or remembering. • Feeling helpless, hopeless, or suffering a loss of self-esteem. • Being grumpy or irritable. • Thoughts of death or suicide. Note . Adapted from National Institute of Mental Health. (2016a). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml Treatment • Ongoing sadness, an empty feeling, or anxiety. • Tired, easily fatigued, exhausted, or lack of energy. • Loss of interest in everyday things. • Difficulty sleeping or sleeping too much. • Loss of appetite or overeating. • Crying too often or for no reason.
Many older adults with depression can be treated successfully. Medications are commonly used but may not be the first option or they may be complemented with other treatments. The following are various treatment options for an older adult: ● Support: For older adults who need coping skills or someone to talk to, a support group, counseling, or even case management may help. ● Socialization: Older adults who feel lonely, isolated, or useless may benefit from participating in activities at the local senior center or from joining a club, exercise group, or volunteer organization. ● Transportation: Older adults might have transportation issues that prevent attending religious services, going to the mall, or attending other events. Assisting older adults to find reliable, affordable transportation might increase their mood. ● Medications: There are many types of medications to treat depression. The healthcare professional will choose one based on medical history and compatibility with other medications. It is important for the healthcare professional to be aware of pharmacotherapy and know of all medications, Although depression cannot always be prevented, there are some approaches older adults can take to lessen the risk. Based on the information from NIMH (2016b), healthcare professionals can teach their patients to do the following: ● Plan ahead for known changes such as retirement or moving. ● Keep in touch with old friends and family members. ● Take time to develop hobbies. ● Let someone know if feeling sad, upset, or stressed.
vitamins, supplements, and herbal products currently being taken to prevent pharmacotherapy mishaps. ● Pets and children: Research has shown that pets improve the mood of older adults. Never force an animal or a child on a patient without first assessing his or her likes, dislikes, and preferences. ● Electroconvulsive therapy: Many older adults are misled about the effects of electroconvulsive therapy (ECT) due to dramatic portrayal on television or in the movies. Today ECT is safe and effective. It is usually reserved for intractable depression. ● Family consideration: It is important for family and friends to be supportive. No one enjoys being around a depressed person, but patience and understanding are needed. Being a good listener is of prime importance and shows care and understanding. Assisting and going along on medical appointments, attending support groups, and arranging outings and activities are all methods of supporting a loved one.
PREVENTION
● Exercise; pick an enjoyable activity, such as walking in the mall, gardening, dancing, or biking. ● Eat a balanced diet to optimize wellness. ● Maintain a healthy weight. Being overweight causes fatigue and sluggishness. ● Manage chronic conditions by following the advice of healthcare professionals.
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Book Code: PTNY3622B
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