Depression

Depression in Older Adults 


Depression is clinically similar at all ages 


  • Looks much the same from the outside 


However: 

Older adults are less likely to admit depressive symptoms 


Older adults are more likely to experience depression along with other conditions 


Older adults are more likely to experience serious consequences


More likely to go unreported and undertreated 

  • Things are not aggressively treated in older adults 



comparison : Young vs. older adults 

  • Sometimes the symptoms of depression and ageing are  too similar \


Risk factors: 

  • gender , female 

  • Personal familial history -> genetic 

  • Bereavement - the loss of people ( increase as we age) 


Medical conditions and functional impairments 


  • Dementia - knowing your future ( closely related to depression) 

  • Parkinsons 

  • Cancer 

  • Disability - permanent sense of loss 


Risk factors

  • Alcohol changes the effect of medication in our body


Functional consequences 

GI symptoms - may deal with more constipation

Fatigue - too tired to be active, you can’t sleep, or too tired you sleep well 

  • Any of these can be attributed to older age, not a generalisation for older adults  


Nursing assessment: 

GDS - Geriatric depression Scale 

  • Can be used for depression and cognitive impairment 

Tools must be evidence based and easy to use 





Nursing intervention 


  • Allows them to maximise movement 

  • Basic counselling 

  • Depression medication is a long term observation 



  1. Alleviating risk factors 



  1. Improving psychosocial function


  1. Promoting health through physical activity and nutrition 



  1. Provide education and counselling 

  • Engage in convo and see how it exits in their life and the impact of it 


  1. Facilitating referrals 


  1. Teaching about 

  • Big groups of medication that treat depression 

  • SSRI is the first group, first - line ,very reliable, few side effects, they act on the brain 


  • No question about SNRI  & MAO & cyclic 


  • Start low and go slow -  when using depression medication, titrate up as time goes

Have the minimum amount that  actually works  


  1. Alternative interventions 

  • Light therapy, people are affected by access to UV, sun changes the way molecules 

  • Stress reduction intervention 


  1. ECT 

  • Electrical induction of seizures, electrical impulse into the brain and create seizure 

  • General anaesthesia: 

  • Just know that this exists 

  • No brain damage, no pain,  low risks 


Suicuide 

  • Elder adults are more successful at suicide attempts - more likely to accomplish what they wanted to accomplish 

  • factors : bereavement, personal and family hx of depression, presence of chronic and severe pain, 

  • Acute pain is sudden and treatable 

  • If suicidal thoughts are suspected or expressed on initial assessment, the nurse probes further.


Responsibility: report and document and keep the person safe