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Depression Assessment Program for Seniors Catherine R. Johnson, PsyD LP Associated Clinic of Psychology 2013 Minnesota Age & Disabilities Odyssey June 17, 2013 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. 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 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 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 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 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 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 Depression in older adults 50% personality disorder traits Physical illness; excess disability Institutionalization Loneliness Risk Factors – Medical Illness Comorbidity with medical illness 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 Psychotropic Medications Antiparkinsonian agents Anticancer drugs Hormonal preparations Antihypertensives Pain medications Alcohol 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 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 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 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 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 Care Parameter If severe (GDS-SF 11 or higher) and 5-9 symptoms: Refer for psychiatric evaluation If mild to moderate (GDS-SF 6-10) and <5 symptoms: refer for mental-health evaluation Treatment options: antidepressant meds and/or psychotherapy, hospitalization, ECT For all persons develop interdisciplinary individual plan, document, and monitor 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 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. Effective Psychotherapies Cognitive Behavioral Cognitive/Behavioral Therapy Brief psychodynamic Life review Reminiscence Problem Solving Interpersonal Therapy Antidepressant Medication Most frequently prescribed to treat depression Valuable when properly regulated and scrupulously supervised Have consider side effects which limit use 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. 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. 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-tomoderate cognitive impairment. PHQ-9 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. Conclusion 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 Senior LinkAge Line 1-800-333-2433 www.MinnesotaHelp.info 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]