Depression In Old Age Flashcards
1
Q
Core symptoms of depression
A
Low mood- 2 weeks most of the time
Lack of energy
Loss of pleasure/ interest
2
Q
Further symptoms of depression
A
Sleep disturbance Impaired concentration Altered appetite Fatigue Agitation/retardation Guilt Worthlessness Suicidal thoughts More common in the elderly
3
Q
Problems in old age depression
A
Pseudo dementia-cognitive impairment 10% suffer delirium Paranoia Agitation White matter hyper intensities and vascular depression Masked depression Hypochondriacal delusions Nihilistic delusions Delusions of poverty
4
Q
Risk factors
A
Older men Widow/er Living alone Social isolation Alcohol abuse Depressive episode Seen GP in last month Previous attempts Sleep disorders
5
Q
Predisposing factors
A
Past history Family history Poor physical health Poverty Institution Lack of confiding relationship Personality problems Retirement Loss of mobility Loss of health Medications
6
Q
Management
A
Monitor risk of self harm Pshychoeducation Treat comorbidities Treat depressive symptoms, aim for resolution-> same as normal depression Prompt referral of complications
7
Q
When to refer?
A
Doubt over diagnosis Severe depression -psychotic -severe risk to health -suicide risk Complex therapy When first time therapy fails
8
Q
Considerations when medicating
A
Polypharmacy Concordance Reduced GFR Decreased lean body mass Decreased plasma albumin Reduced hepatic metabolism Increased CNS sensitivity Decreased total body mass
9
Q
Epidemiology of depression in old age
A
10-15% prevalence 85% also suffer from anxiety 25-30% in residential homes 30-35% nursing homes 40-45% post stroke Increased chance of suicide 25% of suicides!
