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Semester 3 FS Exam 4 > Depression in the Elderly > Flashcards

Depression in the Elderly Flashcards

(63 cards)

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1
Q

Depression is more common in which patient - community, hospital, long term care

A

Long term care

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2
Q

Why is depression more common in long term care patient

A

Relocation
Social factors
Co-morbidity
Medication side effects

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3
Q

Relocation

A

Lack of ind. and stimulation
Deteriorating sense of integrity
Deficiencies in care
Lack of pos. reinforcement

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4
Q

Social Factors

A

Loss of social support
Bereavement
Retirement
Loss of autonomy, status and independence

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5
Q

Co-Morbidity

A

Chronic disease associated with high prevalence of depression

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6
Q

Co-morbidity - stroke association with depression

A

30-60%

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7
Q

Co-morbidity - Coronary artery disease prevalence with depression

A

8-44%

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8
Q

Co morbidity - Cancer prevalence with depression

A

1-4%

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9
Q

Co-morbidity - Parkinsons prevalence with depression

A

40%

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10
Q

Co-morbidity - Dementia prevalence with dementia

A

20-40%

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11
Q

Medication side effects - in general older adults take an average of how many medications
What about in LTC?

A

4

8 in LTC setting

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12
Q

Medication side effects - Depressant effects

A

1/4 of those medications may have a depressant effect

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13
Q

2 main barriers of depression in older adults

A

Under recognition

Under treatment

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14
Q

Consequences of undertreated depression

A

Diminished functioning
Slower recovery
Inc mortality
Suicide

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15
Q

Suicide - adults over age of 65 comprise what percentage of population and what percent of suicide deaths

A

13% of US pop

nearly 18% of suicide deaths

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16
Q

Highest rate of suicide in US

A

White men age 85 or older

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17
Q

Risk factors for suicide

A 
Recent losses
Major medical issues
Social isolation
Being widowed 
(w attempt more, m are more effective)
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18
Q

Sx of depression

A 
Inc somatic complaints
Sleep issues
Loss of appetite
Feelings of worthlessness
Paranoia
Pseudodementia
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19
Q

DSM IV criteria

A

at least 5 sx present in a 2 week period and can’t be due to other things

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20
Q

Diagnosing Depression

A

DSM criteria
Mini mental scale
Geriatric depression scale
Hamilton depression rating scale

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21
Q

Two question screener

A

During past month have you been bothered by feeling down, depressed or hopeless
During the past month, have you been bothered by little interest or pleasure in doing things

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22
Q

Geriatric Depression Scale

A

Long form and short form
Screening tool
Self administered
Yes/no responses
Sensitive (85) and specific (95) at score of 11
Not reliable in those with cog impairment

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23
Q

Hamilton Depression Rating Scale

A

Commonly used
Administered by HCP
Score of 18 is cutoff for depression
Validity not well tested

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24
Q

Dementia vs. Depression - what is the relationship

A

50% of patients with dementia are depressed

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25
Dementia vs. Depression - cognition
Patients with depression do not lost intellectual capacity - executive function
26
Barriers to seeking treatment
Stigma with depression Pts may not realize they are showing signs of depression They may think it is normal part of aging Might think it is due to their illness Denial Financial barrier
27
Treatments for depression
Nonpharacologic Medications Herbal medications Electroconclusive therapy
28
Non-pharmacological Interventions
``` Socialization Spirituality Exercise Regular outdoor activity Positive thinking Daily pleasureable activity ```
29
Pscyhotherapy - what percentage of residents in LTC facility
20-30%
30
Benefits of psychotherapy
Improved outcomes | Combination of psychotherapy and antidepressants - best treatment outcomes
31
Electroconclusive Therapy
Indicated for older pts who are unresponsive to tx | Several studies have shown safety and effectiveness in older adults
32
Side effects for ECT
Short term confusion and memory impairment
33
Medications
SSRI Other antidepressants Tri-cyclic antidepressants Monoamine oxidase inhibitors
34
Rule of thumb with antidepressants
Start low, go slow | Taper slow
35
How do antidepressants work?
Etiology of depression is certain NT deficiencies | Antidepressants work on different NTs
36
SSRI - mechanism of action
Inc level of serotonin
37
Commonly used SSRIs
``` Prozac Paxil Zoloft Celexa Lexapro ```
38
SSRI
1st line of therapy for older adults | Better tolerated but more $
39
SSRI can also be used for
General axiety disorder Panic disorder OCD
40
SSRI Side effects
``` GI sx Anxiety Hyponatremia Sexual dysfunction Weight gain Fatigue or insomnia ```
41
Duloxetine
Also indicated for diabetic neuropathy | Side effects - nausea, insomnia, somnolence
42
Venlaxafine
Act as SSRI at low dose Inhibits uptake of NE at higher doses Effective for depression, GAD Side effects - nausea, hypertension, sexual dysfunction
43
Wellbutrin
Generally safe and well tolerated Inc activity of Dop and NE Also used for smoking cessation Side effects - insomnia, anxiety, tremor, seizures
44
Mirtazapine
Inc Ser and NE Associated with weight gain, inc appetite May be used in older adults who are having failure to thrive Very sedating
45
TCAs mechanism of action
Blocks the reuptake of NE and serotonin
46
Appropriate TCAs for older adults
Nortriptyline | Desipramine
47
TCAs to avoid in older adults
Amitriptyline Doxepin Imipramine Maprotiline
48
Side effects of TCAs
``` Anticholinergic properties - Orthostatic hypertension - Constipation - Urinary retention - Blury vision/dry mouth - Cardiac conduction problems Sedation Weight gain Lower seizure threshold ```
49
MAOIs
Phenelzine | Tranylcypromine
50
MAOI side effects
Life threatening hypertensive crisis can occur if dont watch diet Orthostatic hypertension Use of SSRI and MAOI together leads to serotonin syndrome
51
Serotonin Syndrome
Caused by use, overdose, or combined use of medications like SSRI and MAOI
52
Cognitive sx of serotonin syndrome
Confusion, agitation, anxiety, irritability, and drowsiness
53
Autonomic NS overactive - Serotonin Syndrome
Hyperthermia, diaphoresis, tachycardic, tachypnea, hypertension, dilated or unreactive pupils, GI symptoms
54
Neuromuscular signs with serotonin syndrome
Hyperreflexia, tremor, muscular rigidity, ataxia, clonus, nystagmus
55
Antianxiety medications
Might be first type of drug given to patients exhibiting jittery, nervous type of behavior
56
Ex of antianxiety medications
Diazepam (20-100 hrs) Lorazepam (10-20 hrs) Chloridiazepoxide (5-20 hrs)
57
Antianxiety medications also used as | Side effects include
muscle relaxants | Side effects include sedation
58
Sedative-hypnotic agents
Benzodiazepines with greater sedation rate | Barbituate
59
Ex of benzodiazapine
Triazolam (2 hr) | Temazapam (8-22 hr)
60
Ex of barbituate
Secobarbital (15-40 hr)
61
Side effects of sedative-hypnotic agents
Motor problems, confusion, anxiety, headache, hypotension | Tend to have addictive effeccts particularly the seconal
62
Antipsychotics
Several major drug classifications Impair synaptic transmission of dopamine pathways Anticholinergic effects
63
Ex of antipsychotics
``` Chloropromazine hydrochloride Prochlorperazine Thioridazine hydrochloride Haloperidol Triflupromazine HCl Risperidone ```

Semester 3 FS Exam 4 (11 decks)

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