Depression in the Elderly Flashcards Preview

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

Flashcards in Depression in the Elderly Deck (63):
1

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

Long term care

2

Why is depression more common in long term care patient

Relocation
Social factors
Co-morbidity
Medication side effects

3

Relocation

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

4

Social Factors

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

5

Co-Morbidity

Chronic disease associated with high prevalence of depression

6

Co-morbidity - stroke association with depression

30-60%

7

Co-morbidity - Coronary artery disease prevalence with depression

8-44%

8

Co morbidity - Cancer prevalence with depression

1-4%

9

Co-morbidity - Parkinsons prevalence with depression

40%

10

Co-morbidity - Dementia prevalence with dementia

20-40%

11

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

4
8 in LTC setting

12

Medication side effects - Depressant effects

1/4 of those medications may have a depressant effect

13

2 main barriers of depression in older adults

Under recognition
Under treatment

14

Consequences of undertreated depression

Diminished functioning
Slower recovery
Inc mortality
Suicide

15

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

13% of US pop
nearly 18% of suicide deaths

16

Highest rate of suicide in US

White men age 85 or older

17

Risk factors for suicide

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

18

Sx of depression

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

19

DSM IV criteria

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

20

Diagnosing Depression

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

21

Two question screener

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

22

Geriatric Depression Scale

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

23

Hamilton Depression Rating Scale

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

24

Dementia vs. Depression - what is the relationship

50% of patients with dementia are depressed

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