Depression in Elderly

1
Depression in Elderly

• Common 1 in 5 in the community, 2 in 5 in care
• Risk factors
• Co-morbidities
• Lack of social support/divorced/widowed
• Recent trigger event e.g. bereavement
• Unemployed/lack of role
• Important as similar to RF for suicide
• Presentation
• Physical sx aches pains, tired, wt loss,
  headaches
• Anxiety often dominates
• Dementia like illness
• Can overlap with dementia making diagnosis harder

2
Depression vs Dementia

• Abrupt onset of sx rapid progression
• Previous psychiatric hx
• Poor motivation at MMSE little effort with
  tasks
• Doesnt try to keep up variable performance in
  MMSE
• Complains about memory problems, often in detail
  with emphasis
• Highlights personal failures
• Distressed

• Insidious onset gradual / step-wise decline
• Possible vascular Hx
• Frustrated by MMSE struggles with tasks
• Relies on notes/calendars etc to keep up
• Often oblivious to memory loss, vague complaints,
  may conceal
• Delights in personal accomplishments
• Unconcerned

3
Assessment tools

• Geriatric depression score /15
• Takes 7min to perform
• 92 sensitive 89 specific
• gt 5 mild 5-10 mod gt10 severe
• Screening tool remember suicide risk
• PHQ9 /27
• Scores the 9 DSM IV criteria 0-3
• 5-9 mild 10-14 moderate 15-19 mod severe 20-27
  severe
• Score 10 or more has sensitivity 88
  specificity 88 for major depression

4
NICE

• 2004 guidelines (amended 2007)
• Mild depression
• Watchful waiting
• Guided self help CBT
• Counselling
• Moderate/severe depression
• Drugs
• Psychological support
• Social support
• Life threatening depression
• ECT