Basic of Geriatrics and Internal Medicine for Physiotherapist by Rasheedy D - HTML preview

Depression

Depression is not a normal response to the aging process (It is a disease). It is very common problem in elderly with 25% of patients at primary care report depressive symptoms.

Effects of depression

Depression is associated with poorer self-care and slower recovery after acute medical illnesses.

It can accelerate cognitive and physical decline and leads to an increased use and cost of health care services.

Less effective rehabilitation

Lower quality of life, higher level of chronic pain, and increased disability (is the fourth leading cause of disability in the United States).

The mortality rate coincided with the level of depression even when controlling for other factors.

Types of depression

Primary depression is not triggered by any other psychological or medical cause. Rather, this type of depression is triggered by psychological instability, genetic predisposition.

Secondary depression is caused by one or more negative life events such as illness, this kind of depression is triggered by a medical condition as thyroid gland disorder and by a psychiatric illness as schizophrenia.

Symptoms of depression and how old age can modify its presentation?

1. Depressed mood and/or lack of interest or pleasure in usual activities

  The older adults may be more likely to express a loss of pleasure than to specifically complain of depression

2. Feelings of worthlessness or inappropriate guilt

Less common in older adults than in younger adults

3. Diminished ability to concentrate or make decisions

Often manifested as a complaint of memory problems—adults of all ages with moderate-to-severe depression complain of problems with concentration and memory, but depressed elders, in contrast to younger adults, exhibit impairment on psychological testing even when they do not have a comorbid dementing disorder

4. Fatigue Common regardless of age

5. Psychomotor agitation or retardation

Older persons may exhibit either of these symptoms

6. Insomnia or hypersomnia

Older persons rarely, if ever, exhibit hypersomnia—a symptom that is much more common in adolescence and young adults

7. Significant decrease or increase in weight or appetite

Older adults rarely gain weight or experience an increase in appetite during a depressive episode

8. Recurrent thoughts of death or suicidal ideation

Although thoughts of death are not uncommon in older adults, suicidal ideation among depressed elders is less frequent than among the depressed who are younger but more risky.

9. More likely to express somatic complaints

65% have hypochondriacal symptoms

Screening for depression is performed as a part of comprehensive geriatric assessment by many tools:

1. Geriatric Depression Scale - 15

2. Zung Self-Rated Depression Scale

3. Patient Health Questionnaire-2

INTERVENTIONS

• Seek out medical illness, Recognize medical side effects
• Rehab services to maximize remaining function and retrain impaired ADL’s
• Involve family and caretakers
• Psychotherapy
• Medications: Best to use Selective Serotonin Reuptake Inhibitor Citalopram (Celexa) and Escitalopram (Cipralex) least side effects and drug interactions but may cause hypernatremia and sexual dysfunction.
• Electro-convulsive therapy

Exercise has been shown to benefit patients with mild to moderate mood disorders, especially anxiety and depression.

1. Aerobic and resistive exercises release endorphins from the pituitary gland which are responsible for

Relieving pain

Improving mood.

Lower cortisol levels which have been shown to be elevated in patients with depression.

2. Additionally, exercise increases the sensitivity of serotonin in the same way antidepressants work, allowing more serotonin to remain in the nerve synapse.

3. Depression symptoms can be decreased significantly after just one session but the effects are temporary. An exercise program must be continued on a daily basis to see continued effects.

4. As a person continues to exercise they may experiences changes in their body type which can help to improve self-esteem and body image issues they may have been having.

5. Regular exercise program can enhance social integration

6. Some other benefits of regular physical exercise include: (general benefits apply to all patients)

1. Reduces/prevents functional declines associated with ageing
2. Maintains/improves cardiovascular function
3. Aids in weight loss and weight control
4. Improves function of hormonal, metabolic, neurologic, respiratory, and hemodynamic systems
5. Alteration of carbohydrate/lipid metabolism results in favourable increase in high- density lipoproteins
6. Strength training helps to maintain muscle mass and strength
7. Reduces age-related bone loss; reduction in risk for osteoporosis
8. Improves flexibility, postural stability, and balance; reduction in risk of falling and associated injuries
9. Psychological benefits (preserves cognitive function, alleviates symptoms/behaviours of depression, improves self awareness, promotes sense of well-being)
10. Improves immune function
11. Reduces age-related insulin resistance
12. Improves sleep pattern