RECOGNISING AND REDUCING DEPRESSION IN OLDER PEOPLE Developing Skills – Improving Practice The York Training Programme Session 1

Aims and objectives to be aware of how common depression is, especially in residential and nursing home residents. to realise the complexity of “depression” and that lots of different things can masquerade as depression. to gain knowledge of symptoms of depression. to have confidence in identifying symptoms of depression in residents. to recognise who the significant people are in the care of the depressed resident. to recognise something can be done to help people with depression. to have some idea of the possible treatments for depression.

What is depression? A continuum from –Normal mood lowering To –Abnormal mood lowering To –Abnormal mood lowering and loss of function

What is depression? Symptoms Depressed mood Or Loss of interest and pleasure Plus

What is depression? – cont’d Feelings of worthlessness Feelings of guilt Impaired concentration Loss of energy Fatigue Loss of appetite Loss of weight Sleep disturbance

What is depression? – cont’d Retreating into or dweling on past mistakes Thoughts of suicide or death Retardation Agitation Diurnal variation of –Mood –Behaviour Hopelessness Helplessness “Hypochondriasis” The three ‘H’s

Depression in older people Hopelessness Helplessness Hypochondriasis Diurnal variation (regular change of mood at different times of day) –Mood –Behaviour

Who has it? 10% general population over 65 More than 30% of residents in care homes More than 30% of hospital patients Women more than men

Why is it missed? Older people don’t complain “what can you expect at my/your age?” I’m not depressed. I’ve got nothing to be depressed about” Confused with normal grief Confused by physical illness

Is it important? Treatable Increased mortality Unnecessary institutionalisation Increased dependency Poor quality of life

Physical needs of older people Nutrition Warmth Shelter Comfort Cleanliness

Psychological needs of older people Respect Security Self-determination Occupation Social activity Any more?

‘Causes’ of depression Predisposing familial and genetic factors Stressful life events Losses, including bereavement Sensory losses Physical illness/disability Chronic pain Lack of social input Loss of independence e.g. move to care home Other psychological illness or problems

Significant losses of late life Status Income Health Company Independence Fewer available choices Security of accommodation Significant people through death or moving away

‘Maintaining’ factors in depression may include: Personal disposition Financial worries Health problems –Physical –Other psychological –Problems with social networks and relationships e.g. friends, family Multiple losses

Problems in Care settings Poor relationships with staff Poor relationships with other residents Need for privacy Need for social and emotional support Environmental factors

Treatment of depression Treat underlying physical illness Help with appropriate practical support Reduce social isolation Maximise independence Occupation

Treatment of depression: specialist treatments Talking therapies Bereavement work Cognitive therapy Anxiety management Medical treatments Antidepressants Mood stabilisers e.g. lithium ECT Combinations of psychological and medical treatments

Recognising depression Look at the case studies for Mr Smith and Mrs Jones Are they depressed? If ‘yes’ what makes you think so? What else would you need to know if you’re not sure? How would you find out? Would you ask a doctor or specialist to see them? Why and what reasons would you give?