Chapter 14: Anxiety & Depression in the Older Adult

Learning Objectives Understand the behavioral changes associated with normal aging processes as related to mood. Recognize symptoms of anxiety and depression in older persons. Develop a plan of care for managing anxiety disorder in an older person. Distinguish among anxiety, sadness, and depression. Develop a plan of care for managing depression in an older person. Identify signs of suicidal risk in an older person. Explain an emergency plan for older persons who exhibit signs of suicidal ideation.

Behavioral Changes Associated with Aging Psychological changes in aging vary based on the individual, but often revolve around a person’s role in life Anxiety and depression can be maladaptive response to these changes Older adults may minimize concerns about symptoms of anxiety and depression

Anxiety Understanding anxiety –Normal human reaction; part of the body's fear response –Some risk factors: increasing frailty, illness, loss of relatives, friends, and/or independence Common causes of anxiety –Chronic medical conditions –COPD hypoxia –Financial concerns –Sensory changes –Certain medications

Anxiety (cont’d) Anxiety assessment –Cognitive functioning, functional abilities, mood, and ability to appropriately answer questions Types and symptoms of anxiety (Table 14-3, P.519) –panic disorders –phobic disorders –obsessive-compulsive disorder (OCD) –general anxiety disorder (GAD) –posttraumatic stress disorder (PTSD) –substance-induced anxiety disorder

Anxiety (cont’d) Differential diagnoses –Anxiety can exacerbate other medical conditions –Anxiety may be a symptom of another problem (UTI, URI, constipation, caffeine or nicotine use,…) Anxiety and dementia –Older people with dementia often exhibit anxiety, including exaggerated form known as agitation –Extreme episode of anxious or agitated behaviors may be referred to as psychotic behaviors –Anxious symptoms often present during the progression of dementia

Anxiety (cont’d) Managing anxiety (Box. 14-4, p. 521) –Behavioral counseling –Establish daily routine –Cognitive-behavioral therapy –Medication: anxiolytics –Stress reduction –Getting adequate, efficient sleep –Staying active –Avoiding triggers –Support group therapy

Depression Prevalence in the aging population –Around 10% of men and 18% of women age 65+ –Men over 86 at highest risk Types and presentation –Major depression Anhedonia: loss of pleasure and interest in daily activities. –Minor depression –Dysthymia –Late-onset depression

Depression (cont’d) Manifestations –Men and women behave differently when depressed –Somatic symptoms can be misleading –Different presentations > Catatonic> Melancholic  Psychotic> Atypical  Relationship to chronic disease –Depression concurrent with heart disease, cancer, COPD, or stroke is strongly related to increased burden of illness and worsening overall outcomes.

Depression (cont’d) Diagnosing depression –Geriatric Depression Scale (GDS) –Patient Health Questionnaire 9-Item Test (PHQ-9) Differential diagnoses –Medical and cognitive assessments to determine if depression symptoms are due to underlying Alzheimer’s or dementia Anxiety disorders Late-life schizophrenia Physical disorders, such as anemia, hypothyroidism, Parkinson’s disease, and other neurologic disorders

Depression (cont’d) Depression and dementia –Symptoms consistent with depression have been shown to precede dementia in both men and women Managing depression –Counseling and therapy –Antidepressant Medication SSRIs(Box 14-4, P. 533) SNRIs (Box 14-5, p. 534) Atypical antidepressants

Depression (cont’d) Nursing interventions (p. 534) –Providing a nonjudgmental atmosphere –Encouraging utilization of social support systems –Providing emotional support Suicide –Suicide threat is emergency situation requiring immediate action –Assessing suicidal risks (Box 14.7, p. 537) Suicidal ideation: thoughts & plan r/t suicide White men over age 85 are at the highest risk Suicidal behavior –Suicide prevention (Case study 14-2, p. 538)

Summary Depression and anxiety are common among older adults, particularly those with limited social support or resources. Geriatric nurses play a role in examining all aspects of an older patient, including mental and emotional health, to make appropriate referrals for treatment. Early recognition and intervention for anxiety and depression can improve quality of life and help prevent unnecessary complications.