Chapter 14: Anxiety & Depression in the Older Adult

1. Chapter 14: Anxiety & Depression in the Older Adult

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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)

13. 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.