Three Ds: Dementia, Delirium, and Depression. Depression

Transcription

1 Three Ds: Dementia, Delirium, and Depression Depression

2 Aging population Aging population 1 out of 7 people in Canada is a Senior Citizen Ageism is a barrier to care and compassion Older Adults are not beds, they are people Healthcare costs are expected to be impacted only 1% per year by the aging population Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems Planning for the Aging Population. Retrieved from

3 Points to ponder Self esteem is affected by age-related and disease related changes Self esteem is affected by societal values and life experiences Self concept is threatened by loss Maintaining self-worth and personal value are key to healthy aging We need to promote self esteem in older adults Depression attacks self esteem

4 Depression is Depression is not a normal part of ageing Depression is common, not normal Continues to have a strong stigma associated with it Difficult for a majority of Older Adults to speak about Considered a weakness of character Undertreated and not readily diagnosed

5 Good News! Depression is fairly easy to detect, and treatable!

6 What it looks like Persistent sad, anxious, or empty feeling, or a feeling of hopelessness and pessimism.

7 Life Context Widowhood Bereavement Loss of function Loss of independence Chronic health conditions Depression is often triggered from situational factors

8 Impact Difficulty in adapting to changes Healthy aging is adapting to changes, while not necessarily accepting changes that occur in one's life

9 Impact of untreated depression Complicates and increases impact of health conditions. Increased pain Decreases support network through symptoms and decreased ability to link to support Suicide

10 Symptoms Blue or sad feelings that don t go away in a few days or a week Interferes with Daily life Interferes with relationships

11 Tool for assessing symptoms SIG E CAPS (Source: Michael Jenike, 1989) S Sleep is disturbed I Interest is decreased G Guilt (feelings of guilt or regret) E Energy is less than usual C Concentration is poor A Appetite is disturbed P Psychomotor agitation or retardation S Suicidal Ideation, including passive wish to die

12 Suicide Check I hear your having a hard time right now. Have you had any thoughts of harming yourself? Do you have a plan? Have you ever tried to hurt yourself before?

13 Warning Signs Remember IS PATH WARM? I Ideation S Substance Use P Purposelessness A Anxiety/Agitation T Trapped H Hopelessness/Helplessness W Withdrawal A Anger R Recklessness M Mood Changes From the American Association of Suicidology (AAS) website (

14 Actions If high risk for suicide then refer to mental health specialist Can you assist in changing the potential to act such as guns being removed? Will the person contact and open up to family and friends? What support do they need to do so? Can you facilitate? Need to set up a plan for treatment based on risk and what you have available.

15 Larger picture Majority of people with depression do not want to end their lives. When identified, minor depressive episodes can be treated with readily available actions. Majority of people are resilient. Talk with them and help them to reconnect to life.

16 Resiliency Factors 1. Sense of meaning and purpose in life. 2. Sense of hope. 3. Sense of optimism. 4. Religious (or spiritual) practice. 5. Active social networks and support from family and friends. 6. Good health care practices. 7. Positive help-seeking behaviours. 8. Engagement in activities of personal interest.

17 Treatment Basics What brings you joy in life? Be physical and exercise Walk outside in nature Connect with the people you love Share yourself and accept support Eat well Relax Decrease stress Evaluate substance use Maintain healthy sleeping patterns Be patient and kind to yourself

18 Treatment Overview Psychosocial intervention first line treatment for mild depression. Medication is a last option for mild depression. Medication and psychosocial interventions effective in moderate and severe depression. Reassess weekly to evaluate efficacy of treatment. Involve the resources around you. Work with the person. Broken bones can heal faster than depression does.

19 Communication is Crucial Create rapport Respect the dignity of the older adult Validate their feelings Respond with respect Respond at their pace Create a trusting relationship Be with them in that moment

20 Larger picture Promote healthy ageing in practice and policy Promote living conditions and environments that support wellbeing and allow people to lead health and integrated lifestyles. Support strategies that ensure Older Adults have necessary resources to meet basic needs

21 Summary Ageism is a barrier to care Depression impacts self esteem Depression is not a normal part of ageing Depression is treatable Are accessible tools to assess depression Need to take the time for communication Promote and support active ageing Connect with the joys of life

22 References Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems Planning for the Aging Population. Retrieved from Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems Planning for the Aging Population. Retrieved from The Canadian Coalition for Seniors Mental Health (2015 updated) Tools for Healthcare Providers: The assessment and treatment of Depression in Older Adults. Retrieved from World Health Organization (2015). Suicide fact sheet. Retrieved from Wold, Gloria H. Basic Geriatric Nursing, 4th Edition. Mosby,

23 Tools Geriatric Depression Scale RAI Depression Scale CCSMH suicide brochure