LTC Resources - Depression

Depression is a medical disorder and is an intense feeling of sadness and worthlessness – so bad that you have lost interest in life that requires attention.  Day after day depression affects thoughts, feelings, physical health, and behaviors. Depression is not just “feeling blue” or “down in the dumps.”  It is not an ordinary part of aging: whether depression is a long-term issue or newly diagnosed residents can get better with treatment.

Why is it important?

  • 15% - 25% of residents have symptoms of major depression (1)
  • 25% to 30% of patients fail to respond to initial therapy (3)

Common Causes

  • Health problems:  frailty, illness and disability; chronic or severe pain; cognitive decline; previous stroke, damage to body image due to surgery or disease.
  • Loneliness and isolation: a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
  • Reduced sense of purpose: Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
  • Fears – Fear of death or dying; anxiety over financial problems or health issues.
  • Recent bereavements –death of friends, family members, and pets; the loss of a spouse or partner.(4)

Key Considerations

It is difficult to make a diagnosis of depression, particularly in patients with co-existing dementia and/or chronic
medical illness; left untreated, mental illness can seriously affect physical health (3)

Depression red flags include:

  • sadness
  • fatigue
  • abandoning or losing interest in hobbies or other pleasurable pastimes
  • social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home)
  • weight loss or loss of appetite
  • sleep disturbances (difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
  • loss of self-worth (worries about being a burden, feelings of worthlessness, self-loathing)
  • increased use of alcohol or other drugs
  • fixation on death; suicidal thoughts or attempts

Often presents atypically which may include:

  • cognitive impairment
  • physical symptoms
  • non-specific features of irritability
  • calling out and restlessness may co-exist with dementia

Types of treatment include medication, psychotherapy and peer support.  Treatment can be pharmaceutical (antidepressants) or non-pharmaceutical: to guide choice of antidepressant include previous response, concurrent conditions, type of depression, other medications, and risk of overdose. (2)

References

1.  Canadian Coalition for Seniors Mental Health.  (2006)  Tools for Health Care Providers:  The Assessment
     & Treatment of Mental Health Issues in Long-Term Care Homes (focus on mood and behaviour symptoms).
 
     Retrieved Feb. 2014 from: 
     http://www.ccsmh.ca/en/projects/ltc.cfm

2.   Frank, C.  (2014) Pharmacologic treatment of depression in the elderly.  Canadian Family Physician
      (CFP) vol. 60 no. 2, 121-126, February 2014.  Retrieved Feb.  2014 from:  
      http://www.cfp.ca/content/60/2/121.full    

3.   Mood Disorders Society of Canada.  Retrieved Feb. 2014 from:
      http://www.mooddisorderscanada.ca/

4.   Robinson, L., Segal, J. & Smith, M. (2014) Depression in Older Adults & the Elderly
      Retrieved Feb. 2014 from:
      http://www.helpguide.org/mental/depression_elderly.htm

Recommended Readings / Guidelines

1.   Canadian Coalition for Seniors’ Mental Health. (2006). National Guidelines for Seniors’ Mental Health: The
      assessment and treatment of Depression.  Canadian Journal of Geriatrics,  2006 volume 9, supplement 2. 
      Retrieved March 2014 from:
      http://www.ccsmh.ca/pdf/final%20supplement.pdf 

2.   Dickinson, J., Gorber, S.C., Jaramillo, A.,  Joffres, M.,  Lewin, G., Pottie, K., Shaw, E. and Tonelli, M.  Canadian
     Task Force on Preventive Health Care, Recommendations on screening for depression in adults

      CMAJ  June 11, 2013 vol. 185 no. 9.  Retrieved March 2014 from:
      http://www.cmaj.ca/content/185/9/775.full.pdf+html

3.   National Institute for Health and Clinical Excellence.  (2009).  The treatment and management of depression
      in adults
.  Retrieved March 2014 from:  
      http://www.nice.org.uk/nicemedia/pdf/CG90NICEguideline.pdf

4.   Registered Nurses’ Association of Ontario.  (2004). Caregiving Strategies for Older Adults with Delirium, Dementia
      and Depression
.  Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression

5.   Registered Nurses’ Association of Ontario.  (2003).  Screening for Delirium, Dementia and Depression in the
      Older Adult
. Retrieved March 2014 from: 
      http://rnao.ca/bpg/guidelines/screening-delirium-dementia-and-depression-older-adult