DEPRESSION, A COMPREHENSIVE APPROACH

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DEPRESSION, A COMPREHENSIVE APPROACH

• Joan Behm, LCSW
• Kathi Edling, LPN
• Donna L. Klarsch, RN, BSN

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OBJECTIVES

• To improve understanding of depression
• To identify at risk residents using standardized
  depression scales for elderly residents with or
  without dementia
• To provide non-pharmacological intervention ideas
  to replace or augment medication treatment
• To help facilities develop a comprehensive
  approach to the treatment of depression
• To explore depression in caregivers and the
  community
• To improve quality of care of the depressed
  resident thereby improving quality of life

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WHAT IS DEPRESSION?

• Illness of body, mind, thoughts
• Affects eating, sleeping, self esteem
• Not a sign of personal weakness
• Not a blue mood
• Can last for weeks, months, years

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TYPES OF DEPRESSION

• Major depression
• Combination of symptoms
• Interferes with work, sleep, study, eating,
  pleasure
• Usually occurs more than once in a lifetime
• Dysthymia
• Long term chronic symptoms that do not disable
• Keep you from enjoying life
• Can have a major depression also

• Bipolar disorder
• Manic/depressive disorder
• Severe highs and lows
• Can occur rapidly or over time
• Can worsen into a psychosis

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DEPRESSION FACTS

• Not a normal part of aging
• Can complicate chronic illness
• Can lead to suicide
• 18 of all suicide deaths over age 65
• Highest group men over 85
• Of over 35 million Americans over age 65, 2
  million have a depression diagnosis and 5 million
  remain undiagnosed or treated

• 9.5 Americans over the age of 18 are depressed
• Ø 4 of all preschoolers (1 million) are
  depressed
• Ø 20 of all children are depressed
• Ø 30 of all women are depressed
• Ø 80 of depression victims do not seek treatment
• Ø 92 of depressed African American males do not
  seek treatment
• Ø Depression will be the second largest killer
  after heart disease in 2020
• Ø Depression costs employers 51 billion dollars
  annually

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DIAGNOSIS OF DEPRESSION

• Complete physical
• Thyroid studies
• CBC to rule out anemia
• Neurological exam
• Medical, psychiatric, and family history
• Tendency to run in families
• Mini mental status exam
• To help diagnose dementia
• Depression screen
• Based on the mini mental

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DEPRESSION SCREENS

• Yesavage Geriatric Depression Screen
• Cornell
• Short form geriatric depression scale
• Goldberg mood scales
• The Center for Epidemiological Studies Depression
  Screen
• Various online depression screens

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SCREENS AT THE HIGHLANDS

• Mini mental exam
• Yesavage Geriatric Screen
• OR
• Cornell Screen for Depression in Dementia

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MOOD AND BEHAVIOR SHEETS

• In MDS language
• Documented by the nursing assistant
• Reviewed by the charge nurse each shift
• Reviewed by the social worker during assessment,
  for social service referrals and as needed

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ANTIDEPRESSANTS

• Most common treatment for depression
• Side effects
• Take several weeks to begin to work and up to 12
  weeks to determine effectiveness

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OTHER TREATMENT OPTIONS

• Behavior management/psycho-therapy
• Exercise
• Pet therapy
• Increased family participation
• Cognitive therapy
• Pain management
• Sleep therapy

• Light therapy
• Aromatherapy
• Yoga, tai chi, meditation
• Music therapy
• Herbal therapy
• Dietary options
• Encourage residents to feel useful

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MORE RADICAL OPTIONS

• Electroconvulsive therapy or ECT
• Omega 3 supplementation
• Homeopathy
• Transcranial Magnetic Stimulation or brain
  pacemaker
• SamE

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INTERDISCIPLINARY APPROACH, Educate, Educate,
Educate

• Everyone involved
• Social Worker
• Nursing Assistants
• Housekeepers
• Dietary
• Maintenance
• Nursing
• Hairdresser
• Administration

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NEWS FLASHREAD ALL ABOUT IT!!!

• Depression affects us all
• Residents
• Caregivers
• Families
• Friends
• Young and Old
• Men and Women
• Boys and Girls

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THE BEGINNING

• Identification of depression
• Look for alternative therapies
• Medications have their place
• Use an interdisciplinary approach
• Educate staff, families, the public
• Do your own research