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AGING & DEPRESSION.   Term Paper ID:23510 Click to get this paper

Essay Subject: Incidence, assessment & diagnosis, effects, treatment, causes, special needs of elderly.... More...

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Paper Abstract: Incidence, assessment & diagnosis, effects, treatment, causes, special needs of elderly. Paper Introduction: AGING & DEPRESSION Introduction Depression is common in the elderly population; it is associated with a higher risk of death from suicide than for any other age group. Because of the rapid increase in the proportion of aged in the world population, more people are at risk of developing depression. The study of depression in the elderly includes prevalence, recognition, and diagnosis of the disorder, factors associated with depression, treatment, and concerns and/or needs of the elderly regarding retirement, social interaction, and individuality (Lobo, Saz, Marcos, Dia, & De-la-Camara, 1995; Martin, Fleming, & Evans, 1995). Prevalence, Recognition, & Diagnosis Martin, Fleming, and Evans (1995) reviewed the medical Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. C. Again, the importance of socialsupport and significant interpersonal relationships are noted, as is theimportance of meaningful activity and feelings of self-esteem. Medical debilitation and age-lifestressors may result in feelings of uselessness, a lack of purpose,isolation, a loss of self-worth, and depression. Psychotherapy isalso viewed as important for successful outcomes (Reynolds, 1994). Prevalence, Recognition, & Diagnosis Martin, Fleming, and Evans (1995) reviewed the medical literature andprovided an overview regarding the recognition and management ofdepression. Additionally, thisunderstanding may result in community efforts that provide support systemsto help prevent elderly depression as well as aid in its treatment. Stressful life events and difficulties lower response andstabilization. Literature findings were reported: the agingprocess may bring losses in physical being, close relationships, socialstatus, and independence or autonomy, which may result in a loss of self-worth. Results demonstrated that depressive disorders were found in 4.8 percentof the elderly; 5.5 percent had a dementing disorder. P., Lopez, F. International Journal Aging and HumanDevelopment, 38(4), 3 7-326. M. Conclusions Concerns of the elderly such as needs for independence, autonomy,self-worth, and socioeconomic status, may no longer be met because ofretirement from the workplace. Adequatepsychotherapeutic and pharmacologic treatment for elderly depressionrequires an understanding of these issues. A lack of financial independence may curtail future socialinteraction as well as self-confidence needed to peruse acceptance andadequate interpersonal relationships. Experimental Gerontology, 3 (3/4), 423-43 . Twenty-nine of the cases were diagnoses as mild depression(2.7 percent), and 23 were found to be moderate to severe (2.1 percent);proportions were similar for men and women. It has been stated that depression is commonbut treatable. Martin et al. Mayo ClinicProceedings, 7 , 999-1 6. Dysthymicdisorders in both men and women were related to retirement (the result ofsickness rather than age), small numbers of rooms in the home, lack ofintimate friendships, and many long-standing and current social stressfactors. Thus, hypotheses that depression increases withage and that elderly depression might be largely associated with dementiaor cognitive dysfunction were not supported (Lobo, Saz, Marcos, Dia, and De-la-Camara, 1995). Treatment considerations include medical and psychosocialfactors, variations in etiology, clinical presentation, and treatmentresponse, needs for long-term care facilities, and continuation andmaintenance of treatment to maintain quality of life. Factors such asdeterioration in health, sleep disturbances, and lack of support systemshave been found to predict persistence of depressive symptoms in those 65and older (Reynolds, 1994). (1995). Medical, psychological, and psychosocial factorsneed to be considered. (1995) report that assessment of depression in theelderly requires the obtaining of outside information, a detailed history,to consider thinking and behavioral changes, and consideration of thedifferential diagnosis of depression along with numerous other conditions(also thyroid dysfunction, kidney failure, Parkinson's disease, viralencephalitis, brain tumor, alcoholism, lung or pancreas cancer, perniciousanemia or folate deficiency, and undiagnosed sleep disorder). Additionally, fulfillment of needsregarding social interaction and support may be altered because ofretirement. (1992). Examples of these cognitions are thebelief that one should be competent at everything one attempts, that oneshould become unduly upset if one fails to do well, that control isimportant at all costs. G., & Nation, P. Significant sociodemographiccharacteristics included education levels. Symptoms of depression may beconsidered as normal reactions to life stressors rather than separate andtreatable. M., Fleming, K. (1995). A factor that may predispose the patient for depression includesstroke. Guidelines for treatment ofelderly depression include the following: correct identification ofunderlying organic illnesses; minimum use of depression-inducingmedications; attempts to alleviate isolation and diminished independence;increased stimulation in life circumstances; consideration ofpsychotherapeutic options; and possible psychiatric consultation andpharmacotherapy (Martin, Fleming, & Evans, 1995). Maintenance therapy continuing after full remissionof symptoms is recommended, with continuation of medication. Obstacles to treatment have been identified and include poorcompliance, adverse effects of treatment, inadequate support, comorbidmedical illness, self-medication, bereavement and interpersonal isolation.Suicide rates are higher in the elderly. (1994). (1994).Irrational beliefs and depressive symptoms among younger and older adults:A cross-sectional comparison. Previousstudies demonstrated that adverse life events, lack of confidentrelationships or intimacy, low incidence of social contacts, living alone,poor social support, and childhood traumas are related to high incidence ofdepressive symptoms in old age. Dysthymic personsreported a significantly larger number of interpersonal detrimental eventsthan did non-depressed persons (Pahkala, Kivela, and Laippala, 1992). Psychotherapeutic methods involving the hypnoticstate are viewed as important for the elderly; psychotherapy is reported asdemonstrating positive psychological and physical effects. A physician's assessment may also become complicated since theelderly may be unable to provide an accurate history because of cognitiveimpairment, reluctance, or denial; the patient may have a coexistingmedical condition which may mimic or mask depressive disorders. Elderly depression is often found to be a chronic illness withrecurrence episodes; therefore, patients benefit from maintenance therapy,which begins after full remission and is sustained for four to six months.The same dose of medication during continuation and maintenance therapy isrecommended. Psychological Medicine, 25, 779-786.----------------------- 6 F. Thiscare includes the understanding of needs and concerns of the elderly andrelief for common disorders such as depression (Lobo, Saz, Marcos, Dia, &De-la-Camara, 1995). The study of depressionin the elderly includes prevalence, recognition, and diagnosis of thedisorder, factors associated with depression, treatment, and concernsand/or needs of the elderly regarding retirement, social interaction, andindividuality (Lobo, Saz, Marcos, Dia, & De-la-Camara, 1995; Martin,Fleming, & Evans, 1995). Long-term views are stated as needed, because of relapse, recurrence,and chronic illness factors. References Hayslip, B., Galt, C. Kaufmann and Barolin (1995) also recommend psychorehabilitation forthe depressed elderly, with consideration for their particular needs andconcerns. (1995). (1995).The prevalence of dementia and depression in the elderly community in asouthern European population. Results demonstrated that subjective memory impairment is common,occurring in one of four people over 65, and these subjects aresignificantly more likely to suffer from dementia or depression, with a two-fold greater risk for developing depression. Most (67 percent) reported annual incomes exceeding $1 , .Test instruments included a demographic questionnaire, the Beck DepressionInventory (BDI), and the Irrational Beliefs Inventory (IBI). Treatment of depression in late life.American Journal of Medicine, 97(Suppl 6A), 6A-39S-6A-46S. Fifty percent were married, 6 percent lived alone, and35 percent were widowed. Kaufmann, C., & Barolin, S. Depression is reported as common in the elderly population,and it is associated with high risks for suicide. For these conditions and other disabilities, untreateddepression may slow recovery rates or increase debility (Martin, Fleming, &Evans, 1995). The sample for this study consisted of 118 young adults and 1 7elderly adults (mean age of 72.5). Problems of retirement and aging, with loss ofindependence, feelings of insufficiency, and acceptance of imminent dyingresult in a high risk for depression group of elderly patients.Psychotherapy is needed for assistance in these and other criticalpsychological situations. Social andenvironmental factors and dysthymic disorder in old age. TheGospel Oak Study stage IV: The clinical relevance of subjective memoryimpairment in older people. Poorer health was related to greater depressive symptoms foreach sample (Hayslip, Galt, Lopez, and Nation, 1994). The authors alsofound that poor health was related to greater depressive symptoms.Debilitation and lack autonomy are issues for the depressed elderly thatneed to be addressed. Patient education regarding compliance,with a consistent focus on compliance by medical treatment teams, isrecommended. The biggest obstacle is stated tobe patient compliance; as many as 7 percent take only 5 percent to 75percent of their prescribed dose. Archives of General Psychiatry, 52, 497-5 6. According to Reynolds (1994), treatment needs or concerns for elderlydepression include a long-term view, because of relapse, recurrence, andchronic illness factors. Pahkala, K., Kivela, S. Suicide ratesare high for the depressed elderly, and, therefore, obstacles to treatmentneed to be addressed, with particular emphasis on patient compliance. In this case, impairment of speech or mentation make interviewingthe patient even more difficult, and relatives may assume that depressivesymptoms are normal responses to losses of functions rather than a separatetreatable disorder. Pahkala, Kivela, and Laippala (1992) studied social and environmentalfactors associated with dysthymic disorder in the elderly. Lobo, A., Saz, P., Marcos, G., Dia, J., & De-la-Camara, C. Psychotherapy is therefore viewed asan important and critical adjuvant to pharmacotherapy for the treatment ofelderly depression (Reynolds, 1994). Studies also estimate 8 percent-15 percentprevalence of subsyndromal depression in community samples. However, some studiesshow that the incidence of major depressive disorder late in life is lowerthan in the general population, while others show an increase in depressivesymptoms for this group. Theneed for social support is again indicated to overcome this tendency. Psychorehabilitation aspects inolder age groups. Hayslip, Galt, Lopex, and Nation(1994) note additional depressive factors; they found that the belieffactor labeled cognitive-emotional rigidity/dependency was associated withaffective and somatic depressive symptoms in the elderly. Results demonstrated that a greaterproportion of dysthymic men had retired and did not work at all. Case levels ofdepression were found in 25.4 percent of the demented cases, and caselevels of organic disturbance (cognitive disturbances) were found in 18.2percent of major depression cases. Additional life problems suchas retirement, loss of independence and self-worth, and acceptance of deathmay require both psychotherapeutic and social support systems. Rehabilitation ofphysical, psychological, and social reserves is viewed as necessary toaddress these needs and concerns of the elderly. For this community-based epidemiological survey, the data was derivedfrom 594 persons, 6 or over. A community sample consisting of 7 5 elderly residents over 65and living in their own home was interviewed in 1988; a second screening of524 persons was done in 199 . The majority of the older sample wasfemale (72 percent), retired (83 percent), and indicated that presenthealth was good. Reynolds, C. C., & Evans, J. Manyelderly assume that the aging process is supposed to be frightening anddepressing, and they therefore are reluctant to find help with depressivesymptoms. Rehabilitation of physical,psychological, and social reserves is viewed as crucial to effectiveintegration of the elderly into a social life with personal independence.For example, elderly patients with disabilities exhibit anxiety regardingparticipation in social life because of their disability, indicating theneed for psychotherapeutically-oriented single or group therapy as part ofrehabilitation. AGING & DEPRESSION Introduction Depression is common in the elderly population; it is associated witha higher risk of death from suicide than for any other age group. Statisticalanalysis include three separate hierarchical regression analyses for eachof the three depression factor scores in each sample. Treatment Reynolds (1994) reviewed the literature concerning treatment ofdepression for the elderly. Dementia was associated withdepression in only a quarter of the cases, and depression was associatedwith cognitive disturbances in only 18.2 percent of patients. Needs of the elderly include careful assessment of depressionand additional health problems, attempts to alleviate isolation anddiminished independence, increases in stimulating life events, andconsideration of all available treatment options (psychotherapeutic,pharmacotherapy, social support). The literature reports varied treatment results. Bereavement is also reported to be commonamong the elderly; social support is thought to assist with depressivereactions related to loss. Factors Associated With Elderly Depression Hayslip, Galt, Lopez, and Nation (1994) studied irrational beliefsand depressive symptoms associated with younger and older adults; agedifferences were compared. Journal ofClinical Epidemiology, 45(7), 775-783. Lobo, Saz, Marcos, Dia, and De-la-Camara (1995) also reported onprevalence of depression in the elderly as well as its association withdementia. Depression was more common in women (5.7 percent) than men(3.4 percent). Patients consideredat high risk for depression relapse or chronicity are those with healthproblems and poor social support systems. A lack ofsocioeconomic status appears to contribute to inadequate social contact. Additional factors which may result in a lack of accuratediagnosis include a lack of knowledge or understanding of depression by theelderly and the caregivers, a desire to avoid psychiatric care, fears ofmedical expenses, and a lack of social or work contacts, making depressivesymptoms more difficult to recognize and functional impairment moredifficult to assess. Cognitiveproblems were more frequent in DSM-III-R major depression than in dysthymicor adjustment disorders. The authors conducted a study of 1,134 elderly (449 men and 685women) from a Spanish-speaking country and a southern European community.Research instruments included the Mini-Mental State Examination and theGeriatric Mental State Schedule-Automated Geriatric Examination forComputer Assisted Taxonomy package, and the History and Aetiology Schedule. Dysthymic women tended to live at their present place ofresidence for a shorter time; dysthymic disorder was correlated with movingbecause of poor health and living in institutions, for men as well.Dysthymic women demonstrated low numbers of hobbies, poor socialparticipation, and inadequate personal relationships. Becauseof the rapid increase in the proportion of aged in the world population,more people are at risk of developing depression. Tobiansky, Blizard, Livingston, and Mann (1995) studied theprevalence of subjective memory impairment with its value as a depressionpredictor. Depression may also be attributed to organic illnessin this age-group (Martin, Fleming, & Evans, 1995). Studies conflict regarding associations of increasing age withdepression, dementia or organic disturbances; however, possible factorscorrelated with depressive symptoms include memory impairment (Tobiansky,Blizard, Livingston, & Mann, 1995). Tobiansky, R., Blizard, R., Livingston, G., & Mann, A. Elderly patients may tend to be reluctant or unable to reportdepressive symptoms; thus, depression is often not recognized. Results demonstratedthat, in young adult groups, cognitive belief factors ofexternality/control and dependency/emotionality were associated withaffective and cognitive aspects of depression. Additional conditions associated with depression aredementia, myocardial infarction, coronary artery bypass grafting, andterminal illnesses. Depressionmay not be the main complaint when an elderly patient is experiencing majordepressive disorder; he/she may be experiencing a change in personality,mentation, or level of functioning. L., & Laippala, P. Stroke victims with grief reactions to functional lossesdemonstrate low self-esteem with anger and despair; psychotherapeuticinterventions help with the mourning process and facilitate integrationinto social life. Test instruments included the short-CARE,the Geriatric Mental State-A, the History and Aetiology schedule, and theCognitive Assessment schedule of the Cambridge Mental Disorders of theElderly. Nortriptyline, desipramine, and selective serotonin reuptakeinhibitors, paroxetine and sertraline, are found to be preferredpharmacotherapy for short-term and long-term treatment. For this study, a decrease of frequency of depression with increasedage was found. Martin, Fleming, and Evans (1995) point out thatdepression is frequent in the elderly but may not be easy to recognize.Factors convoluting accurate diagnosis include a lack of understandingregarding depressive symptoms, reluctance or denial, fears, or thecoexistence of a medical condition. Kaufmann and Barolin (1995) reviewed the literature regardingpsychorehabilitation for the elderly and concluded that psychotherapeuticmethods are necessary and useful. Lower probability of depression is reported forelderly with higher socioeconomic status, and lower social status withconcomitant increased social difficulties is related to depressivesymptoms. For example, patients with disabilities and functional losses,and related anxiety, anger, or grief may need assistance with processingemotions and as well as social integration. Additionally, elderly with medical andneurological illness or bereavement-related depression bring greaterconsideration. For older adults, acognitive belief factor labeled cognitive-emotional rigidity/dependency wasassociated with affective and somatic depressive symptoms; a secondcognitive factor, labeled adaptation/internal control (defined as absenceof irrational thinking) was negatively correlated with somatic depressivesymptoms. Adaptive cognitions are viewed as acceptingpersonal responsibility, facing life difficulties, and exercising self-determination and adaptability, retaining a sense of satisfaction andcontrol. Depressive symptoms in the elderlytend to be physical rather than mood-related (Martin, Fleming, & Evans,1995). Elderly Needs/Concerns The proportion of elderly in the world population is increasing, andtherefore the need for adequate care for older adults is increasing. Most (94 percent) had at least a high schooleducation. Depression was associated with lowereducational levels. Martin, L. Additional environmental and social factors, related to elderlydysthymic disorder, found by Pahkala, Kivela, and Laippala (1992), includethe following: adverse life events, lack of interpersonal relationshipsand/or social contacts, bereavement without social support, lowsocioeconomic status, retirement, illness, few hobbies, and large numbersof interpersonal detrimental events. Lack of social support and eccentric personality featuresalso contribute to delayed response. Cognitive theorists are reported as stating that irrationalcognitions and cognitive distortions result in emotional distress whennegative life events take place. Recognition andmanagement of anxiety and depression in elderly patients. Prevalence rates for major depression in the elderlyinclude less than 3 percent in community samples, 15 percent-25 percent innursing homes, and 13 percent annual incidence of new episodes for those inlong-term care facilities. If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.