Depression « The Professional Geriatric Care Manager’s Blog

Depression in the Senior Years

May 20, 2011 at 10:30 am | Posted in Deborah Varisco, GCM | Leave a comment
Tags: Aging, Depression, Education, Eldercare, Health, Seminar

I attended a conference this week entitled “The Golden Years? Medical, Legal, Ethical Challenges Facing Seniors and their Caregivers.” One of the topics of the program was “Depression in the Senior Years.” The speaker started off with saying depression is a medical disease, just like diabetes, heart disease and cancer; one in five people will develop depression in their senior years.

Depression is characterized as an all-encompassing low mood, accompanied by low self-esteem, and by the loss of interest and pleasure in normally enjoyable activities. The causes of depression can include psychological, hereditary, or biological factors. Certain medications can cause depression. The abuse of alcohol and drugs can cause depression. In the elderly, depression can often coexist with physical disorders, such as stroke, cardiovascular diseases, Parkinson’s disease, and chronic obstructive pulmonary disease.

Symptoms of depression in the elderly include headache, pain, fatigue, insomnia, and digestive problems. There exists a low rate of detection of depression in the elderly by primary care physicians, and depressed older adults have the highest risk of suicide in our society. Once depression is diagnosed there are varying treatment plans. Depression can be successfully treated with antidepressant medication, psychotherapy, electroconvulsive therapy, or a combination of therapies.

As geriatric care managers, we observe for symptoms of depression. We know that changes in an older person’s behavior or mood should not be ignored. Many of our clients suffer from dementia, or have a history of other physical disorders such as stroke. The risk of major depression has been shown to increase with neurological conditions such as stroke and Parkinson’s disease. If we suspect depression, we will bring it to the attention of the client’s primary care physician, who can prescribe a course of treatment after a medical examination. The primary care physician may also refer the client to a neurologist or psychiatrist for further evaluation. Additional testing is also performed to eliminate causes of the symptoms. Blood tests, such as thyroid tests, to rule out a metabolic disturbance; and a full blood count with ESR, to rule out a systemic infection are drawn. Cognitive testing and brain imaging are done to help distinguish depression from dementia. A CT scan of the brain eliminates any evidence of physical problems, such as brain tumors. As care managers, we arrange for any testing ordered and accompany the client to the scheduled test. At weekly visits we can continually assess the patient. We set up weekly pill boxes to make sure clients are compliant with their medications, particularly if medications have been prescribed for depression. We engage clients in activities, such as working with a senior fitness trainer, sessions with a psychotherapist, or our therapy dog Romeo. The goal is to eliminate feelings of hopelessness and emptiness a client may be experiencing, to aid in the diagnosis and treatment of depression in the elderly, and not just view it as a natural consequence of aging.

Distinctive Care Geriatric Care Management serves Bergen, Passaic, Rockland and Orange County with nurses licensed in New Jersey and New York. We help families dealing with various issues related to their elderly loved ones and would be happy to discuss any concerns you may have related to long term care. Please contact us in our Ridgewood Office at 201-587-5283 to schedule a consultation.

Pseudo-dementia

November 11, 2009 at 7:01 am | Posted in Sophia Heftler, GCM | Leave a comment
Tags: Dementia, Depression, Drug Interaction, Medication

As most of you know I have frequently talked about how adverse medication reactions can cause lots of problem in older adults. This is particularly true because often times the older adult’s kidneys and liver do not work as well as when they were younger and the drugs are not metabolized as quickly.

I have an interesting experience I’d like to share with you about my favorite Client, my dad. Many of you are aware of the fact that my mother died in March of this year. My parents were married for over 60 years and my father has taken her death extremely hard. Most recently he had been complaining to me that he has been feeling “fuzzy” around the edges. As someone who suffers from depression, I can tell you with certainty that fuzziness is a symptom of depression. I hate depression and even though it’s to be expected during the grieving process I was concerned enough about my father to consult with his geriatrician and get him started on an antidepressant.

My father suffers from dual dementia, he has both Alzheimer’s disease and vascular dementia. He is relatively high functioning and is taking Aricept and Namenda to slow the progression of these diseases. He takes other medication for his blood pressure and cholesterol as well.

Well, I picked up the new medication and filled his mediminders. Day one of the new medication was uneventful. Day two, my father seemed increasingly confused. He could not subtract 20 dollars from his checking account balance. (I handle most of his finances, but he has always been able to handle small checks for even amounts.) He did not answer the phone when I called him…after checking on him he indicated that he heard the phone, but didn’t know what to do with the phone.

Oh-oh! What happened to Dad??? Luckily as a nurse the first thing I suspected was a drug interaction! I called the doctor and let him know that I was discontinuing the medication. On top of the two dementias he really has, he was experiencing a pseudo-dementia. It took two days but he is back to his baseline now…still not perfect, but he can subtract even amounts and knows what to do with the phone again!

One of the things we do at Distinctive Care Geriatric Care Management as part of our initial assessment process is a complete medication review to determine if there are any drug interactions the family should be aware of that could potentially be exhibiting as signs of dementia and should be investigated. We also do medication management for our Clients, monitoring for adverse side effects, especially when starting on a new medication.

Distinctive Care Geriatric Care Management serves Bergen and surrounding counties. If you are interested in finding out more about the medications your loved one is taking contact us for a medication review at any of our 3 locations, in Ridgewood, Tenafly and Dumont by calling our main office at 201-587-5283.