1. Jessica Miller

2. 1. Define depression 2. Recognize different symptoms in men and women 3. Identify at least 5 causes of depression 4. Recognize the effects of cognitive impairment and depressive symptoms have on motor function 5. Know at least 2 way to identify and assess depression 6. Identify at least 5 symptoms of depression 7. Identify the 3 most common way to treat depression 8. Understand how PT/OT can help treat with depression 9. Know how depression affects therapy treatments

3. Depression a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason. a depression so severe as to be considered abnormal, either because of no obvious environmental causes, or because the reaction to unfortunate life circumstances is more intense or prolonged than would generally be expected. Clinical Depression

4. Study done in Germany Objective: Investigate gender differences of depressive symptoms of the elderly 236 subjects, 357 control subjects Used a questionnaire CIDI Results: In general women suffer from more depressive symptoms than men. Major depression in the elderly presented with a similar number of symptoms in men and women. Women suffer more from appetite disturbances. Men suffer more frequently with agitation.

5. Previous history of depression Chemical imbalance in the brain Damage to Body Memory Loss Loneliness, isolation Being unmarried or widowed Decreased mobility due to illness Dependency on others Fear of death or dying Difficulty adjusting to new or changed living situation

6. Objective: Cognitive impairment (CI) and depressive symptoms(DS) inter-relate to effect functional decline 5697 participants Followed for 2 years Results: No ADL dependence, both CI and DS effect decline ADL dependence, only CI effects decline.

7. Self-report forms Patient Health Questionnaires Geriatric Depression Scale Cornell Scale for Depression in Dementia Six Item Cognitive Impairment Test Looking for signs and symptoms Simply asking questions

8. Change in appetite Bowel changes General appearance Sleep disturbance Skin Picking Hand Wringing Diminished interest Tired/Sleepy Weight change Diminished ability to think

9. anti-depressants severe side effects early withdrawal counseling services offer little often fail exercise therapy cost effective

10. Motivation Get back to regular activities Social Time Therapist Other patients Physical Activity Improves mood by releasing endorphins Regaining independence

11. Most affects of depression can negatively affect PT and OT sessions. These things don’t allow the pt to get a full treatment time in and they don’t give full effort when these factors play a part. No motivation Fatigue/Tired Irritation Incontinence Decrease in functional abilities Agitation/Yelling Out

12. Demonstrating empathy Lending support Help patient find support groups Referring patients to appropriate resource Focus on their progress Remind them how far they have come Be encouraging MOTIVATE

13. 1. Brown C. I've got a right to sing the blues; or recognizing depression in the elderly. Tar Heel Nurse [serial online]. March 2002;64(2):16-17. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 9, 2012. 2. Cripps F. Exercise your mind: physical activity as a therapeutic technique for depression... including commentary by Craft LL and McDougall T. International Journal Of Therapy & Rehabilitation [serial online]. October 2008;15(10):460-465. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 10, 2012. 3. Dutton, Mark. Orthopaedics for the Physical Therapist Assistant. MA: Jones & Bartlett Learning; 2012: 632 4. Hardy S. Depression in the elderly: ways to offer support. Practice Nursing [serial online]. October 2011;22(10):520-525. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 9, 2012.

14. 5. Kockler,, Heun,. Gender differences of depressive symptoms in depressed and nondepressed elderly persons. International Journal Of Geriatric Psychiatry [serial online]. 2002;17(1):65-72. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 9, 2012. 6. Mehta K, Yaffe K, Covinsky K. Cognitive impairment, depressive symptoms, and functional decline in older people. Journal Of The American Geriatrics Society [serial online]. June 2002;50(6):1045- 1050. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 9, 2012. 7. Pain, anxiety, and depression: why these conditions often occur together and how to treat them when they do. Harvard Mental Health Letter [serial online]. May 2010;26(11):1-3. Available from: CINAHL with Full Text, Ipswich, MA. Accessed June 10, 2012. 8. U.S. Department of Health and Human Services. What is Depression? National Institute of Mental Health. 2011. Available at: http://www.nimh.nih.gov/health/publications/depression/what-is- depression.shtml. Accessed June 8,2012. http://www.nimh.nih.gov/health/publications/depression/what-is- depression.shtml