1. DEPRESSION IN THE ELDERLY HEALTH CARE PROVIDERS NEW ZEALAND INAUGURAL CONFERENCE “LIFTING YOUR HORIZONS” 10/8/05

2. “ BETWEEN 1-10% OF OUR OLDER POPULATION ARE CLINICALLY DEPRESSED AT ANY GIVEN TIME”

3. “BY 2020 DEPRESSION WILL BE SECOND ONLY TO HEART DISEASE AS A CAUSE OF DISABILITY” W.H.O. 2004

4. DEPRESSION MAY BE AFFECTING AS MANY AS 80, 000 OLDER PEOPLE IN NEW ZEALAND, BY THE TIME WE RETIRE.

5. BARRIERS TO DIAGNOSIS “DEPRESSION IS NORMAL IF YOU ARE ILL”. MISINTERPRETING SYMPTOMS. NOT SCREENING. RELUCTANCE TO TREAT.

6. MODELS OF DEPRESSION. MEDICAL/BIOLOGICAL MODEL. PSYCHODYNAMIC MODEL. SOCIAL MODEL “MODELS HELP US UNDERSTAND, AND RESPOND”.

7. DSM IV CRITERIA DEPRESSED MOOD/LOSS OF PLEASURE PLUS 4 OF APPETITE OR SLEEP CHANGE SLEEP CHANGE PSYCHOMOTOR CHANGE WORTHLESSNESS/GUILT DIFFICULTY THINKING/ CONCENTRATING THOUGHTS OF DEATH/ DYING (INTENSE ENOUGH TO AFFECT FUNTIONING)

8. IN OLDER PEOPLE THIS LOOKS LIKE: SELF CARE NEGLECT AGGITATION/ ANXIETY, OR APATHY “BEING A BURDEN”. STOPPING ACTIVITIES PREOCCUPATION WITH HEALTH COGNITIVE IMPAIRMENT SUICIDAL THOUGHTS OR BEHAVIOUR FEELING “EMPTY”

9. DEPRESSION OR DEMENTIA? RAPID ONSET MOOD CHANGES SUBJECTIVELY POOR MEMORY ENERGY DECREASED SLEEP/APPETITE CHANGE GRADUAL ONSET MOOD UNCHANGED SUBJECTIVELY OFTEN “NO PROBLEM” ENERGY UNCHANGED SLEEP/APPETITE UNCHANGED

10. THE EXPERIENCE OF GRIEF SADNESS OR ANGER APPETITE AND ENERGY LOSS INSOMNIA GUILT AND WISHFUL THINKING VISIONS OF THE DECEASED PERSON

11. LOSS CAN BE FOR: SELF (HEALTH, FUNCTION) FOR OTHER (POSSESSIONS, PEOPLE) FOR TANGIBLE OR INTANGIBLE THINGS OR ANTICIPATION OF LOSS

12. TELLING GRIEF FROM DEPRESSION HOW LONG HAS IT GONE ON FOR? HOW PERSISTANT IS IT? IS THERE PROLONGED FUNCTIONAL IMPAIRMANT? ARE THERE THOUGHTS OF SELF HARM? ARE THERE OTHER HALLUCINATIONS OR DELUSIONS?

13. DEPRESSION IN REST HOME RESIDENTS 15% will experience Depression within the first year. 30%will have depressive symptoms. (NZ Ministry Of Health 1997, Kluiter at al 2004)

14. SOCIAL RISK FACTORS Three of the four biggest risk factors for rest home residents developing Depression are social in origin- Functional impairment (disability/dependence) Loneliness Lack of social support (Physical illness, hospitalisation, pain, and adverse life effects not as important as expected.) Eisses et al, 2004.

15. ALL RISK FACTORS BIOLOGICAL/MEDICAL MODEL MEDICAL ILLNESS FAMILY HISTORY PAST HISTORY DEMENTIA

16. PSYCHOLOGICAL: MALADAPTIVE GREIF DIFFICULTY ADAPTING TO CHANGE AND LOSS CHANGES IN INDEPENDENCE MALADAPTIVE COPING STRATEGIES

17. SOCIAL: ISOLATION LONELINESS MOVING TO INSTITUTIONAL LIVING CHANGES IN LEVEL OF COMMUNITY SUPPORT/INTEGRATION.

18. GERIATRIC DEPRESSION SCALE A SCREENING TOOL USED BY NURSES DESIGNED FOR OLDER PEOPLE ‘SELF-RATING’ THRESHOLD IS 7 FROM 15 QUESTIONS (PLEASE USE, WHEN DEPRESSION IS SUSPECTED)

19. INTERVENTIONS THE MEDICAL/BIOLOGICAL MODEL: ANTIDEPRESSANTS MOOD STABILISERS ANTI ANXIETY DRUGS HERBAL REMEDIES ELECTROCONVULSIVE THERAPY

20. PSYCHOLOGICAL TREATMENTS: CHALLENGING DISTORTED BELIEFS SUPPORTING NEW BEHAVIOURS ALLOWING EXPRESSION OF FEELINGS

21. SOCIAL INTERVENTIONS: ENCOURAGE RESIDENTS TO STAY CONNECTED TO THEIR COMMUNITIES ASSIST THE FORMATION OF NEW FRIENDSHIPS VALUE RESIDENTS’ CONTRIBUTIONS “AJUSTMENT CAN TAKE UP TO 18 MONTHS” SUPPORT INDEPENDENCE SUPPORT DIVERSIONAL THERAPY “LISTEN” TO YOUR RESIDENTS

22. REFERANCES/ WEBSITES Eisses, Kluiter, Jongelinis, Pot, Beekman and Ormel (2004). Risk indicators for depression in residential homes. In International Journal of Psychiatry. Vol 19634-640. Arthur, Jagger. Lindsay. (1999) Using an annual over 75 health check to screen for depression: validation of the short geriatric depression Scale within general practice. In International Journal of Psychiatry. Vol 14, 431-439. Diagnostic and Statistical manual of Mental Disorders Forth Ed, text revision. (2000). American Psychiatric association. Public Health Report Number 3. (1997) Mental Health In New Zealand from a Public Health perspective. Ministry of Heath.. Wellington, NZ.

23. National Health Committee (1996). Guidelines for the treatment and management of Depression by Primary Healthcare Professionals.Ministry of Health, Wellington. Smith (2000). Sharing the load; What to do when someone you love is Depressed. Random House, NZ. Nolen and Zohar (1995). Refractory Depression, current strategies and future directions. Wiley Press, Brisbane. Powell (1992).Mental Health Handbook WP Press England www.stanford.edu/%7Eyesavage/ACRC.html Geriatric Depression Scale research, Stanford University

24. ww.mentalhealth.org.nz (Mental Health Foundation of New Zealand) www.moh.govt.nz (Ministry of health) www.mhc.gowvt.nz (mental Health Commission) www.nzgg.org.nz (New Zealand Clinical Guidelines Group) WilliamG@waikatodhb.govt.nz Gwyneth Williams Clinical Nurse Specialist Mental Health Services Older Person 214 Pembroke St Hamilton