DEPRESSION IN OLDER ADULTS

Current & Future Need for Better Diagnoses & Treatment

Sara DavenportArgosy University

Abstract A cross-section of theories relating to

characteristics of and risks for depression in older adults

Effective, documented treatments Frequency by which depression is

overlooked by primary care physicians Common theme: Better strategies in

managing mental health care for older adults

The Baby Boom Generation Urgent call for more comprehensive

research

Current & Future Need for Better Diagnosis & Effective

Treatment: Literature Overview •35 Million in U.S. over 65 years of age. One half need mental health services; less than 20% receive treatment. (Benek-Higgins, McReynolds, Hogan & Savickas (2008).

•Baby Boomers add 76 million in next 18 years

•No good prior models of care= need for change.

•Articles focus on American populations plus three International Study Groups

Subjects: Patient/doctor relationship, major issues of concern for elders, influence of social interaction, impact of loneliness, role of religion, physiological effects of aging on depression and therapeutic options for enhancing well-being.

Missteps in the Doctor’s Office

Less than 4% of geropsychology/geropsychiatry clinicians work with elderly patients. (Benek-Higgins, McReynolds, Hogan & Savickas 2008).

Older patients visit general practitioners – not well-versed in geriatric care.

Without sound medical diagnosis, older patients dismissed.

Medicare=50% co-pay for medical; only 20% for mental health; in facility stay 90 days.

Some sample populations small; larger groups would be better (Adelman, Greene, Friedmann & Cook 2008).

The Importance of Purpose

“Mattering” Important to Elders (Andrea Dixon 2007)

Reduced StressGreater Self-EsteemPersonal StrengthGreater Overall Well-BeingFewer Experiences of Depression and Sadness

Explore Extracurricular ActivitiesDay-to-day responsibilitiesSpiritual/religious connectionsRelationships with Families / FriendsActive Social Life

Effects of Gender, Marital Status, & Community Involvement

•Difference between women and men regarding social networking (Ahern & Hendryx 2008).

•Volunteering, religious attendance community involvement = reduced risk of depression in women – not men.

•Men rely on women – do not adapt well to widowhood; women enjoy sense of freedom!

•Outside interests decrease loneliness, depression, anxiety interpersonal hostility, increased vulnerability to health problems and suicide (Rokach, Matalon, rokach & Ssafarov 2007).

•Information presented by authors highly scientific – not contradictory.

The Aging Brain

Longitudinal versus cross-sectional study (Dotson, Davatzikos, Kraut & Resnick (2009).

Relationship between late-life depression and decreased brain volume?

Research skewed

Future research recommended; comparative studies helpful

Religion & Well-Being•76% of Older Americans agree : Religion important (Princeton Religion Center, McFadden 1995).•Church attendance increases with age•Religious older people have higher levels of physical and mental health•1987 Yale Health and Aging Project (McFadden 1995) indicates lower levels of functional disability and depression in elderly.•Studies indicating correlation between religion and mental health not as valid as religion and physical health.•“Empirical studies show that religion can have salutary effect on late life well-being.” (McFadden p.161).

Helpful TherapiesMeditation-Based InterventionPhysical ActivityGoal SettingSense of Humor

Conclusion•Literature review = Comprehensive summary of factors influencing diagnosis and treatment of depression in older adults. •Each presented different aspects – only minor contradiction.•Possibilities for future research = strategic planning & funding issues, comparisons between value of influencing factors on well-being of elders, use of medication.•Prevailing agreement of research: lack of accurate diagnosis in mental health issues, better attention today and for burgeoning Baby Boomer group.

References IAdelman, Ronald D., Greene, Michele G., Friedman, Erika, Cook, Mary Ann. (2008).Discussion of Depression in Follow-Up Medical Visits with Older Patients. JournalOf American Geriatric Society, Vol. 56 (1), 16-22.

Ahern, Melissa M, Hendryx, Michael. (2008). Community Participation and the Emergence of Late Life Depressive Symptoms: Differences Between Women and Men. Journal of Women’s Health, Vol. 17 (9), 1463-1470.

Ayers, Catherine R., Sorrell, John T., Thorp, Steven R., Wetherell, Julie Loebach (2007).Evidence-Based Psychological Treatments for Late Life Anxiety. Psychology and Aging,Vol. 22, 8-17.

Benek-Higgins, M., Hogan, Ebony, McReynolds, C.J., & Savickas, S. (2008). Depression and the Elder Person: The Enigma of Misconceptions, Stigma and Treatment. Journal of Mental Health Counseling, Vol. 30 (4), 283-296.

Cairney, John, Faulkner, Guy, Veldhuizen, Scott, Wade, Terrance J. (2009). ChangesOver Time in Physical Activity and Psychological Distress Among Older Adults. Canadian Journal of Psychiatry, Vol. 54 (3), 160-169.

References IIDixon, Andra L. (2007). Mattering in the Later Years: Older Adults’ Experiences of Mattering to Others, Purpose in Life, Depression and Wellness. Adultspan: Theory Research & Practice, Vol. 6 (2) 83-95.

Dotson, Vonetta M., Davatzikos, Christos, Kraut, Michael A., Resnick, Susan M. (2009).Depressive Symptoms and Brain Volumes in Older Adults: A Longitudinal Magnetic Resonance Imaging Study. Journal of Psychiatry and Neuroscience, Vol. 34 (5) 367-375.

Laidlaw, Ken, McAlpine, Susan. (2008). Cognitive Behavior Therapy: How Is It Different withOlder People? Journal of Rational-Emotive & Cognitive Behavior Therapy, Vol. 26 (4), 250-262.

Lowe, Deborah A., Rogers, Steven A. (2009). Changing Face of Depression Among AgingPopulation. Conference Abstract U.S. American Psychological Association.

Marziali, Elsa, McDonald, Lynn, Donahue, Peter (2008). The Role of Coping Humor in thePhysical and Mental State of Older Adults. Aging and Mental Health, Vol. 12 (6), 713-718.

Reference IIIPaukert, Ambul, Phillips, Laura, Cully, Jeffrey A., Loboprabhu, Sheila M., Lomax, James W., Stanley, Melinda (2009). Integration of Religion into Cognitive-Behavioral Therapy for Geriatric Anxiety and Depression. Journal of Psychiatric Practice, Vol. 15 (2).

Rokach, Ami, Matalon, Raan, Rokach, Ben, Safarov, Artem (2007). The Effects of Gender and Marital Status on Loneliness of the Aged. Social Behavior and Personality, An International Journal, Vol. 35, (2), 243-253.

Smith, A, Graham, L., Senthinathan, S. (2007) Mindfulness Based Cognitive Therapy for Recurring Depression in Older People: A Qualitative Study. Aging and Mental Health, Vol. 11 (3), 346-357.

Street, Helen, O’Connor, Moira, Robinson, Hayley (2007). Depression in Older Adults: Exploring the Relationship Between Goal-Setting and Physical Health. International Journal of Geriatric Psychiatry, Vol 22 (11), 1115-1119.