Three Ds: Dementia, Delirium,
and Depression
Depression
Aging population
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Aging population
1 out of 7 people in Canada is a Senior Citizen
Ageism is a barrier to care and compassion
Older Adults are not beds, they are people
Healthcare costs are expected to be impacted
only 1% per year by the aging population
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Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems
Planning for the Aging Population. Retrieved from http://www.cfhi-fcass.ca/SearchResultsNews/1107-26/b973ebc3-706a-4c3d-b9d5-6c40c616c25c.aspx
Points to ponder
• Self esteem is affected by age-related and disease
related changes
• Self esteem is affected by societal values and life
experiences
• Self concept is threatened by loss
• Maintaining self-worth and personal value are
key to healthy aging
• We need to promote self esteem in older adults
• Depression attacks self esteem
Depression is
• Depression is not a normal part of ageing
• Depression is common, not normal
• Continues to have a strong stigma associated
with it
• Difficult for a majority of Older Adults to speak
about
• Considered a weakness of character
• Undertreated and not readily diagnosed
Good News!
• Depression is fairly easy to detect,
and treatable!
What it looks like
• Persistent sad, anxious, or empty feeling, or a
feeling of hopelessness and pessimism.
Life Context
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Widowhood
Bereavement
Loss of function
Loss of independence
Chronic health conditions
Depression is often triggered from situational
factors
Impact
• Difficulty in adapting to changes
• Healthy aging is adapting to changes, while
not necessarily accepting changes that occur
in one's life
Impact of untreated depression
• Complicates and increases impact of health
conditions.
• Increased pain
• Decreases support network through
symptoms and decreased ability to link to
support
• Suicide
Symptoms
• Blue or sad feelings that don’t go away in a
few days or a week
• Interferes with Daily life
• Interferes with relationships
Tool for assessing symptoms
SIG E CAPS
(Source: Michael Jenike, 1989)
S Sleep is disturbed
I Interest is decreased
G Guilt (feelings of guilt or regret)
E Energy is less than usual
C Concentration is poor
A Appetite is disturbed
P Psychomotor agitation or retardation
S Suicidal Ideation, including passive wish to die
Suicide Check
• I hear your having a hard time right now.
• Have you had any thoughts of harming
yourself?
• Do you have a plan?
• Have you ever tried to hurt yourself before?
Warning Signs
Remember “IS PATH WARM?”
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P
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Ideation
Substance Use
Purposelessness
Anxiety/Agitation
Trapped
Hopelessness/Helplessness
Withdrawal
Anger
Recklessness
Mood Changes
From the American Association of Suicidology (AAS) website (www.suicidology.org).
Actions
• If high risk for suicide then refer to mental
health specialist
• Can you assist in changing the potential to act
such as guns being removed?
• Will the person contact and open up to family
and friends? What support do they need to do
so? Can you facilitate?
• Need to set up a plan for treatment based on
risk and what you have available.
Larger picture
• Majority of people with depression do not
want to end their lives.
• When identified, minor depressive episodes
can be treated with readily available actions.
• Majority of people are resilient.
• Talk with them and help them to reconnect to
life.
Resiliency Factors
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Sense of meaning and purpose in life.
Sense of hope.
Sense of optimism.
Religious (or spiritual) practice.
Active social networks and support from family and
friends.
6. Good health care practices.
7. Positive help-seeking behaviours.
8. Engagement in activities of personal interest.
Treatment Basics
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What brings you joy in life?
Be physical and exercise
Walk outside in nature
Connect with the people you love
Share yourself and accept support
Eat well
Relax
Decrease stress
Evaluate substance use
Maintain healthy sleeping patterns
Be patient and kind to yourself
Treatment Overview
• Psychosocial intervention first line treatment for
mild depression.
• Medication is a last option for mild depression.
• Medication and psychosocial interventions
effective in moderate and severe depression.
• Reassess weekly to evaluate efficacy of
treatment.
• Involve the resources around you.
• Work with the person.
• Broken bones can heal faster than depression
does.
Communication is Crucial
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Create rapport
Respect the dignity of the older adult
Validate their feelings
Respond with respect
Respond at their pace
Create a trusting relationship
Be with them in that moment
Larger picture
• Promote healthy ageing in practice and policy
• Promote living conditions and environments
that support wellbeing and allow people to
lead health and integrated lifestyles.
• Support strategies that ensure Older Adults
have necessary resources to meet basic needs
Summary
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Ageism is a barrier to care
Depression impacts self esteem
Depression is not a normal part of ageing
Depression is treatable
Are accessible tools to assess depression
Need to take the time for communication
Promote and support active ageing
Connect with the joys of life
References
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Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems Planning for
the Aging Population. Retrieved from http://www.cfhi-fcass.ca/SearchResultsNews/11-07-26/b973ebc3706a-4c3d-b9d5-6c40c616c25c.aspx
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Canadian Health Services Research Foundation (July 2011). Better With Age: Health Systems Planning for
the Aging Population. Retrieved from http://www.cfhi-fcass.ca/SearchResultsNews/11-07-26/b973ebc3706a-4c3d-b9d5-6c40c616c25c.aspx
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The Canadian Coalition for Seniors’ Mental Health (2015 updated) Tools for Healthcare Providers: The
assessment and treatment of Depression in Older Adults. Retrieved from
http://www.ccsmh.ca/en/projects/depression.cfm
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World Health Organization (2015). Suicide fact sheet. Retrieved from
http://www.who.int/mediacentre/factsheets/fs398/en/
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Wold, Gloria H. Basic Geriatric Nursing, 4th Edition. Mosby, 102007.
Tools
• Geriatric Depression Scale
• RAI Depression Scale
• CCSMH suicide brochure