Managing anxiety and depression in older patients

Amanda Lyons

22/01/2018 2:34:57 PM

Issues of depression and anxiety are often overlooked in older patients, but these conditions can be just as important to monitor as physical health.

Depression and anxiety often goes undiagnosed among older people
Depression and anxiety often goes undiagnosed among older people

According to Osvaldo Almeida, Professor of Psychiatry and Director of Research at the Western Australian Centre for Health and Ageing at the University of Western Australia, the prevalence of depression and anxiety tends to decline as people reach their 60s, but rises again as they go into their 70s and 80s. This is particularly the case for people who enter aged care facilities.
There are a number of physical healthcare issues to consider in older patients, from blood pressure to arthritis and osteoporosis. There are also concerns of cognitive decline from diseases such as dementia, which increase exponentially as people age.
But in the midst of all these concerns, more day-to-day mental health issues may often be overlooked in this population: depression and anxiety.
 ‘It’s probably fair to say about 20%, or two in 10 people in residential care communities who do not have cognitive impairment will be experiencing symptoms of clinical depression,’ Professor Almeida told newsGP.
Although anxiety and depression may seem less urgent in older patients than  immediately demanding physical conditions, leaving it untreated can have serious implications.
‘The quality of life of the person who is suffering declines quite dramatically,’ Professor Almeida said.
‘There is also an increase in morbidity, so people who are depressed tend to have other illnesses more frequently than those who are not.
‘People who are depressed and anxious tend to use health resources more frequently and extensively. And their life expectancy also declines, so people die prematurely as a result of having depression and anxiety symptoms.’
Professor Almeida believes that GPs are key to detecting these conditions in older patients, as they often see them fairly frequently.
‘If you consider that 9 in ten older people will see their GP at least once in a year, it shows what an important role GPs have to play in terms of assessing, screening, managing or referring those who have mental health issues,’ he said.
Professor Almeida recommends active screening of older patients for mental health, including gathering collateral histories for patients in residential care facilities. He also believes that depression and anxiety symptoms in older people are often modifiable without medication.
‘There is very good evidence now that simple psychological interventions can have a positive effect on the mood of older people,’ Professor Almeida said. ‘For example, behavioural activation, which involves getting people to remain active in their daily routines, so they can experience the positive feedback of being involved with the routines from a social as well as a personal point of view.’
Professor Almeida also recommends that GPs themselves can receive help and support in treating older people with mental health issues by linking to their local mental health services and national organisations such as beyondblue and Dementia Australia.
‘I think GPs do a great job,’ he said. ‘It’s helpful for GPs to know they are not in this by themselves and they can make use of resources in the community.’ 
GPs can also access the RACGP guidelines, Medical care of older persons in residential aged care facilities on the RACGP website. These guidelines contain a chapter on diagnosing and treating depression in older patients. 

Aged care healthcare mental

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Mai Maddisson   23/01/2018 12:36:57 PM

“The wisdom of the bards”
Since the dawn of time life has been meaningful for most people: They wended their way through life with the knowledge that as they approached ‘old age’ they would remain a valued member of the community.
Of course people died of undiagnosed and untreatable maladies before their mobility and visual acuity condensed their accessible worlds which in themselves were small and comprised of a similar demographic. They remained relevant to the world in which they lived. They were respected by those younger than themselves as a source of experience having met a given scenario managed in a diversity of ways and able offer helpful suggestions how the younger of their tribes could optimise their available resources.
Life had a meaning and relevance for them. In the 1950s and 1960s such was still the case and one knew that one had to die one day but until that day came they could remain an integral part of the society they lived in. There was a reliable available access to that commodity called “Hope”. There was no need for despair and angst.
Today we live in vast multicultural societies where commonly two people working/living side by side have no shared experiences which enable them to connect with each other: Given the paucity of chosen employment any spare time is consumed seeking out such. That is already the story of the young.
With people now living to ages where their mobility and visual acuity is reduced the luxuries of finding a member of their ‘tribe’, let alone their tribe is often zilch.
While at work there is still a shared commonality of cause not method. The person approaching retirement has already been sidelined long ago. One does not have to move outside out own vocation to prove that point. During the last word few months I found the following words on a document which circulated among our own ranks.
“Older members who have gone probably won’t be coming back. They are entrenched in their views and probably can’t be changed........ The ones with the new calling. We should focus on them and their well-being.”
In simple lingo our younger colleagues are saying “Roll over Beethoven” –to doing what; playing tiddly winks?
Such ethos exists in all walks of life. A whole life time of experience is just being cast down the gurgler. Inclusion does not mean agreement of all fronts merely of bringing all cards to the table and considering how they can be rearranged to optimally meet current needs: Just like it was in the days of the bards.

The elderly are cast aside, usually to live in proximity of their children who may have very different interests and live in quite different enclaves often at the opposite side of a vast metropolis from their nearest friends (who too are undergoing attrition). They are removed from the enclave where have fruitfully lived their youth. There is no one to reflect with, no one to reminisce with. My closest friends with shared interests now live 40-50 km away on the other side of the city I live in. That is a long return trip for anybody, even a youngie.

How can you young be so rash as to call the aging generation depressed or anxious. They are despondent at having lost a place in life. How fortunate I feel. I can still move around, my fingers are still agile enough to type, and my eyesight good enough to read the computer monitor. With that tool I can travel to Europe and UK and anywhere I need to pursue my interest in Children in War, amongst whom my life began and I have a lifetime of experience in how such kids reconstruct their lives.
If feels good to contribute to the ongoing welfare of mankind: To see one’s writings published where they are relevant.

Should life become unkind and remove my vehicle of relevance to the world I live in, don’t dare any guru call me depressed or anxious. The correct word is DESPONDENT.

Metropoli are full of despondent elderly people: Find them some relevance- don’t dump DSM labels on them.