Feature
Managing anxiety and depression in older patients
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
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.
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