Home' Australian Pharmacist : Australian Pharmacist September 2015 Contents Australian Pharmacist September 2015 I ©Pharmaceutical Society of Australia Ltd.
It is well established that the prevalence
and incidence of both anxiety and major
and minor depressive disorders in later
life are much higher in residential aged
care settings than in the community.3,4
More than half (52%) of Australian
aged care residents have symptoms of
depression, compared with 10–15% of
older people living in the community.5,6
Yet, depression is often overlooked
and under-diagnosed in older
patients, in part because it is assumed
to be a normal response to ageing,
physical losses, or other life events.
Furthermore, in the medically ill elderly,
depressive symptoms may be overlooked
because of the assumption that they
are a part of the concurrent medical
People living in residential aged
care often have complex care needs,
making the identification of depression
difficult. Older people are also less likely
than younger people to recognise their
own symptoms, often attributing them
to normal ageing.5
Depression is also
difficult to differentiate from dementia
and is often complicated by dementia.
In fact, depression in later life is
associated with an increased long-term
risk of dementia.
The most serious consequence
of depression in older persons,
as in younger patients, is suicide.
Other consequences include impairment
in function, poor nutritional intake,
worsening of other medical conditions,
excessive use of medical resources,
and increased mortality from causes
other than suicide (e.g. coronary
‘Greater recognition and more aggressive
treatment of depression in older patients
Unlike depression in other age groups,
in the elderly it can be characterised by
frequent physical complaints, irritation,
and delusional tendencies.
of depression in the elderly can be
assisted by use of age-specific screening
instruments, such as the Geriatric
Depression Scale (as shown in Box 1).
Importantly, the assessment of an older
person with a possible diagnosis of
depression should include several steps 16:
• Confirm the diagnosis and, in particular,
differentiate depression from dementia
• Identify any reversible causes and
conditions that may contribute
• evaluate and reduce the risk of
A number of medical disorders
may be associated with depression
(e.g. hypothyroidism, cancer,
Parkinson’s disease, multiple sclerosis),
as may abuse of alcohol and the use
of some prescription drugs such as
some antihypertensives, antiepileptics
(e.g. topiramate, levetiracetam),
anti-retroviral drugs (e.g. efavirenz,
tenofovir, etravirine, raltegravir),
interferons, varenicline, adalimumab,
possible reversible causes, such as
medications or underlying medical
conditions, including vitamin
deficiency, chronic pain or
hypothyroidism, is a first step in managing
depression in older patients.
As with many other conditions,
randomised clinical trials of drug and
non-drug therapy approaches for
depression in the elderly are scarce,
so treatment decisions are often
guided by data from younger adults.
Non-pharmacological or psychosocial
management (including counselling,
cognitive behavioural therapy,
increasing social participation,
and regular exercise) is the main
treatment for mild depression (e.g. due to
grieving), and provides additional support
to antidepressant medication in major
In fact, the combination
of antidepressants and psychotherapy
is the preferred treatment option for
late-life major depression.
moderate-intensity exercise reduces
depressive symptoms in older adults.
The relatively poor real world use of non-
drug interventions in the elderly is the
result of a number of factors. Funding for
such activities in residential aged care is
The Geriatric Depression Scale is
available in many languages and can be
downloaded from: www.stanford.edu
The Geriatric Depression Scale is used
to identify major depression in older
people in aged care facilities and
community settings. Sensitivity ranges
from 79-100%. Specificity ranges from
67–80%. Calculate the total score
by adding up the ticks in bold. each
scores one point. Scores greater than
5 suggest the presence of depression.
Scores>10 almost always indicate the
presence of depression.
Choose the best answer for how you
have felt over the past week:
• Are you basically satisfied with your
• Have you dropped many of your
activities and interests? YeS/NO
• Do you feel that your life is empty?
• Do you often get bored? YeS/NO
• Are you in good spirits most of the
• Are you afraid that something bad is
going to happen to you?
• Do you feel happy most of the time?
• Do you often feel helpless?
• Do you prefer to stay at home, rather
than going out and doing new
• Do you feel you have more problems
with memory than most? YeS/NO
• Do you think it is wonderful to be
alive now? YeS/NO
• Do you feel pretty worthless the way
you are now? YeS/NO
• Do you feel full of energy? YeS/NO
• Do you feel that your situation is
• Do you think that most people are
better off than you are? YeS/NO
box 1. geriatric depression scale
Links Archive Australian Pharmacist August 2015 Australian Pharmacist October 2015 Navigation Previous Page Next Page