Mood Assessment Overview Clinically significant depressive symptom affects 10 to 15% of older adults. Depression can present in atypical ways in older adults e.g. pseudodementia, apathy, weight loss, irritability and anxiety. Ask about the patient’s sleep quality. MDD in older adults/late life depression is common Indications Screen all patients annually Diagnostics Examples of screening tests: PHQ2, followed by PHQ-9 if score is greater than or equal to 3 or PHQ-9 GDS-15 Consider an adequate screening score. E.g. geriatrics depression scale – 15. Neurological diseases and co-exiting medication conditions are common in this age group -> work up thoroughly to exclude physical causes. Management Pharmacotherapy Note: older adults have an increased risk of adverse reactions from the medications. SSRIs is the preferred first line treatment. SNRIs are second line. Atypical antidepressants e.g. bupropion and mirtazapine are third line. Consider reducing the frequencies and/or lower the doses than in the general population. Minimise polypharmacy whenever possible. ECT Highly effective Response rates are better in the elderly than in older adults. Lifestyle modifications. Sleep hygiene: regular aerobic exercises, avoid naps in the day, avoid stimulants such as coffee and nicotine, bright lights, electronic screens before sleep, establish bedtime routine, and regular sleep pattern of 7 or 8 hours. Reduction in substance use Stress reduction Increasing social support Regular aerobic exercise Relaxation/mindfulness. Improve nutrition. Psychotherapy May be used alone or in combination with pharmacology. CBT Behavioural modification and reconstructing change in disruptive thought pattern. Interpersonal therapy Improves understanding of problematic relationships and/or life situations and therapy to help control moods and patterns of behaviours. Behavioural activation Focuses on facilitating change by raising patients’ awareness of behavioural patterns that influence their mood. Treatment aims at encouraging activities that have a positive impact on their behaviour. Psychodynamic psychotherapy Uncovers unconscious patterns of childhood experiences, previous relationships, past conflicts and desires with the goal of improving an individual’s current situation. Supportive psychotherapy Used especially for anxiety disorders. Focuses on empathises with the patient and providing encouragement and coping techniques to improve self-esteem and functioning. Assessment of Social Situation EVALUATION FOR Social support: Who the patient lives with The frequency of visits from friends and family. The number of close friends available for emotional support. Availability of help in case of sickness or disability. Financial difficulties: Ability to pay for food Ability to pay for medications Ability for rent. Risk factors for elderly abuse: Isolation and lack of social support. Functional impairment Decreased physical health Lower income Living in a shared space with many household members. If suspect abuse: Refer to social support services. For patients experiencing loneliness and/or social isolation: Addressing existing sensory impairments that may contribute to this e.g. hearing aids and visual aids. Treat underlying depression. Referral to community support groups or encouraging activities such as lunch clubs and dance class.