Individual differences in personality traits are generally stable during adulthood; where there are changes, they are generally in the direction of greater maturity. The trends are similar for men and women and across cultures. With advancing age, people generally become more emotionally stable, agreeable, and conscientious, with better impulse control, but less active and less open to new actions and values than younger individuals. Those trajectories provide several insights into adult development, challenging some negative stereotypes about older adults and serving as a reminder that enduring individual differences are more important than age in understanding personality.
Key words: personality traits, aging, cross-cultural, depression, Alzheimer’s disease.
The management of depression among individuals with dementia can be one of the more challenging problems in geriatric practice. Depression in dementia is common regardless of the type of dementia and compounds the impairment of the underlying dementing illness. Some symptoms of dementia, including apathy, impaired concentration, and decreased food intake, may be difficult to distinguish from similar symptoms of depression. This article presents background information on the epidemiology and pathophysiology of depression in dementia followed by recommendations for a systematic approach to diagnosis. Treatment modalities including psychotherapy, pharmacotherapy, and electroconvulsive therapy are reviewed.
Key words: dementia, depression, Alzheimer’s disease, psychotherapy, psychopharmacology.
Depression is a common sequela of stroke, occurring in approximately 33% of all patients. Post-stroke depression (PSD) is associated with greater cognitive and functional impairments, excess mortality, and increased health care costs, although symptoms are often mild. Diagnosis of PSD can be made using standard clinical criteria, despite the potential overlap with the somatic and vegetative symptoms of stroke. Post-stroke depression responds to standard antidepressant pharmacotherapies, but use of tricyclic antidepressants may result in increased cardiac adverse events. Given the high prevalence and major negative impact of PSD, active screening of all stroke patients for depression and aggressive treatment is recommended.
Key words: stroke, depression, diagnosis, risk factors, treatment.
Approximately 25% of persons with cancer report symptoms that meet the diagnostic criteria for the most prevalent mood disorders, including major depression, dysthymic minor depression, and adjustment disorder with depressed mood. This is two to four times the incidence found among the general population. To simply consider depression as “normal” precludes the possibility that some very good things can happen when patients are properly diagnosed and referred to a psychosocial program to be seen by a psychiatrist, psychologist, or social worker. Asking about a patient’s general mood or spirits needs to become as routine as asking about pain. While screening instruments can be very helpful, single questions are equally useful for identifying patients with this unmet need. Otherwise, patients remain feeling helpless or that their condition is hopeless, and this can easily spiral into despair and significantly worsened depression.
Key words: cancer, depression, psychosocial, supportive care, coping.
Psychotic symptoms, hallucinations, and delusions, arising de novo in older adults, represent a major risk factor for the development of dementia, illness, delirium, functional impairment and death. These symptoms and associated behavioural manifestations overlap with depressive disorders and may be signs of cognitive impairment or dementia. Symptoms may be vague or legitimized so that the psychosis is unrecognized by family and physicians. Specific queries regarding the nature of the symptoms and the impact on function will provide diagnostic clues. Several brief assessment tools can be used in primary care, specifically the NPI-Q and Blessed Dementia Scale.
Key words: psychosis, hallucinations, delusions, dementia, depression.
Approximately 20% of older adults with cardiovascular disease (CVD) experience significant depression. Further, in a pattern consistent with the general adult population, women with CVD have double the rates of depression compared to men. Among older men and women with CVD, depression is associated with poorer cardiac outcomes, although patterns of depressive symptoms appear to differ between men and women. Treatment approaches include traditional modalities, namely psychotherapy and pharmacotherapy. Additional recommendations involve emphasizing adherence to prescribed medical and behavioural health regimens, fostering social support, and increasing referrals to cardiac rehabilitation programs as medically appropriate.
Key words: depression, gender differences, cardiovascular disease, myocardial infarction, mortality.
Depression is highly prevalent among older adults with chronic pain living both in community and institutional settings. It is associated with decreased quality of life, including impairments in physical and social well-being. This article reviews the relationship between pain and depression. The potential mediating role of disability, life interference, and perceived control are described. Routine assessment of both pain and mood, using scales validated for this age group, is advocated. Finally, the importance of integrating pharmacological and psychological interventions for the management of pain and depression in the older adult is highlighted.
Key words: chronic pain, depression, mood disturbance, assessment, management.
Due to the aging of society and the increase in ethnic diversity, there is a growing interest in the needs of ethnically diverse caregivers for older adults. Based on a recent meta-analysis, this article outlines ethnic differences in caregiving stressors, available social resources, and caregiver health. We offer suggestions on how to consider ethnic differences in the planning and implementation of caregiver interventions.
Key words: family caregivers, ethnicity, stress, burden, depression.
Dysthymic disorder is a chronic depressive illness that affects approximately one to five percent of seniors. Often undetected and untreated, dysthymia is associated with significant psychological distress, medical burden, and functional impairment. Dysthymic disorder in the older population can be challenging to diagnose because of comorbid medical conditions and life losses. Dysthymic seniors often present differently than younger patients. The general practitioner plays a crucial role in identifying and providing interventions for older dysthymic patients. Careful evaluation, psychoeducation, and therapeutic interventions are essential to alleviate further suffering and to improve quality of life and function for these patients.
Key words: dysthymic disorder, depression, psychological symptoms, medical comorbidities.
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