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10.03.2015

Depression screening tools for elderly, chronic fatigue causes stress - Plans Download

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Edinburgh Postnatal Depression ScalePhysician instructions: Have the patient complete the scale by marking one answer for each question that comes closest to how she has felt in the past seven days, not just how she feels today.
Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. National Institute of Mental Health treatment of Depression Collaborative Research Program.
Symptom profiles of depression among general medical service users compared with specialty mental health service users. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Development and validation of a geriatric depression screening scale: a preliminary report. The performance of simple instruments in detecting geriatric conditions and selecting community-dwelling older people for geriatric assessment. A multifactorial intervention to reduce the risk of falling among elderly people living in the community.
Screening for gait instability is commonly accomplished with either the Timed Up and Go (TUG) test or the Performance-Oriented Mobility Assessment.
The proportion of hospitalized elderly patients who are malnourished varies between 6.5% and 85%, depending on the criteria used for diagnosis. There are many causes of unintentional weight loss, including acute infections, depression, drugs (eg, chemotherapeutic agents, laxatives, thyroid medications, and amphetamines), conditions that prevent food consumption (eg, painful mouth sores, newly applied orthodontic appliances, loss of teeth), loss of appetite, malignancy, smoking, and AIDS. Because malnutrition is a marker of mortality, identifying nutritional status has long been a criterion for selecting therapy in oncology.
Involuntary weight loss greater than 5% in 1 month, 7% in 3 months, or 10% in 6 months should signal the need for further evaluation. Metastatic disease to the brain or spinal cord can interfere with nerve pathways needed for normal micturition and cause incontinence.[38,39] Furthermore, incontinence is sometimes an early indication of an underlying urinary tract infection, which may lead to sepsis in older cancer patients.
Many of the symptoms of depression, such as appetite change, weight loss, and loss of energy, are similar to cancer symptoms.[44] Depressed patients with cancer may be at higher risk of suicide.
Primary care physicians, not mental health professionals, treat the majority of patients with symptoms of depression. Preventive Services Task Force (USPSTF) recently reviewed new evidence finding that patients fared best when physicians recognized the symptoms of depression and made sure that they received appropriate treatment.8 Based on this evidence, the USPSTF issued new depression screening recommendations last May, encouraging primary care physicians to routinely screen their adult patients for depression. Signs of depression that are more common in the elderly than in other populations include diminished self-care, irritability, and psychomotor retardation. Geriatric Depression Scale–Short FormReprinted with permission from Sheikh JI, Yesavage JA.
Comprehensive health maintenance screening of this population is becoming an important task for primary care physicians.
The poor compliance rate was determined to be secondary to patients' concerns about adverse reactions to immunizations and physicians' overlooking the need for such immunizations.


Two of the more common changes are cognitive decline and depression.COGNITIONDementia is chronic and progressive, and it is characterized by the gradual onset of impaired memory and deficits in two or more areas of cognition, such as anomia, agnosia or apraxia.
In older cancer patients, decreased appetite from the underlying tumor may account for the weight loss. Specific risk factors for suicide include prior psychiatric diagnosis, family history of suicide, delirium, disfiguring disease or surgery, poorly controlled pain, increasing age, poor social support, advanced disease, and substance abuse. All measures have a statistically predetermined cutoff score at which depression symptoms are considered significant.
Early diagnosis and treatment of depression in the elderly improve quality of life and functional status, and may help prevent premature death.When using screening instruments with elderly patients, it is important to consider their level of cognitive impairment along with visual deficits.
Once depression is diagnosed and treatment is initiated, repeated administration of these measures provides an excellent means of tracking response to pharmacotherapy or psychotherapy.Depression measures should be selected based on the patient population (Table 4). The most common causes of visual impairment in the elderly include presbyopia, cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration. Finally, the USPSTF recommends that all family members of geriatric patients receive training in cardiopulmonary resuscitation.6Remaining as independent as possible for a long as possible is a primary concern for most elderly patients.
Paclitaxel (Taxol) is also known to cause peripheral neuropathy, and in conjunction with cisplatin, can potentiate neuropathy.[30] For these reasons, the older cancer patient should be assessed for gait and balance instability prior to and during the course of chemotherapy.
Finally, the diagnosis and treatment of cancer can contribute to depression in family caregivers, possibly limiting their ability to provide support for the cancer patient.
The Pediatric Symptom Checklist may serve as a general psychosocial screen for children and adolescents. Preventive Services Task Force, assessment categories unique to elderly patients include sensory perception and injury prevention. Changes in vision can cause a significant number of problems for elderly patients, including an increased risk for falls.16The Snellen eye chart is an appropriate tool for visual acuity screening in the elderly.
These factors include depression, smoking and alcohol use, dysphagia, mucositis, changes in taste and smell, difficulty chewing, the inability to shop or cook, and the side effects of medication.
Identifying patients with depression can be difficult in busy primary care settings where time is limited, but certain depression screening measures may help physicians diagnose the disorder. An interview is necessary because many conditions have symptoms that are common to depression. The GDS is unique in that it was specifically developed for use in geriatric patients, and it contains fewer somatic items. In adult patient populations, screening with the BDI, CES-D, or Zung measures is recommended in targeted, high-risk populations. Geriatric patients are at higher risk of falling for a number of reasons, including postural hypotension, balance or gait impairment, polypharmacy (more than three prescription medications) and use of sedative-hypnotic medications. As suggested by the USPSTF,6 an annual influenza vaccination in the fall is recommended for all elderly patients. Patients who score above the predetermined cut-off levels on the screening measures should be interviewed more specifically for a diagnosis of a depressive disorder and treated within the primary care physician's scope of practice or referred to a mental health subspecialist as clinically indicated. In addition, screening measures do not address important diagnostic features such as duration of symptoms, degree of impairment, and comorbid psychiatric disorders.
Edinburgh Postnatal Depression ScaleReprinted with permission from Cox JL, Chapman G, Murray D, Jones P.


In postpartum women, the Edinburgh Postnatal Depression Scale is the preferred measure.The use of depression screening measures in elderly patients varies with their cognitive status and clinical presentation. Interventional areas that are common to other age groups but have special implications for older patients include immunizations, diet and exercise, and sexuality. Targeted screening in high-risk patients such as those with chronic diseases, pain, unexplained symptoms, stressful home environments, or social isolation, and those who are postnatal or elderly may provide an alternative approach to identifying patients with depression.
An evaluation is critical in ruling out conditions that may present with symptoms of depression, such as hypothyroidism and pancreatic cancer. In cognitively intact patients older than 65 years, the GDS or one-item screen are currently the preferred instrument because the psychometric data on the BDI and CES-D are mixed in this population.44In patients who have cognitive deficits, interviewer-administered instruments such as the Cornell Scale for Depression in Dementia (Figure 4)24 or the Hamilton Rating Scale for Depression45 are preferred.
Use of the GDS is limited to cognitively intact or mildly impaired elderly patients and interviewer-administered instruments, such as the Cornell Scale for Depression in Dementia or the Hamilton Rating Scale, are preferable when cognitive deficits are present. Cognitive ability and mental health issues should also be evaluated within the context of the individual patient's social situation—not by screening all patients but by being alert to the occurrence of any change in mental function.
These instruments require more time to administer; however, they are more appropriate than self-report instruments for cognitively impaired patients.
However, older patients with depression may also present with unexplained somatic symptoms and may deny sadness or loss of pleasure. Using an organized approach to the varied aspects of geriatric health, primary care physicians can improve the care that they provide for their older patients. It manifests as a combination of feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt, accompanied by an array of physical symptoms (Table 1).6 Recognizing depression in patients in a primary care setting may be particularly challenging because patients, especially men, rarely spontaneously describe emotional difficulties. As a result, the number of elderly Americans could increase from 34 million in 1998 to approximately 69 million in 2030. This increase, combined with the disproportionate rate at which elderly patients use medical resources, will require that primary care physicians become increasingly knowledgeable about the needs of geriatric patients and increasingly efficient in the evaluation and management of concerns unique to these patients.The value of performing a comprehensive geriatric assessment appears to be equivocal. Preventive Services Task Force (USPSTF) published the second edition of its Guide to Clinical Prevention Services.6 In this publication, the USPSTF updated earlier recommendations on preventive services for patients at various stages of life.
The recommendations for patients 65 years of age and older include a number of items common to other age groups. The unique assessment categories for older patients are sensory perception (hearing and vision screening) and accident prevention. Assessment areas common to other age groups but with special implications for the elderly include diet and exercise, immunizations and sexuality.
Screening for common problems in ambulatory elderly: clinical confirmation of a screen instrument. Although the USPSTF found little evidence in 1996 to support the value of screening for dementia, recent pharmaceutical advances have resulted in beneficial treatment options that were not available just a few years ago.7Using the USPSTF recommendations as a guide, this article reviews available standardized assessment tools and techniques that can be used in outpatient settings.
The goals are to encourage a systematic assessment of various areas of potential geriatric risk and to develop a database appropriate to the unique concerns of elderly patients.



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