Depression Anxiety in Older Adults: Gaps in the Knowledge

Depression trouble in Older Adults Gaps in the KnowledgeDepression and anxiousness in Older AdultsAre there gaps in current knowledge regarding diagnosis and treatment?Introduction kind wellness problems in senior adults can ca ingestion a massive social impact, oftentimes delivery about poor quality of life, isolation and exclusion. Depression is unmatchable of the most debilitating mental health discommodes worldwide, affecting approximately 7% of the elderly population (Global Health Data Exchange, 2010). Despite this, it is also one of the most underdiagnosed and undertreated conditions in the primary portion out setting. Even with estimates of approximately 25% of over 65s living in the community having depressive symptoms severe enough to warrant medical intervention, only one terce discuss their symptoms with their GP. Of those that do, only 50% receive treatment as symptoms of picture within this population often coincide with other later life problems ( IAPT, 2 009 population Health Organisation (WHO), 2004).Chapter 2 Literature inspection2.1 Depression and Anxiety in older adultsMany misconceptions surround ageing including the fact that depression is a normal part of the ageing process. Actual evidence indicates that other material health issues often replace the presentation of depressive symptoms in older adults which may suggest that the rearment of depression is highly influenced by deteriorating physical health (Baldwin, 2008 Baldwin et al, 2002). Depression may present diametrically in older adults in comparison to adolescents or even working age adults. Although the same disorder may be present throughout different stages of the lifespan, in older adults certain symptoms of depression may be accentuated, such as somatic or psychotic symptoms and memory complaints, or suppressed, such as the feelings of sadness, in comparison to younger people with the same disorder (Baldwin, 2008 Chiu, Tam Chiu, 2008). OConnor et al (2001 ) carried out a get wind into the influence of age on the response of major depression to electroconvulsive therapy and found that when confounding variables are controlled (age at the beginning of a study), there is no difference in the remission rates for depression in both younger and older adults, however, relapse rates remain higher for older adults. Backing this up, Brodaty et al (1993) conducted a qualitative naturalistic study into the prognosis of depression in older adults in comparison to younger adults and again affirm that the prognosis and remission for depression in older adults is non significantly worse than for younger adults. However, the bad weather of a qualitative naturalistic study is argued by proponents as being value-laden in nature, while criticisms of this study approach highlight it as being subjective, anecdotal and subject to researcher bias (Koch, 2006).In growth to depression, anguish disorders are also common among older adults, often present ing as a comorbid condition. In 2007, 2.28 cardinal people were diagnosed as having an dread disorder, with 13% of those individuals aged 65 and over. By 2026, the projected number of people diagnosed with an anxiety disorder is expected to rise by 12.7% to 2.56 million with the greatest increase expected to be seen in the older adult population (Kings Fund, 2008). Despite the prevalence rate, anxiety is poorly researched in comparison to other psychiatric disorders in older people (Wetherell et al, 2005). Of the anxiety disorders, phobic disorders and generalised anxiety disorder (GAD) are the two most common in older people (Bryant et al, 2008). It wasnt until 1980 that the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of kind Disorders (DSM) 3rd Edition which introduced mouth Anxiety Disorder (GAD) into the psychiatric nomenclature, distinguishing it from other anxiety disorders for the first time (APA, 1980). MCManus et al (2009) esti mate that in England alone, as many as 4.4% of people in England suffer with GAD with prevalence rates in the midst of 1.2 and 2.5 times higher for women than men (Prajapati, 2012).Post-Traumatic Stress Disorder (PTSD) has received more clinical interest lately, correlating with individuals from the flash World War, Holocaust and Vietnam Veterans reaching or being well into old age and increasing reference of PTSD. Despite this, data relating to prevalence rates still remains limited with research tending to revolve about on specific populations as opposed to community figures, for example, with regards to UK war veterans, approximately 30% will develop PTSD (pickingupthepieces.org.au, 2014). Unfortunately, stigma tends to misrepresent PTSD statistics as sufferers tend not to seek diagnosis or researcher bias is present. Britt (2000) found that many service personal within the military utter that admitting to a mental health problem was not only more stigmatising that admitting to a physical health problem but they also believed it would have a more detrimental impact on their flight prospects. Furthermore, Mueller (2009) conducted a study into disclosure attitudes in which it was concluded that these attitudes can strongly predict symptom severity. With this in mind, it is important to stress the importance of practicing within the limits of NMC (2008) code of conduct in which unconditional positive regards essential be show by all nursing staff whilst incorporating a non-bias attitude in practice.Anxiety and depression comorbidity is well established. A longitudinal study, noted for its beneficial adaptability in enabling the researcher to depend at changes over time, conducted by Balkom et al (2000) found that in a random community judge of adults (55 and older), who were diagnosed as having an anxiety disorder, 13% also met the criteria of major depressive disorder (MDD). Adding weight to the evidence of anxiety and depression comorbidity in older adults, Schaub (2000) who also conducted a longitudinal study, found that 29.4% of a sample of older adults in a German community met the criteria for a depressive disorder. Longitudinal studies are thought to vary in their inclemency due to the attrition of randomly assigned participants during the course of the study, thus producing a final sample that is not a true representation of the population sampled (Rivet-Amico, 2009).King-Kallimanis, Gum and Kohn (2009) examined current and lifetime comorbidity of anxiety with depression. Within a 12 month period they found 51.8% of older adults with MDD in the United States also met the diagnostic criteria for an anxiety disorder. There is evidence to suggest that the first presentation of anxiety symptoms in older adults suggests an underlying depressive disorder (Chiu et al, 2008). Unfortunately, comorbid anxiety and depression in older adults is associated with much higher risks of suicidal symptoms (Bartels et al, 2002 Lenze et al, 2000) in addition to change magnitude reports of more severe psychiatric and somatic symptoms and poorer social functioning when compared to depression alone (Lenze et al, 2000 Schoevers et al, 2003).2.2 Diagnosis and back ToolsAPP TO PRACTICEDementia, along with depression and other priority mental disorders are included in the WHO Mental Health Gap Action Programme (mhGAP). This programme aims to improve care for mental, neurological and substance use disorders through providing guidance and tools to develop health services in resource poor areas.Synthesis and example of empirical research is an important aspect of evidence-based care. Only within the context of the holistic assessment, can the highest quality of care be achieved.ReferencesBaldwin, R., Chiu, E., Katona, C., and Graham, N. 2002. Guidelines on depression in older people Practising the evidence. London Martin Dunitz Ltd.Baldwin, R. 2008. Mood disorders depressive disorders. In Jacob R et al, Oxford Textbook of Ol der Age Psychiatry. Oxford Oxford University Press.Balkom, V., Beekman , A., de Beurs, E., et al. Comorbidity of the anxiety disorders in a community-based older population in the Netherlands Online. Acta Psychiatrica Scandinavica 101(-). 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