Older adults are among those at the highest risk for committing suicide.undefined#ref2">2 Assess for suicidal ideation in all older adult patients suspected of being depressed and obtain an order for a psychiatric practitioner consult if suicidal ideation is present.
Depression is the most predominant mood disorder among older adults worldwide.2 It is a serious public health concern and is associated with significant functional disability. Depression interferes with a person’s ability to function daily and, in many cases, requires treatment to manage symptoms. Many older adults face significant life changes and stressors that put them at risk for depression. There is also evidence that many physical illnesses affecting older adults are associated with depression; these include cardiovascular disease, diabetes, Parkinson disease, and illnesses associated with chronic pain.9
Depression is frequently unrecognized and untreated in the home setting because it is thought to be a normal part of the aging process. Because depression can impact the patient’s response to care and quality of life, assessing for and addressing its signs and symptoms is important. Differentiating between depression and normal grief also is important.5
Forms of depression include minor depression, psychotic depression, and seasonal affective disorder.1 Depression involves symptoms of depressed mood, diminished interest or pleasure in almost all activities, changes in sleep and appetite, increased fatigue, social withdrawal, feelings of worthlessness, poor memory and concentration, and suicidal ideation.1
Depression is not a normal part of aging and when diagnosed can be successfully treated in most people.2 Older adults have more expected losses, so grieving and sadness are common; if sadness persists, depression should be considered. The onset of depression later in life may contribute to dementia and cardiovascular problems.11 In addition, older adults may have substance use issues, which complicate and worsen the depression.7
Depression increases suicide risk. Specific risk factors for older adults include:10
Rationale: A history of suicide attempts places the patient at a higher risk for another attempt.
Rationale: Assess the medications that the patient is taking, including over-the-counter medications, vitamins, and herbal supplements.4 Polypharmacy is a risk factor for depression in older adults.3
Rationale: Direct questioning with a matter-of-fact attitude provides clear communication regarding what is being assessed.
Rationale: Determining if a patient is exhibiting symptoms of grief or depression is important. When experiencing grief, a patient’s feelings, emotions, and behaviors typically come as a result of a loss. These feelings typically come in waves and diminish in intensity over time.
Ensure that a patient who has a specific suicide plan is not left alone. If weapons, medications, or any other lethal means are in the home, arrange for their immediate removal.
Determine if the patient is a danger to others. If safety is at risk, contact local law enforcement for assistance.
Follow the organization’s practice for mental health emergencies.
Rationale: Patients should be instructed on the effects and possible adverse reactions associated with their medications and potential drug-to-drug interactions.
Rationale: Antidepressant therapy may not take effect for 4 to 6 weeks,2 so the patient will need encouragement to continue with the prescribed medications.
Rationale: Chronic pain is a risk factor for depression.2
Haigh, E. and others. (2018). Depression among older adults: A 20-year update on five common myths and misconceptions. The American Journal of Geriatric Psychiatry, 26(1), 107-122. doi:10.1016/j.jagp.2017.06.011
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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