Meredith Bailey, LCSWTimberlawn HospitalFebruary 26, 2009

1

Scope of Problem

Number of CaregiversAverage Period of Caregiving

2

Psychiatric Conditions Complicate Caregiving Issues

Getting Appropriate Assessment

Making Appropriate Care Plans

3

Background

Geriatric Mental Health Foundation Estimates6.5 million older adults are depressedBy 2030 the number will be 15 million

4

Risk Factors For Late Life Depression

Changes in MedicationsRecent Loss of Loved OneLiving Alone—Feeling IsolatedSerious Medical ProblemSevere or Chronic Pain

5

Symptom Manifestation in the ElderlySomatizationIndecisivenessLack of feeling or emotionSocial withdrawalFeelings of worthlessnessThoughts of death

6

Somatic concernLowered affectCognitive impairmentFeelings of discriminationImpaired motivationLack of future orientationLack of self esteem

The Geriatric Depression Scale

7

Bipolar Disorder

Afflicts .5% of elderly populationHave proportional number of hospital visits to younger population

Hospital stays are longer

8

Anxiety Disorders

11.4% of older adults meet criteria

Agoraphobia often develops in elderly

9

Schizophrenia

Afflicts .6% of older adults compared 1.3% in 18 to 55 year olds

10

Psychosis

50% of Alzheimer's patients have delusions/hallucinationsSuspiciousnessParanoiaCombativenessAggressiveness

11

Suicide

The elderly are 11% of overall population but represent 17% of suicides

12

Suicide Risk FactorsPrior history of suicide attemptsLethality of prior attemptsCurrent plan--do they have one and what is it

GenderDebilitating medical illness or chronic pain

Lack of support system13

Suicide Risk Factors (continued)

History of suicide in the familyHopelessnessSubstance abuse

AlcoholismPrescription medications

14

Assessment Tools

Geriatric Depression ScaleCasemanagement Questionnaire

15

Geriatric Depression Scale

15 and 30 question versionsScoring and use

16

Casemanagement QuestionnaireDemographicsActivities of daily livingVision and mobilityMedical conditions—stable vs. unstable

Psychiatric conditionsSupport availabilityFinancial considerations

17

Referrals & ResourcesCommunity

Area aging resourcesMedical center—geriatric

assessment centersInformal networks

InternetEldercare resourcesCase managersFacility referral

18

AttachmentsGeriatric Depression ScaleCasemanagement QuestionnaireResource listEldercare website listBibliography

19

20

21

22

23

24

25

26

27

28

29

30

31

32

Bibliography

“Caregiving in the US” National Alliance for Caregiving and AARP 2004 “Geriatrics and Mental Health” American Association for Geriatric Psychiatry AAGP Health Care Professionals “Stroke and Depression: Frequently Asked Questions” Robert Robinson, MD Division of Psychiatry University of Iowa Hospitals and Clinics “Suicide Prevention Training” Diamond Health Care Staff Training 2007 “Suicide in the Elderly” CEU Units at Home 2004 “Suicide in Older Adults: How do we detect risk and what do we do about it?” Psychiatric Times Nov 2006 Vol. 13 No. 13