Anxiety and Depression in Older Adults

Aims of Presentation
To identify Doris’s needs
To suggest the most appropriate therapeutic interventions to meet Doris’s needs and discuss the rationale for them
To present evidence supporting these proposed interventions

Key issues identified from Doris’s profile:
Being treated for anxiety by her GP for the last 2 yrs – taking Lorazepam 2mg 3 times per day
Retired 5 years ago
Two friends have died in the last year
Breathless attacks (particularly at night)
Feels tired all the time, and has difficulty sleeping
Says things are getting on top of her, and she gets little pleasure out of life
Rarely goes out of the house

Anxiety or Depression?
“ All professionals working in the community have to decide whether anxiety symptoms are evidence of an anxiety state or symptoms of another disorder, like depression, that might require a different therapeutic approach”
(Manthorpe & Illife, 2006)

ICD-10 Criteria for Depression
Depressed mood
Loss of interest and enjoyment
Reduced energy leading to increased fatigability and diminished activity
Reduced concentration and attention
Reduced self-esteem and self confidence
Ideas of guilt and unworthiness
Bleak and pessimistic views of the future
Ideas or acts of self-harm or suicide
Disturbed sleep
Diminished appetite
(WHO, 1992)

Treatment of Anxiety & Depression
When depressive symptoms are accompanied by symptoms of anxiety, the first priority should usually be to treat the depression.
Psychological treatments for depression often reduce anxiety
Many anti-depressants have sedative/anxiolytic effects
(NICE Guidelines, 2004)

N.I.C.E. Guideline 23
NICE guidelines recommend the following initial treatments for mild to moderate depression;
Exercise
Psychological treatments e.g. problem solving therapy, short-term cognitive behavioural therapy and guided self-help
Alternatively, counselling or computerised CBT may help (Beating The Blues).
(NICE Guidelines, 2004)

Exercise 1
Can improve your health
Lift your mood
Reduce anxiety
Improve self-esteem and concentration (Mental Health Foundation, 2005)
An exercise programme usually consists of 3 sessions per week (lasting for 45 minutes to an hour each)
Should be continued for 10 to 12 weeks
Can consist of any exercise appropriate to the individuals fitness level e.g. walking or swimming
Recommend local services e.g. walking or exercise groups

Exercise 2
If Doris does not wish to leave her home, discuss appropriate exercises e.g. exercise tapes OR discuss treating everyday activities as exercise
Should be scheduled and recorded by Doris for reflection
To try to involve her friends: take Doris shopping
Should be a collaborative process – determine what she wants to do, what she feels is appropriate (considering age, gender, physical condition)

Why is this intervention therapeutic for Doris?
It could help Doris re-establish existing social contacts, and also create new ones – she feels she is not as sociable as she once was
It could help promote her self-esteem and confidence through achieving goals and targets – something which has been lacking since leaving work
Keeping a diary would enable Doris to reflect on her feelings – show her how much she has actually achieved in a day
Help with her negative feelings – she may feel fitter and healthier, feel more positive about the way she looks
Exercise may help her regulate her sleep pattern, which in turn could help her with task management during the day
Could also be of benefit to her breathlessness

References
World Health Organisation (1996), International Classification of Diseases
NICE Clinical Guidance 23 (2004), Treatment of Depression in Adults
Hughes, C, Depression in older people in Redfern, S & Ross, F (2006) Nursing Older People, Elsevier, Edinburgh
Beech, I The person who experiences depression in Barker, P (ed) Psychiatric and Mental Health Nursing: The craft of caring (2003), Hodder Arnold, London
Manthorpe, J, Iliffe S (2006) Anxiety and depression, Nursing Older People, 18, 1, 24-29
Department of Health (2001) National Service Framework for Older People
British National Formulary 52 (2006) RPS Publishing London
Bryant, C et al (2008) The prevalence of anxiety in older adults: Methodological issues and a review of the literature, Journal of Affective Disorders 109, 233-250
Mental Health Foundation (2005), Up and running! How exercise can help beat depression, http://www.mhf.org.uk/