Common Mental Disorders Depression - New Zealand Doctor

8
Special issues: older adults/
koroua/kuia
This chapter focuses on special issues in the recognition and assessment of common
mental disorders and the management of depression in older adults/koroua/kuia.
Recommendations
Older adults
Targeted screening for common mental disorders is indicated for older
adults in groups with high prevalence rates including:
• older adults in residential care
• older adults with a history of mental disorder or suicide attempt
• older adults with multiple symptoms
• older adults with a recent significant loss
An older adult presenting with possible cognitive impairment should be
assessed for both dementia and depression
Where there is a rapid change in cognitive status in an older adult,
medical assessment should exclude delirium
An older adult with depression should be offered the same range of
psychological therapies as other adults: chronological age should not
be a bar to specific therapies
Selective serotonin reuptake inhibitors (SSRIs) are suitable as a firstline
antidepressant for an older adult: for a patient also taking other
medications, choose one with a low risk of drug interactions
An older adult prescribed antidepressants should be carefully
monitored for adverse effects
Where antidepressants are the treatment of choice, treatment for an
older adult with depression and dementia should be as for other older
adults with depression
Grades indicate the strength of the supporting evidence, rather than the importance of the
recommendations – refer to Appendix B for grading details
C
C
C
C
C
C
C
Identification of Common Mental Disorders and Management of Depression in Primary Care 109