Common Mental Disorders Depression - New Zealand Doctor

Chapter 8 Special issues: older adults/koroua/kuia
bereavement and social isolation. 508 Elder abuse and/or neglect can be associated
with low self-esteem and depression. 509
Overall, the 12-month prevalence of depressive disorders among community-dwelling
older adults aged 65 years and over in New Zealand primary care is about 2% for
men and 5% for women. 1 Older adults in residential care are at much higher risk of
depression, with a prevalence of about 18% in low-level care residential facilities. 110
8.1 Psychosocial assessment of older adults/
koroua/kuia
The psychosocial wellbeing of older adults can be assessed using the same approach
as for other adults. Targeted screening for common mental disorders is indicated for
older adults in groups with high prevalence rates, such as:
• older people in residential care
• those with multiple symptoms
• a history of mental disorder or suicide attempt
510
• a recent significant loss.
Among older adults living in residential care, older adults with other risk factors
or where there is clinical concern, routine psychosocial assessment should include
questions that screen for depression, anxiety and substance abuse. This assessment
should be conducted annually.
A low threshold for intervention is required where there is evidence of suicidal ideation
or intent in older people, as there is a high rate of completed suicide in this group,
particularly in men aged 75 years and over. 511
The Guideline Development Team (GDT) noted that older Mäori living away from their
birthplace sometimes describe feelings of moke moke, a sense of loneliness or physical
and mental displacement that may resolve when they return to their home environment.
8.2 Assessment tools for older adults:
evidence review
As for other adults, a brief assessment tool may be useful as an adjunct to clinical
assessment of older adults. A systematic review of the evidence on brief assessment
tools for common mental disorders in older people was undertaken. ‘Brief’ was
defined as taking 5 minutes or less to administer.
Identification of Common Mental Disorders and Management of Depression in Primary Care 111