1.Overview: It is a more common mental disorder, and the prevalence of depression in the elderly is 1-5%. It is significantly higher in women than in men, and 50%-80% of elderly people who commit suicide suffer from major depression.
2. Etiology: It is “multifactorial”, but current brain imaging studies suggest the presence of frontotemporal lobe atrophy and frontal white matter lesions in elderly depressed patients. Damage to the “striatum-pallidum-thalamus-cortex” pathway leads to dysfunction of neurotransmitters related to mood control, such as norepinephrine and 5-hydroxytryptamine, resulting in depression.
3, the characteristics of the clinical phase of geriatric depression: neurological lesions and physical diseases account for a large proportion, cognitive impairment, complaints of physical discomfort, strong suspicion; weight change, early awakening, loss of libido, lack of energy and other factors become less prominent due to age; some elderly depressed patients will be irritable, aggression, hostility as the main performance; insomnia, loss of appetite is obvious; emotional vulnerability, mood volatility, sadness The emotions are often not well expressed; suicidal ideation is often not clearly expressed. Secondary depression accounts for a significant proportion.
4, the regression of geriatric depression: Post has proposed the 1/3 principle: 1/3 will improve, 1/3 remain the same, 1/3 getting worse;
Geriatric depression regression: 97% recover; 32% relapse after recovery; 14% are in persistent disease; 31% die or develop dementia in the follow-up.
5. Treatment of geriatric depression.
Acute phase treatment: In treating elderly patients with depression, the following factors should be considered: pharmacogenetic characteristics of the elderly; drug interactions; physiological characteristics of the elderly make them more sensitive to cognitive impairment of drugs; complex psychosocial factors in the elderly.
Maintenance therapy: the older the age of onset, the greater the number of relapses, and the higher the risk of relapse again. Most researchers advocate that depressed patients over 60 years of age with a first episode of depression should be maintained on treatment for at least 12 months after achieving clinical recovery. In case of relapse, medication should be taken for more than 2 years, and in case of a second relapse, medication should be taken for life.
Management of geriatric mental disorders
The following comprehensive measures are appropriate.
①Good family care ;
②Comfortable recuperation environment;
③Supportive psychotherapy;
④ Encourage participation in recreational therapy activities;
⑤Ensure adequate nutrition;
⑥Prevention of physical comorbidities such as infections and accidents such as wandering;
⑦Reasonable medication.
Prevention of dementia.
1.Raise people’s awareness of dementia through various means, reduce risk factors, protect susceptible people, and prevent the occurrence of dementia;
2.Guiding and helping elderly patients who have or may have dementia to actively seek medical treatment and receive timely medical help;
3.Establish a practical social support system. Help and guide patients’ life caregivers to take care of dementia patients scientifically and prevent complications from occurring. Prolong life and improve the quality of survival of patients.
Caring for the mental health of the elderly.
For geriatric mental disorders, experts point out that in addition to reasonable medication and life conditioning, the treatment of geriatric psychosis is more important than communication and care from children’s relatives, and requires psychological patience and care from the relatives around. Therefore, as children, no matter how busy we are, we need and should take the appropriate time to care for our elderly parents or elders, so that they can spend their twilight years in a warm and caring atmosphere and enjoy the joy of family life!