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Recognizing and treating depression in older people
Depression isn't just "having the blues."
It's a disabling, even deadly disorder - and it's particularly
common in older people living in institutions. Studying
how best to treat depression and prevent relapse is
the research focus of Dr. Alastair Flint, Senior Scientist
at Toronto Rehab.
"Untreated depression can result in significant
suffering and disability. People with depression frequently
function at a lower than normal level - they may have
difficulty caring for themselves or taking part in social
activities. They are less likely to recover from concomitant
physical illness. People with depression are more likely
to die in the first year or two after a heart attack."
Most of Dr. Flint's patients are treated with antidepressant
medication. They may also receive psychotherapy. Treatment
is aimed at relieving depression and preventing relapse.
This is important, because older people with depression
are at high risk of future episodes. Treating them over
a period of years significantly reduces this risk.
Depression is an all-too common problem. About 10 per
cent of older people living in the community suffer
from clinically significant depressive symptoms - roughly
the same rate as other age groups. However, for older
people living in institutions, the risk soars. As many
as one-third of these people have depression.
"There is an association between physical illness
and depression, as well as between dementia and depression,"
says Dr. Flint. "Many people in nursing homes are
physically unwell and many have dementia. Both factors
increase the risk of depression."
Sometimes, depression "masquerades" as other
disorders, such as anxiety. "Some older people
become very anxious or worried, constantly brooding
on various concerns," says Dr. Flint. "When
we dig down a little, we often find that they are depressed.
We treat the depression and the anxiety improves.
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Quick
Biography
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Dr. Flint is a Senior Scientist at Toronto Rehab
and the University Health Network (UHN). Head
of the Geriatric Psychiatry Program at UHN, he
is a professor of psychiatry and faculty member
of the Institute of Medical Science at the University
of Toronto. Dr. Flint's current research interests
include depression and anxiety in the elderly.
He is principal investigator of a National Institute
of Mental Health-funded study investigating the
pharmacologic treatment of psychotic depression.
He has authored or co-authored over 100 scientific
articles. His medical degree is from the University
of Auckland, where he completed his residency
training in psychiatry, followed by a clinical-research
fellowship at the University of Toronto.
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"One symptom that we have looked at recently is
fear of falling. In some older people, the fear is an
appropriate response to falls. In others, however, the
fear is excessive. In some cases, fear of falling prevents
people from leaving their houses or even their chairs.
They may become housebound or avoid basic activities
such as taking a bath or shower. Many of these people
are actually suffering from depression or an anxiety
disorder."
Dr. Flint became interested in geriatrics during his
internship. "I enjoy working with older people.
Also, I was interested by the fact that older people
have multiple, interacting problems that are best managed
on a multidisciplinary basis. When I trained as psychiatrist,
I was interested in geriatrics right from the start.
"One of the most satisfying aspects of my work
is the astonishing improvement we see when treatment
is successful. Some patients are so severely depressed
they have become bedridden. They may not be eating or
drinking, some have become incontinent, some delusional.
After treatment, they become functioning individuals
once more. These dramatic responses make my work very
rewarding."
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