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Pain and Depression in Older Adults PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Pain and Depression in Older Adults” by Stephen Thielke.

This medical PowerPoint presentation is about pain and depression in older adults. Pain and depression are common conditions among older adults, and they can often be intertwined. Chronic pain, which is defined as pain that lasts for more than three months, is more common in older adults than in younger adults. At the same time, depression is also a prevalent condition in older adults, and it can worsen the experience of pain.

Chronic pain can have a significant impact on an older adults quality of life, leading to reduced physical activity, social isolation, and sleep disturbances. These factors can contribute to the development of depression, which can further worsen the experience of pain.

There are many potential causes of chronic pain in older adults, including arthritis, osteoporosis, and neuropathic pain. These conditions can be challenging to treat, but there are many strategies that can help manage pain, including medications, physical therapy, and cognitive-behavioral therapy.

Depression in older adults can also be caused by a range of factors, including social isolation, chronic illness, and cognitive decline. Treatment for depression may include therapy, medication, or a combination of the two.

Its important to note that pain and depression are not a normal part of aging and should not be ignored. If you or a loved one are experiencing chronic pain or depression, its essential to speak with a healthcare provider to receive appropriate treatment and support.

Tags : Pain and Depression in Older Adults, Geriatrics, Geriatric Medicine, Geriatrics PowerPoint presentation

Published on : May 09, 2023 | Views : 855 | Downloads : 0

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Slide 1-

Pain and Depression in Older Adults Stephen Thielke Seattle GRECC
Slide 2-

Disclosures My research is supported in part by a Geriatric Health Outcomes Research Award from the American Geriatric Society Foundation for Health in Aging No other disclosures or conflicts of interest
Slide 3-

Overview Depression Pain Overlap of depression and pain in aging Similarities and differences Depression through the lens of pain Treatment recommendations
Slide 4-

Depression and Aging Thielke, Aging and Mental Health, 2009
Slide 5-

Depression and Aging Thielke, Aging and Mental Health, 2009 Incidence Persistence
Slide 6-

Chronic Pain and Aging 2/3 of older adults report chronic pain [lasting 3 months or more] (Gagliese 1997) Of older adults with pain, 83% report that pain interferes with daily activities and negatively affects quality of life (Herr 2001) Most frequent pain types in those 65 or older are osteoarthritis of hip or knee (58%) and low back pain (35%) (CDC) Mean # of pain sites in older adults: 4.3
Slide 7-

Chronic Pain and Aging Highest prevalence of chronic pain occurs at about age 65, after which there is a slight decline with advancing age, even beyond age 85 (Gibson & Helme 1995) Pain Intensity not associated with advancing age, but slightly greater intensity of low-level pain (Rustoen 2005)
Slide 8-

Pain and Aging Many types of chronic pain disorders occur less commonly with advancing age: Headache Migraine Abdominal pain Chest pain Low back  Chronic pain is NOT a “natural part of getting older”
Slide 9-

Depression is Common in Patients with Pain US Geriatric Population 5% Ambulatory Medical Patients 5-9% Medical Inpatients 15-20% Pain Clinics 10-100% (~50%) Pain is Common in Patients with Depression ~65%, regardless of treatment setting Bair et al, Arch Int Med 2003
Slide 10-

Pain Is Strongly Associated with Depression ** ** ** ** p < 0.001 Thielke, HRS, 2008
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Depression and Pain in Older Adults European 11-country study, Aged in Home Care (AdHOC) 3976 subjects, 65 years and older, receiving home care Pain: any daily pain over the last week, or pain behaviors Depression: MDS depression scale Onder, J Clin Psy 2005
Slide 12-

Depression and Pain Patients with pain have 2-5 times increased depression incidence Greater risk of depression with: Multiple pain complaints Multiple episodes Severe pain Patients with pain and depression have greater: Pain complaints Pain intensity Chronicity Directionality?
Slide 13-

Similarities and Differences Between Pain and Depression in Older Adults
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Neuroimaging Studies Many, but not all, of the same brain areas that are stimulated by physical pain are also stimulated by: -Induced sadness -Social exclusion -Grief “There is that cliché of a broken heart, but my ribs ached from the pain in my heart. I had to go to the doctor because I thought I was having heart attacks.”
Slide 15-

Psychological and Physical Pain “I have suffered from severe, recurrent depression for 40 years. The psychological pain that I felt during my depressed periods was horrible and more severe than my current physical pain associated with metastases in my bones from cancer.” “I woke up in the middle of the night to use the bathroom and forgot that my furniture had been re-arranged. I accidentally tripped over my cocktail table, breaking both of my legs. The pain that I experience from depression is so much worse than the pain associated with my breaking both of my legs.” Mee et al, J Psychiatric Res2006
Slide 16-

Physical Pain During Depression
Slide 17-

Sleep, Pain, and Depression 50-80% of patients with chronic pain have a significant sleep disturbance Sleep disturbance is one of the cardinal symptoms of depression Insomnia predicts depression onset Experimental disruption of slow-wave sleep increases pain sensitivity Sleep deprivation can temporarily relieve depressive symptoms
Slide 18-

Pain Impairs Depression Treatment Response Thielke, et al. Am J Geriatric Psych. 2007. Baseline Pain Interference Category Increasing Pain % with Depression Response
Slide 19-

Depression Pain Treatment Overlap for Pain and Depression “Opium cure” for depression never worked ECT not effective for chronic pain Antidepressant response: -Depression response usually 6-8 weeks -Pain response usually 3-4 weeks Noradrenergic drugs have direct analgesic properties Pure serotonergic drugs have no direct effect on pain Doses for pain are roughly ½ of those for depression
Slide 20-

Placebo Response Rates Brief Pain Inventory - Severity Depression trials show ~30% placebo response Only 48% of placebo-controlled trials of antidepressants showed superiority to placebo Khan & Bhat, J Clin Psy, 2008
Slide 21-

Key Similarities and Differences Human suffering Sleep disturbance High placebo response Brain areas Human suffering Prevalence Neurotransmitters Medication effects Pain and depression often occur together “Psychic Pain” and “Physical Pain” are different  Pain and depression are a bad combination
Slide 22-

Depression Through the Lens of Pain Why do we need physical pain? What would happen if we didn’t have pain? Why don’t people treat their pain? What does psychological pain do for us? Why don’t more people treat their depression?
Slide 23-

Congenital Analgesia Depression = Guarding from Social Pain?
Slide 24-

Most Patients Do Not Seek Out Treatment for Pain or for Depression
Slide 25-

The Experience of Pain in Aging Belief that pain is “just a part of getting older” “Many [osteoarthritis patients] were unwilling to use medication. For these individuals, treating pain with medication was seen as masking rather than curing symptoms, and was seen as potentially harmful because of an increased risk of unwanted side effects.” Gignac, Hawker et al 2006
Slide 26-

Evidence-Based Options for Treating Pain OTC analgesics Prescription analgesics Physical therapy Exercise Weight loss Acupuncture Massage Injections Joint replacement Supplements
Slide 27-

“Taking”  Taking Effectively 19 older adults with osteoarthritis pain Qualitative interview 4/19 (21%) taking medications as prescribed or directed Others use lower doses than prescribed or less often than directed None using analgesics in advance of activities Sale, Gignac, Hawker 2006
Slide 28-

Filling Percodan prescription and throwing the whole bottle away Filling higher-dose bottle with lower-dose pills Rationing pain medications to refill far less than allowed Not telling family members about using less than prescribed Adhering to pain medications differently than to other medications Sale, Gignac, Hawker 2006 Medication-Related Behaviors
Slide 29-

Willingness to Undertake Risk in Pain Treatment Preference for topical treatments such as capsaicin over oral agents; pills preferred only if they were reported as being three times as effective as capsaicin All the patients switched their preferences when offered a safer but less effective treatment option 20% of older patients are unwilling to accept any additional risk for reductions in pain Many patients consider medications to be a treatment of last resort Fraenkel et al, 2004 Ross et al, 2001
Slide 30-

Values and Perceived Need Thrifty Wasteful Cautious Rash Stoical Hedonistic Patient Hurried Selfless Selfish “I need to take something to feel better now.” “I don’t need to treat this. I’ll hold out.”
Slide 31-

Responses to Pain May Explain Responses to Depression Depression as a form of “social pain”? Social comparison as the cause of depression in older adults? (Blazer 2008) Patients resist NEEDING a treatment for pain or depression Suffering the symptom often feels like the right thing to do Suffering the symptom often seems safer than risking something unknown just to placate it
Slide 32-

TREATMENT RECOMMENDATIONS Ask about pain and about depression Ask about pain and depression treatments Work to understand effects of mental health on use of pain treatments Do not assume that one problem is causing the other Do not assume that addressing one problem will fix the other
Slide 33-

TREATMENT RECOMMENDATIONS The realistic goal is to make the depression go away, but not to make the pain go away Consider antidepressants for pain and for depression, but do not expect them to fix the problem Placebo response is large in both depression and pain: use this to your advantage Understand patient’s sense of “as needed”
Slide 34-

Be Careful with Opioid Analgesics Accidental deaths in US from prescription opioids exceed deaths from heroin & cocaine More deaths in Washington State last year from prescription opioids than from traffic fatalities!
Slide 35-

Collaborative Care Interventions for Pain and Depression Improve Both IMPACT-DP, n = 13
Slide 36-

Dobscha, S. K. et al. JAMA 2009;301:1242-1252. n = 401 Collaborative Care Interventions for Pain and Depression Improve Both