Steiner D, Marcopulos B
University of Virginia School of Medicine, Department of Behavioral Medicine and Psychiatry, Staunton.
Nurs Clin North Am. 1991 Sep;26(3):585-600.
Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.
重度抑郁症以及具有临床意义的抑郁症状在社区居住的老年人、患有内科疾病的老年人和机构养老的老年人中普遍存在。由于这些综合征会导致显著的发病率和死亡率，重度抑郁症和抑郁症状都需要进行全面评估和治疗。抑郁症可能难以诊断，尤其是在内科疾病患者中，因为躯体不适会掩盖抑郁症状，或者人们会认为症状是由并发的内科疾病引起的。因此，临床医生必须警惕老年患者患抑郁症的可能性。虽然没有特定的诊断测试，但评定量表有助于筛查老年患者的抑郁症。有必要排除内科疾病或药物作为导致抑郁症的因素。心理治疗和心理药理学单独或联合使用，对大多数老年抑郁症患者都是有效的治疗方法。电休克疗法是治疗该人群重度抑郁症的一种安全有效的方法。老年抑郁症可能是一种慢性复发性疾病，伴有显著的相关内科和社会发病率。由于护士与老年人接触频繁，他们在抑郁症的诊断和治疗中发挥着特别重要的作用。他们需要识别抑郁症的典型和非典型症状，并且必须熟悉抗抑郁治疗的潜在副作用。密切监测这些潜在副作用可以将残疾风险降至最低。通过与医生、心理学家和其他人员组成团队合作，护士在照顾老年抑郁症患者方面发挥着必要的作用。
