Improving Mood in Older Adults
Published on 10 December 2014
A warm meal, some conversation, and access to health care may work just as well as antidepressant medications for older adults. That’s the trend Scott Vouri, Pharm.D., BCPS, CGP, assistant professor of pharmacy practice at St. Louis College of Pharmacy found when he looked at a group of older adults enrolled in PACE (Program of All-Inclusive Care for the Elderly).
“A person coming into the program might have a poor mood because of change in his living situation, being isolated, or grieving over the loss of a spouse or friend,” Vouri says. “Feeling down doesn’t mean someone is depressed.”
Vouri says a standard treatment is to start younger patients on antidepressants. But for older patients, according to Vouri, there needs to be a different mindset.
“As the pharmacist on the PACE interdisciplinary health care team, I recommended we shouldn’t automatically be treating with medication because of the possibility of side effects,” Vouri says. Often those side effects lead to more complications like loss of balance or confusion. “A lot of times once you start an older adult on medicines, it’s hard to get them off of it.”
Vouri reviewed the Geriatric Depression Scale (GDS) scores of the enrollee at the time he or she started the program, at three months, and then again at nine months. He found a trend of improved mood especially in patients with a positive GDS score for probable depression.
“We found the biggest improvement in those first 90 days,” Vouri says. “And mood continued to improve throughout the study period.”
The study did not look directly at whether improved mood was due to the enrollees receiving health care services that had been previously neglected, or the other aspects of the program like the provision of meals and socialization. However, a correlation of these services for mood improvement is theorized.
In addition to regularly screening for interactions, Vouri also examined whether medications were necessary given the patient’s age and overall health.
“Older adults want to be on less medicine,” Vouri says. “I get a lot of positive feedback when recommending less medications. Improving quality of life is a big measure.”
Vouri collaborated with Stephanie Seaton, Pharm.D., BCACP, CGP, assistant professor of pharmacy practice, on the research.
“Keeping the whole patient in mind is important when it comes to treatment options for mood, especially in the older adult,” Seaton says. “Depression is not a predestined part of the aging process and should not be treated like it is.”
The work was chosen as the best poster out of 45 accepted entries at the recent American Society of Consultant Pharmacists national meeting in Orlando.
“Just being named in the top four was nice,” Vouri says. “It gave us the opportunity to present to a larger audience.”
Vouri and Seaton hope the exposure will help other pharmacists and health care practitioners think about the relationship between older adults and the need to use medications to treat poor mood.
“There are cases when an antidepressant medication is completely appropriate,” Vouri says. “With older adults there are a number of mitigating circumstances that are sometimes forgotten, especially when it comes to mood.”