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Depression beim gebrechlichen Alterspatienten

Diagnostik und Therapie

Depression in frail geriatric patients

Diagnostics and treatment

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Zusammenfassung

Gebrechlichkeit erhöht das Risiko einer depressiven Störung. Der vorliegende Beitrag gibt eine selektive Übersicht zu den Fragestellungen Koinzidenz von Depression und Gebrechlichkeit, Symptomatik, Diagnostik und Therapie der Depression bei gebrechlichen Menschen. Depressive Störungen im höheren Lebensalter sind durch eine zunehmende Häufigkeit und Intensität von somatischen Symptomen geprägt. Diese Symptome überlappen mit einigen Kriterien der Gebrechlichkeit. Beide Störungen weisen ein erhöhtes Risiko für eine Verschlechterung der körperlichen und seelischen Gesundheit, für Heimeinweisung und für Tod auf. Die Erfassung subsyndromaler depressiver Störungen bei gebrechlichen Menschen ermöglicht Perspektiven der Prävention. Bei präventiven und therapeutischen Maßnahmen ist besonderes Augenmerk auf Therapiesicherheit sowie einen barrierefreien Zugang zu Therapieangeboten zu legen. Da körperliche Begleitsymptome das Risiko einer Verschlechterung der Depression bedingen, müssen sie gemeinsam mit den psychischen Symptomen in einem fächerübergreifenden geriatrisch-gerontopsychiatrischen Therapiekonzept behandelt werden.

Abstract

Frailty is associated with an increased risk of depressive syndromes. This review aims to summarize data on coincidence, clinical presentation, and diagnostic and therapeutic work-up of depression in frail patients. Depressive syndromes in geriatric patients are characterized by increased frequency and intensity of somatic symptoms. There is considerable overlap with symptoms of frailty. Both syndromes indicate an increased risk for subsequent somatic morbidity, worsening depression functional deterioration, admission to a nursing home and mortality. Diagnosis of subthreshold depressive syndromes allows preventive measures to be initiated. Barrier-free access to preventive and therapeutic interventions is essential. Concomitant somatic symptoms in subthreshold depression increase risk of progression to major depression. They must be addressed in an interdisciplinary approach involving geriatric teams and geriatric psychiatry.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautorin auf folgende Beziehungen hin: D.K. hat Honorare für Fortbildungsvorträge und Unterstützung für Fortbildungsveranstaltungen von den Firmen Lilly Deutschland GmbH und Lundbeck erhalten. Bei J.H. besteht kein Interessenkonflikt.

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Authors and Affiliations

  1. Geriatrische Klinik und Zentrum für Klinische Psychologie und Psychotherapie, Marienkrankenhaus Hamburg, Alfredstr. 9, 22087, Hamburg, Deutschland

    D. Kopf

  2. Geriatrisches Zentrum, Agaplesion Bethanien-Krankenhaus Heidelberg, Heidelberg, Deutschland

    J. Hummel

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  1. D. Kopf
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  2. J. Hummel
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Correspondence to D. Kopf.

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Kopf, D., Hummel, J. Depression beim gebrechlichen Alterspatienten. Z Gerontol Geriat 46, 127–133 (2013). https://doi.org/10.1007/s00391-012-0461-9

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  • DOI: https://doi.org/10.1007/s00391-012-0461-9

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