Risk Factor | Management Strategy | Best Practice Guideline Recommendation |
---|---|---|
Presence of Medical Illnesses Associated with Depression, e.g., Parkinson's Disease, Dementia (all types), Cardiovascular Disease, Diabetes, Stroke, TIA + Presence of Multiple Co-morbid Health Conditions + Recent major physical illness | Assessment and management of chronic and acute illness (within last 3 months); continued medical management as per physician; education for disease self-management | [17] |
Taking Depressogenic Medications Taking inappropriate medications as per the Beer's criteria | Regular critical review of all medications, including herbals and OTC for depressogenic medications and potentially inappropriate medications using the Beer's criteria; Initiate Medication Alert to family physician for critical medication review and modification/withdrawal; Medication review by client's own pharmacist; Client education re: safe medication use, reliable means of organizing pills, medication side effects and possible interactions, inform physician/pharmacist of non-prescription medications. | [17] |
Limitations in activities of daily living | Referral to OT/PT or community resources for assistance with ADLs, e.g., personal care, meals on wheels, home maintenance services); Education of caregivers if required | [17] |
Cognitive Impairment and/or recent change in mental functioning identified by SMMSE score: < 24/30 [81] | Initiate Dementia Alert to family physician for further assessment or discuss diagnosis and treatment; Ongoing monitoring to anticipate future needs for support; Recommend environmental adaptations; Refer to community supports; Education regarding cognitive limitations, strategies, disease process; Referral to OT/PT and family physician for treatment of perceptual disorders | [17] |
Delirium identified by the Confusion Assessment Method (CAM) [135] | Initiate Delirium Alert to family physician for immediate treatment Identify potential risk factors for delirium | [17] |
Anxiety identified by Generalized Anxiety Disorder (GAD-7) Screener Score ≥ 5/21 [107, 108] | Provide support and information; Referral to family physician for further assessment and treatment and need for medication Initiate problem-solving therapy; Refer to community supports | [18] |
Living alone Social isolation or withdrawal | Discussion of increased risk and possible change of living arrangement; Education regarding community resources to enhance social supports, e.g., Seniors club;; Participate in congregate dining; Refer to other community supports | [17] |
Excessive Alcohol Consumption (> 14 standard drinks/wk for men and > 9 standard drinks/wk for women) | Refer to community resources | [17] |
Vision/hearing Impairment | Assess client for visual impairment or hearing loss; Suggest use of visual aids (glasses, magnifying glass, CNIB); Referral to audiology; Referral to CNIB | [17] |
Low Income Level | Ask client if they have enough money for the things they need; able to afford necessities; Referral to Social Work or other community supports for assistance with financial matters | [17] |
Low Education Level | Provide resources for literacy | [17] |
Primary caregiver to a significant other with a chronic health condition Caregiver burden/strain identified by Modified Caregiver Strain Index (CSI) Score [136] | Assess caregiver health (physical and mental), level of caregiver strain, level of social contact and supports, and physical activity; Refer to community supports; Provide education regarding available community services and supports for caregiving | [17] |
Adverse Life Event Chronic Stress | Ask client about any recent stressful life events (e.g., separation, losses, financial crisis, relocation to LTC); Provide education regarding ways to lessen stress; Refer to community supports | [17] |
Recent Bereavement (3 to 6 months) | Refer to community supports, e.g., support groups | [17] |
Chronic Pain | Assess current pain levels and treatment; Refer to family physician for review of current treatment; Refer to specialized pain clinic | [17] |
Avoidant or Dependent Personality Types | When asking client about previous depression history, also ask about any other psychiatric illness such as personality disorders or anxiety | [17] |
Persistent Sleep Difficulties | Assess for change in sleep patterns; Educate client about sleep hygiene techniques, and non-pharmacological approaches to improve sleep; Refer client to physician for further assessment if sleep is identified as a major issue | [17] |
Nutritional risk identified by Screen II Score: < 50/64 [137] | Nutrition education; Refer to Registered Dietitian Assess need for alternative feeding methods and/or supplements; Review medications and potential for food/drug interactions | [17] |