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Transcript of Depression
Presenting Characteristics (X2)
- Depression is the second most common mental health problem in the elderly as it affects over 20% of people aged 65 and older
- Depression not only affects one’s emotions and outlook on life but it also impairs one’s quality of life and ability to function
-Depression is more common among LTC residents than those living in the community. Approximately, 15% to 25% of LTC residents have symptoms of major depression and another 25% have depressive symptoms of lesser severity.
-Rates of depression are higher in elderly women because they have a longer life expectancy and will most likely outlive their male partner
- Depression affects 121 million people worldwide and is predicted to be the second leading cause of disease burden by 2020
Depression is an abnormal emotional state characterized by a wide spectrum of affective, physiological, cognitive, and behavioral issues.
Common mental and physical symptoms include: exaggerated feelings of sadness, melancholy, emptiness, hopelessness and a lack of motivation.
The onset of depression can be neurotic or psychotic
neurotic = a traumatic or unidentifiable trigger
psychotic = a mental or physical impairment triggered by intra-psychic conflict
Types of depression include: agitated, anaclitic, retarded, reactive and involutional melancholia as well as major depressive disorder.
-Untreated depression is prevalent among older adults living in institutionalized settings
Health care providers lack the knowledge of depression and the self-efficacy in assessment, identifying, screening, referring, and implementing nursing interventions.
Older adults also grew up in a different time where asking for help was uncommon as knowledge of mental illnesses were lacking.
-Depression is often thought of as a natural part of aging as the risk for depression increases with age.
Depression can fog self perceptions and can lead to patients over reporting being disabled functionally, or the opposite, that they say they are able to do things when they really cannot.
-Lack of transportation
-Loss of independence
-Loss of connection with people outside of facility
-Not enough opportunity to get to know other residents because patients are in bed a lot of the time
-Lose contact with society outside of facility
Do you think that depression is a natural part of aging?
What interventions would you do for these clients?
What would you say if your patient told you they felt "worthless" or if they stated that "suicide was never far from their thoughts" ?
“Increasing gerontological nurses’ awareness and understanding of patients preferences is an important aspect of patient-centered care that can promote quality of care and quality of life for their depressed patients.
Cognitive difficulties associated with depression may be more common than symptoms of sadness in older adults (sadness may not be present at all)
Knowing which changes commonly occur may help nurses and other health care providers detect depression sooner than later
What's The Problem?
Risk for Ineffective Coping
Risk for Suicide
Risk for Social Isolation
Challenges of Living in
Depression & Comorbidities
Health Maintenance/ Interventions
-Retirement, loss of one's role, reduced income
-Chronic medical conditions
-Functional decline cognitively and physically
- Personal or family history of depression
-Substance abuse or dependence
- one must be aware of the risk factors for depression
- Observing signs and symptoms is extremely important in diagnosing depression
- A Head-To-Toe sreening should be performed on
older adults on a regular basis
- Identifying and treating will increase the ability of people with depression to function
- Mood can be improved with physical activity
- Nurses can promote meaningful relationships with other residents, increase family involvement, and provide emotional support, as well as activities for diversion
- Nurses must also ensure multidisciplinary collaboration among staff for continuity of care
-Increasing physical activity and socialization
-Maintain client-centered approach
-Improving mental health care for older adults
-Knowing what changes commonly occur can help nurses detect depression sooner rather than later
-Cognitive difficulties associated with depression may be more common than symptoms of sadness in older adults
- Monitoring antidepressant medications.
- Nurses can assist patients in developing a positive perspective
- Nurses can also provide contact
information for useful agencies and
programs providing depression groups
- Nurses can encourage patients to participate in reminiscing and the telling of life stories
- Client preferences should also be included the treatment
- Staff engagement in geriatric mental health training is important in ensuring all staff are educated in caring for patients with depression.
- Nurses can also promote positive coping strategies, such as talking, participating in spiritual activities and caring for others
Chan, M. (2014). Reducing depression among community-dwelling older adults using life- story review: A pilot study. Geriatric Nursing, 35, (2). 105-110. doi:10.1016/j.gerinurse.2013.10.011
Contrada, E. (2012). Depression in Older Adults. American Journal of Nursing, 112 (11), 22-28. doi:10.1097/01.NAJ.0000422252.72836.88
Dahle, R., & Ploeg, J. (2009). A qualitative descriptive study of the lived experiences of older women with depression living in long-term care. Journal of Gerontological Nursing Association, 33, 5-12
Doenges, M., Moorhouse, M., & Murr, A. (2013). Nursing diagnosis manual: Planning, individualizing, and documenting client care (4th ed.). Philadelphia, PA: FA Davis Company.
Fyffe D., Brown, E., Sirey, J., Hill, E. & Bruce, M. (2008). Older Home-Care Patients' Preferred Approaches to Depression Care: A Pilot Study. Journal of Gerontological Nursing, 34(8), p. 17-22.
Lach, H., Chang, Y., Edwards, D. (2010). Can Older Adults with Dementia Accurately Report Depression Using Brief Forms?: Reliability and Validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5), p. 30-37.
Mellor, D., Russo, S., McCabe, M. P., Davison, T. E., & George, K. (2008). Depression training program for caregivers of elderly care recipients: implementation and qualitative evaluation. Journal of Gerontological Nursing, 34(9), 8-15.
Mosby, I. (2009). Mosby's dictionary of medicine, nursing & health professions (8th ed.). St. Louis, Mo.: Mosby/Elsevier.
Mynatt, S. L. (2004). Depression in the older adult: recognition and nursing intervention. Tennessee Nurse / Tennessee Nurses Association, 67(4), 8-10.
Phillips, Lorraine J, PhD,R.N., F.N.P.-B.C., Rantz, Marilyn, PhD,R.N., F.A.A.N., & Petroski, G. F., PhD. (2011). Indicators of a new depression diagnosis in nursing home residents. Journal of Gerontological Nursing, 37(1), 42-52. doi:http://dx.doi.org/10.3928/00989134-20100702-03
Touhy, T.A., Jett, K.F., Boscart, V., McCleary, L. (2012) Ebersole and Hess’ Gerontological Nursing and Health Aging, C. Gerontological Nursing (1st Canadian Edition). Toronto: Elsevier.
ependency, denial, devalue of self, decrease in weight,
ejection, reluctance to talk about emotions,
ating disturbances, Exhaustion
adness, self harm, social deficits
solation, Irritability, increase in weight, insomnia, inability to cope and focus.
ot “accepting the past”, negativity
opelessness, helplessness, hatred, hypersomnia, hostility
educed affectivity, remorse
Create Supportive environments
Eliminate discrimination and violence in environment
Provide social support groups that contribute to good health
Promote Social Inclusion: involvement in the community, group activities and supportive relationships
Help elders develop coping mechanisms to allow control over their life
Provide health teaching about the importance of social interaction and expressing feelings and emotions
Use various depression scales and head to toe to diagnose depression in elders during primary prevention- Early diagnosis allows for early interventions such as psychosocial therapy
-Many illnesses in older adults are known to be associated with depressive symptoms which is why nurses can overlook depression. Physical symptoms of depression are similar to that of other illnesses.
-Cardiovascular disease is linked with depression because its associated with low physical activity.
-Diabetes, parkinsons, and chronic pain are interconnected with depression as all of these conditions reduce the quality of life and make it difficult for nurses to diagnose patients.
Antidepressant medications: - acts on the neurotransmitters involved in regulating mood such as serotonin, epinephrine, and dopamine.
must be taken at least 4-6 weeks in order to have a full effect
electroconvulsive therapy and brain stimulation therapy can also be used in the event that antidepressant medication have no effect