The Nurse’s Role in Preventing Depression in the Elderly

Depression is significantly affecting the elderly. The rate of depression in the elderly has increased over the past decade, and awareness and interventions are essential to bringing forth improvements. There is a challenge in detecting depression in the elderly; one thing that must be addressed is that many seniors diagnosed with dementia suffer with depression as well. Depression and other illnesses tend to coincide. Because of this depression is often over looked in order to treat the more prominent/ apparent illness (Cyr, 2007). Because depression in the elderly has a negative impact on one’s health and overall well-being, early detection by nurses is of the utmost importance. This can contribute to the prevention of depression in the elderly and promote healthy strategies towards integrity versus despair through the screening and assessment process. This can be achieved by taking a thorough patient history and by implementing activities that promote both social and physical activities. Most importantly nurses must take the time to educate, listen and observe changes in the patient’s behavior for signs and symptoms of depression which are pivotal for implementing interventions towards a life that ends in integrity rather than despair.

Depression is a frequent problem in the elderly. It is not surprising that the elderly would exhibit signs of depression because as one ages there are losses that they face such as losing their independence, reduced income, death of family and friends, decreasing physical ability, and the loss of one’s role. This accounts for a huge increase of depression affecting the elderly, and has resulted in many suicide attempts and death. According to Scanlon (2006), “suicide was the 9th leading cause of death in the U.S. - deadlier than chronic kidney or liver ailments, Alzheimer’s Disease, or homicides… and twice as deadly as the modern scourge of AIDS” (p. 1). Depression is a huge concern for society, healthcare, and family members, but most importantly for the individual who is suffering, so it is of vital importance that correct diagnosis and treatment occur for the elderly who is suffering from depression. Author Waughn (2006) states it best, “that for some it is the difference between life and death” (p. 30).

One nursing strategy is to get a thorough patient history by asking key questions about their mood, sleep and eating patterns, and by reviewing their medications, because changes may be contributing to depressive symptoms. By asking pertinent questions the nurse is able to identify possible symptoms and risk factors for depression. Some of the symptoms include loss of confidence, reduced appetite/weight loss, feelings of hopelessness, and even suicidal thoughts and behaviors. In addition, “the number of older people who have depression and dementia in later life is considerable, and about 50% of people with dementia have depressive symptoms” (Manthorpe, 2006, p. 3). When working with the elderly the nurses should always think about dual diagnosis. In this way they can understand and communicate that there is more to the problem than what is seen on the surface. Asking appropriate questions and observing changes in behavior can lead to the root of the problem. Key questions that nurses can ask their elderly client are, “How are you sleeping? Do you have much of an appetite? Are you keeping active or have you lost interest in your daily activities? Do you feel happy most of the time?” (Waughn, 2006, p. 3). After assessing signs and symptoms of depression it is up to qualified nurses to critically think and supplement interventions that can help their elderly patient towards successful treatment.

Once the signs and symptoms of depression are confirmed, another key strategy is to encourage activities that promote both social and physical well-being. These activities stimulate the elderly client and consequently increase his sense of worth as a productive member of society. “Daily activities such as reading, discussing the news, watching television documentaries, and engaging in social activities and voluntary work have been shown to improve older clients’ feelings of loneliness and depression” (Murphy, 2006, p. 4). An intervention that should be utilized and would be productive for the elderly patient with depression as well as the youth of our society would be to form a version of Big brother/Big sister connecting teenagers and young adults with the elderly through a YMCA program. This experience would promote and maintain older people’s interest and help them enjoy the experience of everyday living. Therefore, it is extremely important that nurses take the time to listen, educate, and observe changing behaviors in the elderly’s symptoms of depression so that interventions are possible and can lead towards integrity rather than despair. Whether it is their daily activities, medication, or illness, continued reassessment is needed in order to stay on tract towards further improvement and well being.

Maintaining open communication with the elderly who suffer from depression is extremely important. Taking the time to actually talk to a patient can reveal more than ailments, it can determine the cause of their depression or problems. This in turn, can help solve the problem by educating the patient on why, what, and when their symptoms occur and together the nurse and patient can begin to set goals and develop interventions that will be successful in promoting wellness for the individual. “Many older clients welcome the chance to talk to their carers who are seen as playing a pivotal role in providing them with social support” (Murphy, 2006, p.4). Just taking the time to give an extra five to ten minutes can mean helping an elderly client feel valued and heard and leads towards productive treatments and outcomes that result in a life of fulfillment and integrity.

Awareness is key. The issue of elderly depression is becoming more main stream and as elderly depression is discussed, help and interventions can be addressed. Listening and using therapeutic communication is crucial in assessing the elderly for signs and symptoms of depression and implementing interventions can help prevent and treat their depression. Taking a thorough patient history and providing activities that promote social and physical well-being is an essential first step in promoting health strategies that move toward integrity. Most importantly, by listening and by educating the patient on the effects of depression, communication lines are open and the patient is more able to ask for help. Ultimately, this helps with implementing interventions that lead to quality of life. Nurses and healthcare professionals must address key strategies together and continue to brainstorm more ideas because, we all face growing older, and this is a problem that affects us all. The ultimate goal we all hope to achieve is that we look at the end of life with integrity rather than despair.


References


Cyr, Nancy R. (2007, Feb.). Depression and older adults. AORN Journal, 8(4), 397-401.
Retrieved April 10, 2007, Expanded Academic ASAP database.

Manthorpe, J. & Iliffe, S. (2006, March). Depression and dementia: Taking a dual
diagnosis approach. Nursing Older People, 18(5), 24-28. Retrieved April
23, 2007, from Expanded Academic ASAP database.

Murphy, Fiona. (2006, June). Loneliness: a challenge for nurses caring for older
people. Nursing Older People, 18(4), 22-25. Retrieved April 23, 2007, from Expanded Academic ASAP database.

Scanlon, B. (2006, May). Recognizing depression in later years. Retrieved April 23, 2007,
from http://healthyplace.healthology.com/healthy-aging/article23.htm07.
Waughn, A. (2006, September). Depression and older people.

Nursing Older People, 18(4), 27-30. Retrieved April 10, 2007, from Expanded
Academic ASAP database.



Intervention #1

Nurses need to take a thorough patient history when it comes to diagnosing depression in the elderly. By asking pertinent questions nurses are able to identify possible symptoms and risk factors for depression.

Disadvantage #1

More often then not when it comes to depression especially in the elderly their mental health is over looked. “More than 3.5 million people do not receive satisfactory services and support and those using mental health services are often ignored” (Gilbert, 2007, pg. 1). Many elderly patients have admitted that even when they were suffering from depression they never spoke with their doctors at all about their emotional state. A recent study in the Journal of the American Geriatrics Society, reviewed videotapes of 385 appointments with elderly patients and found that the average time spent discussing mental health was only two minutes (Nagourney, 2008, pg.6). An even bigger problem is that when patients told their doctors about their problems, the study found, that the doctors “responses were often ineffective or worse” (Nagourney, 2008, pg. 6). The number of elderly people suffering from depression is on the up rise, so now is the time to put something in place to address it. That is why it is so important that nurses take a thorough patient history and ask pertinent questions that can help identify risk factors for depression in the elderly.

Disadvantage #2

Nurses need to be aware that their own bias and discrimination is at the heart of many problems in mental health services for older people. “The central fallacy is that depression is an inevitable part of getting old” (Lishman, 2007, pg. 30). Even in nursing schools gerontology curriculum is integrated, “but more often the approach often perceives aging as a risk factor for numerous diseases and disabilities but ignores the needs and experiences of healthy older adults. Consequently, students may believe all older adults have chronic illnesses that cannot coexist with healthy or successful aging” (Walker, Newcomb, & Cagle, 2005, pg. 283). The problem of elderly discrimination is not solved by providing specialist services but by training all health and social care professionals to take the time to take a thorough patient history in order to recognize and respond to the mental health needs among older people. Education is key and it needs to start in nursing schools, because depression dose not just happen as one becomes older. That is why it is so important that students as well as nurses in the hospital setting receive a balanced view of aging so bias and discrimination cease to occur.


Intervention # 2

Nurses need to encourage activities that promote social and physical well-being in order
to prevent/alleviate risk factors of depression in the elderly.


Disadvantage #1

There are many challenges that face nurses when it comes to caring for the elderly. One
challenge in particular is the fact that older people may feel alone and isolated and may be
exhibiting signs of depression, but they do not want to do anything about it. “The challenge for
nurses is promoting and maintaining older people’s interest so that they can get back to enjoying the everyday moments of their life” (Murphy, 2006, pg. 25). Many elderly have stated that they are scared to try new things and that they feel they have nothing to offer. Studies show that older people who are physically disabled or who suffer from visual or auditory problems tend to be lonelier (Murphy, 2006). This is due to the fact that they limit their activities and isolate themselves because they attribute their disability as a burden and sometimes prefers to be alone then with others. This ultimately is more debilitating then their physical disability. In turn, they become isolated and feelings of loneliness occur and then ultimately depression sets in. Motivating the elderly to take a proactive role in their mental health can be just as challenging as diagnosing depression. The key is providing them with social support. “By identifying individuals at risk because of poor social networks and of feeling lonely is crucial before the person becomes too weak and unmotivated to participate in healthy alternatives that promote an overall well-being, by helping them to create or maintain better networks” (Murphy, 2006, pg. 24).


Disadvantage #2

Another problem facing the elderly who suffer from depression is that depression is often
under detected because many of the symptoms can be mistaken for dementia and other illness. Often older people with depression may present with physical symptoms such as slowing of thoughts and activity, and many healthcare professionals attribute this to another illness such as dementia than psychological symptoms like depression (Waughn, 2006, pg. 28). The older
person becomes frustrated and even embarrassed that they do not have control of the slowing of their thoughts and motor ability, that they often isolate themselves from the public. They
exacerbate the problem and end up feeling more alone and isolated and in turn become depressed. This misinterpretation that they have dementia or another illness can further frustrate the elderly patient and they become more symptomatic and further withdraw from people and activities. The promotion of social and physical activities have been known to provide a therapeutic effect and slow down the aging process, but when illness hits the elderly person they assume that depression is part of it and seek help only for the more prominent illness. “It has been demonstrated that, if depression is not identified and treated, the elderly have an increased risk of functional, cognitive, and psychological impairment, and early death” (Waughn, 2006, pg. 28). The early promotion of social and physical activities can help, but both nurses and doctors need to be aware of dual diagnoses so that depression can be prevented before it is too late.






References

Gilbert, Helen. (2007, August). No time for patients. Hospital Doctor, 6. Retrieves April 13,
2008, from Proquest database.

Lishman, Gordon. (2007, August). How bias starts at 65. Community Care, 1688, 30-31.
Retrieved April 13, 2008, from Proquest database.

Murphy, Fiona. (2006, June). Loneliness: a challenge for nurses caring for older
people. Nursing Older People, 18(4), 22-25. Retrieved April 23, 2007, from Expanded Academic ASAP database.

Nagourney, Eric. (2008, January). Mental health overlooked in care of elderly patients. New
York Times, p. F6. Retrieved April 13, 2008, from Proquest database.

Walker, C.A., Newcomb, P., & Cagle, C. (2005, June). Age and Ageism: Inhabiting the lives of
older adults through video narratives. Journal of Nursing Education, 44(6), 283-285.
Retrieved April 13, 2008, from Proquest database.

Waughn, A. (2006, September). Depression and older people.
Nursing Older People, 18(4), 27-30. Retrieved April 10, 2007, from Expanded
Academic ASAP database.