Depression in the Chronically Ill Elderly Patient

Of the total population of the United States, 39 million are 65 and older. Of those 39 million older adults, about 5% reside in nursing homes, with the median age of 83. 2 years (Urdaneta & Thakur, 2010). It is estimated that by the year 2030, 20% of the nation’s population will be 65 and older (Glaister & Blair, 2008). With the number of older adults rising significantly, so will the number residing in nursing homes. A significant amount of older adults will experience depression. Depression is prevalent in older adults, and those residing in nursing homes seem to be at greater risk for developing it (Urdaneta & Thakur, 2010).

It is also estimated that the number of older adults experiencing depression is three to five times that of older adults residing in the community (Glaister & Blair, 2008). The need for recognition and proper treatment of depression will be great. With nurses on the frontlines of patient care and communication, it is essential that they be fully educated about proper assessment and treatment of depression. Studies found that depression rates among nursing home residents ranged from 9 to 75% (Choi, Ransom, &Wyllie, 2008).

Depression is a broad term that encompasses many diagnoses, of which include: major depressive disorder, psychotic depression, dysthymia, minor depression, bereavement, adjustment disorder with depressed mood, and depression secondary to general medical condition. Social, psychological, vascular, neurotransmission, endocrine, and genetic factors all contribute to the development of depression (Urdaneta & Thakur, 2010). It most often occurs alongside a chronic illness, the greatest of which being dementia.

Depression can have both physical and psychological effects on the patient, family, and caregiver. It contributes to the deterioration of functional health, as well as to the decline in overall quality of life of the patient (Choi, Ransom, &Wyllie, 2008). Symptoms of depression may vary. Feelings of sadness, fatigue, worthlessness, guilt, difficulty making decisions and concentrating, changes in appetite, weight gain or loss, altered sleep patterns, psychomotor retardation, agitation, and thoughts of suicide or death are of the most common symptoms reported.

However, it is estimated that about one in three patients is properly diagnosed. Risk factors for depression include: family history, stressful situations, female gender, prior episodes of depression, onset before age 40, medical comorbidity, past suicide attempts, lack of support systems, history of physical or sexual abuse, and substance abuse (Swearingen, 2008). Assessment for depression includes a complete history and physical, and screening with a standardized scale, such as a Geriatric Depression Scale, Minimum Data Set, and Mini-Mental State Examination.

The primary care provider is also essential in the diagnoses of depression. Diagnoses of depression is largely based on the patients self-reports. Only the patient can completely assess his or her feelings and thoughts. The under-diagnoses and under treatment of depression in the nursing home setting are both major issues that should be examined. Many aspects of being newly admitted to a nursing home can contribute to a depressed mood or feeling in older adults.

The loss of autonomy, independence, and freedom, social isolation, loneliness, having a roommate, sharing a bathroom, increased rules and regulations, co-residence with cognitively impaired residents, frequent encounters with death and grief, staff turnover and shortages, and lack of meaningful in-house activities could all contribute to mood and feeling changes (Choi, Ransom, &Wyllie, 2008). Transition into a nursing home can be a difficult and upsetting time for the older adult patient. The adjustment period to their new life with more rules, restrictions, and regulations alone can be overwhelming for them.

With fewer RN’s in the nursing home setting than other health care facilities, education is essential for correct detection, diagnoses, and treatment of depression (Kerber, Dyck, Culp, &Buckwalter, 2008). RN’s are the primary care givers in nursing homes. They are the frontline, an essential component of the care of the patient. Education of the patient, as well as the nurse, is just as important. The nurse can teach the patient coping mechanisms and strategies to help the patient overcome their depressed moods, thoughts and feelings.

A positive attitude, religious beliefs, family support, sense of reality, and therapy are all proven successful ways of helping to deal with symptoms of depression in the elderly (Choi, Ransom, &Wyllie, 2008). Caregivers may also experience depression after a family member or loved one enters a nursing home. Even though the placement of a family member or loved one into a nursing home relieves the caregiver of previous duties and care of the patient, feelings of stress and burden are still reported. Caregivers must also go through an adjustment period.

They are no longer responsible for the direct care of the patient, and must go through a dramatic role change. Stressors of the caregiver may include travel time to the nursing home, monitoring of the residents care, and managing financial and bureaucratic matters. The problems with memory and behavior of the loved one or family member is also proven to be a huge stressor, as well as the dissatisfaction with the care of the resident. One of the best coping solutions for the caregiver is social support, which is associated with psychological well-being (Majerovitz, 2007).

The nurses role in the treatment, prevention, health protection, and health promotion is multifaceted. Treatment of depression is most often done with antidepressants, but nonpharmacological methods are just as important. Nonpharmacological methods may include electroconvulsive therapy, light and exercise, and psychotherapy (Urdaneta & Thakur, 2010). Social and family support, as well as pets are proven great ways to reduce depression. Nurses must be able to recognize signs and symptoms of depression to be able to properly treat and help diagnose the patient.

Depression is often time mistaken for a normal consequence of aging and chronic problems. This may contribute to the under use of mental health professionals, services, and assessment tools. It is reported that only 15 to 27% of newly admitted nursing home patients with depression were recognized. This means that many patients go untreated for their mental illness (Glaister & Blair, 2008). Assessment of patients by nurses should be made frequently and educational material made readily available to patients about depression.

The nurse should be able to recognize and report signs and symptoms of depression, as well as understand the fundamentals of aging, mental health, and depression, and the appropriate responses.