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It is a common misconception that depression
is a natural part of aging. How often have you heard someone say, "No
wonder he's depressed, he's 92!", "How do you expect her to
feel after a stroke?", "Wouldn't you be depressed if you had
my health problems?", "Who wouldn't be depressed in a nursing
home?" In our culture that values youth very highly, the myths and
false impressions regarding aging are rampant. One such myth is that depression
is a natural function of growing old. This is not true. The elderly have
rates of depression similar to those of younger persons, however the elderly
have higher rates of undiagnosed and untreated depression than do younger
persons.
Depression causes suffering in the individual, both emotionally and physically,
but it is also implicated as a risk factor for: morbidity, amplification
of pain and disability, worse outcomes after recovery from illness and
surgery, excessive health care costs, decreased physical functioning including
cognitive impairment and under-nutrition and mortality, which includes
both an increase in suicide-and non-suicide related death (Crystal, Sambarmoorthi,
Walkup & Akincigil, 2002; NCA, 2005).
Of the nearly 35 million Americans age 65 and older, an estimated 2 million
have a depressive illness and another 5 million may have "subsyndromal
depression" or depressive symptoms that fall short of meeting full
diagnostic criteria for a disorder. Subsyndromal depression is especially
common among older persons and is associated with an increased risk of
developing major depression. In any of these forms, however, depressive
symptoms are not a normal part of aging. In contrast to the normal emotional
experiences of sadness, grief, loss, or passing mood states, they tend
to be persistent and to interfere significantly with an individual's ability
to function (NIMH, 2003).
In addition to the human cost of pain and suffering and the diminished
quality of life that depressive illnesses cause, there are high economic
costs as well. The direct and indirect costs of depression have been estimated
at $43 billion each year (AAGP, 2004). Older patients with symptoms of
depression have roughly 50% higher healthcare costs than non-depressed
seniors (NMHA, 2005). Depression in the geriatric population is particularly
costly because of the disability that it causes and the impact on the
physical health of the older person (AAGP, 2004).
Because depressive illnesses are so widespread, nurses will regularly
come into contact with elders who are depressed. And because nurses practice
in a wide range of healthcare settings, they are in a unique position
to identify depression among their geriatric patients and facilitate treatment.
Case Studies
Mr. L. has been admitted to the hospital
for a mild myocardial infarction. He presents as irritable, with a very
low frustration tolerance. He has gotten a reputation among the nurses
since his hospitalization, as a "difficult patient." He is quite
dependent on his wife, whom he constantly directs to provide care to him,
often in a berating tone. He has slept very poorly since admission and
his appetite is not good. He reports that he used to enjoy reading the
newspaper, but now just finds it "annoying." He complains of
discomfort in his abdomen, muscle aches bilaterally in his lower legs
and upper arms. The nurse has offered pain medications as prescribed,
but Mr. L. is adamant that they do not work; once he threw the medicine
cup at the nurse.
Ms. J. has been a resident at a long-term care facility for approximately
2 years. She was admitted because she could no longer safely care for
herself at home. According to the nurses, she adjusted well to the facility,
particularly enjoying the social activities as she had been living independently
prior to admission and often felt lonely. She had been highly social.
However, 2 months ago, she suffered a stroke, which left her with left
sided weakness and some expressive aphasia. She has been tearful repeatedly
since her return from the hospital 3 weeks ago. Although she continues
to go to activities, it is only with much direction from the nurse. She
participates little in the activities now.
Ms. H. lives alone. The home care nurse notes that she eats very little,
often the delivered meals are stacked, uneaten in the refrigerator. She
complains of feeling very weak and tired all the time. Her lab work has
been normal and a complete physical shows Ms. H. to be in relatively good
health, despite a wound on her leg, which is not healing well. Ms. H.
seems to enjoy the visits from the nurse, often detaining the nurse with
stories from her early life. She has difficulty adhering to her medication
schedule and treatments for her leg wound.
Are these patients depressed? How should the nurses in these situations
proceed? The purpose of this course is to help nurses increase their knowledge
and skill in identifying and intervening in depressive illnesses in geriatric
patients.
© 2003, 2005 NYSNA All rights reserved.
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