Elderly and Their Risk of Depression Until

¶ … Elderly and their Risk of Depression

Until just recently geriatric depression was not regarded as a medical diagnosis, however, with the elderly suicide rate being the highest in the country it has now come to the forefront of medical research. There are numerous reasons for depression in anyone, at any age, but it seems to plague the elderly at a much higher rate. This is due to a variety of reasons. One factor is the health condition of elderly people who ultimately become victims of a medical ailment by sixty-five years of age. This enhances the chances of depression substantially. Another major reason for geriatric depression is the loss a spouse, in which the passing of our significant other becomes such a traumatic experience that reclusiveness, denial, and ultimately depression are resorted to.

It has been recently acknowledged that insomnia is another cause of geriatric depression, often diagnosed as a sleeping disorder instead of a major participant and contributor of depression. These are just a few causes of this dark, lonely medical misconception. As we embark on the theories of depression and the current roles of nurses' interaction with the depressed elderly, the reason for research reform becomes apparent. A few of the problems with the solution is the resistance of the elderly to acknowledge and accept proven treatments. Late-life depression affects about 6.5 million Americans age 65 and older, but only 8% to 10% receive treatment (Reynolds & Kupner, 1999). Older patients with significant symptoms of depression have roughly 50% higher healthcare costs than non-depressed seniors (Reynolds & Kupner, 1999). Thus, it becomes difficult for the elderly to maintain medical bills in addition to other medical costs.

As we analyze treatment for geriatric depression, the causes and effects of this silent predator must be understood. Depression later in life frequently coexists with other medical illnesses and disabilities. Advancing age is often accompanied by the loss of social support systems due to the death of a spouse or siblings, retirement or relocation of residence. Furthermore, depression tends to last longer in elderly adults and increases their risk of death. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increased the likelihood of death from those illnesses (Lee, 2001). Depression has also been associated with increased risk of death following a heart attack. Clinical depression can be triggered by long-term illnesses that are common later in life, such as diabetes, stroke, heart disease, cancer, chronic lung disease and Alzheimer's disease.

The most compelling consequence of depression later in life is increased by mortality from both suicide and medical illness. Bereavement depression often coexists with another dimension of emotional distress, which has been termed traumatic grief. The symptoms of traumatic grief are a combination of both separation and traumatic distress. Elderly who are depressed often have poor eating habits, so it is difficult to determine whether the vitamin deficiency is a cause or result of depression. As a result, doctors often recommend that depressed patients try to improve their eating habits and take a multivitamin along with other treatment. However, appropriate treatments for this phenomenon still need to be developed and tested.

Accordingly, the role of the registered nurse (R.N.) lends itself an increased responsibility as well as accountability. This role of service is so essential to quality healthcare that many have turned to private home-nurses for their end-of-life care. The interactions between nurse and patient play an important role in receiving the best possible treatment for the patient. A nurse assesses all available information on the patient, acts as the liaison between doctor and patient, and when the doctor is not around, acts as the primary caregiver. These responsibilities become even more essential when the nurse does routine check-ins, monitors all vital signs, and speaks to the patient on a frequent basis. This is the key to diagnosing geriatric depression; a simple conversation can enable a nurse to determine some revealing components to depression.

For example, useful questions a nurse asks their patient is "Are you sad?" "Are you sleeping poorly?" And "What have you enjoyed doing lately?" The responses to these questions give a glimpse into the state of mind of the patient. These questions obviously do not determine whether the patient should be diagnosed as depressed but it allows the possibility to be further explored and assists in a future diagnosis of depression. Results of a study of 33 registered nurses that worked with elderly patients on a regular basis in the medical and surgical units of a large tertiary care hospital revealed three major themes of assessment of the elderly (Lee, 2001). The themes impacting nurses' assessment and management of depression were time, knowledge and resources (Lee, 2001). Nurses reported that they lacked time to adequately assess depression in elderly because of the complexity of its manifestation in this population and the limited interaction with patients due to short hospital stays and competing priorities.

To determine risk for depression, these nurses relied predominantly on physical symptoms, which require time with the patient and family for an accurate and thorough assessment (Lee, 2001). The nurses' individual background, with the exception of gerontological nursing experience, did not significantly have any influence on their assessment of depression (Lee, 2001). Nurses had inconsistent and incomplete knowledge of the assessment of depression with elders, including their failure to identify patient age as a significant factor (Lee, 2001). Nurses also had difficulty identifying strategies to implement their recommended approaches to improve the assessment and management depression with elderly patients (Lee, 2001).

Medical colleagues must be trained to elicit symptoms proactively through screening and questions. One of the major issues facing today's medical communities is the recognition and treatment of depression among elderly patients seen in the general medical sector. Another improvement that must be made to adequately improve the treatment of depression is appropriately prescribing medication for geriatric depression. The principal medication management errors include under-dosing, failure to consider proper drug interaction, discontinuing medication too early and unskilled polypharmacy. Another major issue is the failure to monitor outcomes, failure to educate the patient and their families, and compliance.

Another component of successful treatment in elderly is family interaction, as revealed by dramatic statistics in the depressed elderly with and without family support. For example, a geriatric patient with medically diagnosed depression with a family member that participates in an intricate part of their treatment has a higher opportunity of overcoming depression. Moral support during any traumatic situation is often considered to have a positive effect. Since an important contributor of depression is the lack of support, any support given to seniors becomes immediate non-medical medicine for the soul. In many cases the patient refuses to take prescribed medication, and therefore it become vital that a family member or a private nurse is there to ensure a balanced diet as well as monitor the medication intake.