Depression in older adults: prevalence, causes, and nursing interventions

Therapeutic Intervention
Part A
Introduction
One of the major challenges that older adults (ages 65+) face in terms of a mental health issue is the problem of altered mood—i.e., depression (Cornwell & Waite, 2009; Landeiro, Barrows, Musson, Gray & Leal, 2017). This paper will be divided into two halves. In the first part, it will describe the prevalence of depression among the elderly population and use a biopsychosocial framework to explain the causes and risk factors of depression in this population. It will describe the spectrum of changes in behavior, cognition, mood, physical functioning and communication that may be experienced by the individual with this mental health issue. In the second part, the paper will discuss one non-pharmacological therapeutic intervention that is available to assist people in this population in order to manage the health issue. It will include a discussion of the effectiveness (not efficacy) of the approach as well as any drawbacks of the approach that may be experienced by individuals. This section will finish with an explanation of one salient consideration for nursing practice when working with a person from the elderly population group suffering from depression.
Prevalence
The prevalence of depression among the elderly population has been assessed to be between 10% and 20% depending upon cultural backgrounds (Barua, Ghosh, Kar & Basilio, 2011). Pilania et al. (2019) conducted a systematic analysis of literature published on the elderly population over the course of forty years and concluded that approximately 34% of this group will suffer from depression. Mirkena et al. (2018) has placed prevalence as high as 40%. Elias, Neville and Scott (2015) have placed the reate of loneliness and depression among the long-term care elderly population as high as 56%. The World Health Organization has estimated prevalence for the global elderly population to be 15% (WHO, 2017). Among the American elderly population, Steffens et al. (2009) found the prevalence rate to be 11.19%. In short, there is a wide range from roughly 10% to 50% of the elderly population who may experience depression as a result of their environment, condition, or place in life.
Causes and Risk Factors
Causes for depression among the elderly population can range from biological to psychological to sociological factors. Biological causes include the process of ageing, which can result in the individual’s body not responding the way it used to—as is the case with Parkinson’s (Frisina, Borod, Foldi & Tenenbaum, 2008). This can lead to adjustments needing to be made that the individual does not want or does not know how to make (Brojeni, Ilali, Taraghi & Mousavinasab, 2019). Psychological causes such as memory problems such as dementia or Alzheimer’s can be afflictive and worsen an elderly person’s mood can be an issue (Osman, Tischler & Schneider, 2016). Sociological factors may also be a problem, such as the elderly person living alone or living in a nursing home without any visitors ever coming to visit (Banks, Willoughby & Banks, 2008). Or they may suffer from elder abuse and become depressed from this experience (Jackson, 2016). There is also the problem of ageism and of the elderly population fearing the taboo of aging and becoming a burden on others, which can lead them into depression as there is really no way to prevent aging from occurring (Davoodvand, Abbaszadeh & Ahmadi, 2016). Risk factors include nutrition (which can help maintain a healthy and strong body and mind), exercise (to help prevent falls), and strong familial support systems (to help prevent isolation and/or abusive situations from occurring). Neglecting these areas can lead to significant risk of depression for the population.
The spectrum of changes in behavior, cognition, mood, physical functioning and/or communication that may be experienced by the elderly person suffering from depression includes anything from secluding oneself in one’s room (isolation) to wanting to commit suicide. The elderly person who is depressed may cease attempting to socialize with others; may stop eating altogether; may stop taking medicines that have been prescribed to help with health related issues (Yamada et al., 2015). The elderly individual who is suffering from depression may not even show any signs—may join in social activities, talk, and take medications—but there are times where alone that the person feels incredibly lonely and sad, and these are times that can be intensely personal and isolating. It helps therefore to have a confidante and many elderly persons lack such a confidante simply because of the nature of their circumstances, their environment, and the way their lives have taken them.
Part B
Reminiscence Group Therapy
One non-pharmacological therapeutic approach that is available to assist elderly people suffering from depression so that they can manage their mental health issue is reminiscence group therapy (Liu, Lin, Chen & Huang, 2007). As Elias et al. (2015) show, this type of intervention is successful at treating loneliness and depression among the elderly population because it allows the elderly population to open up, reflect on the past and share stories that are meaningful to them. It provides an opportunity for socialization with others of the same age group, which allows for unity and true communality that cannot be had when older people socialize with younger people who are of a different generation and a different mindset.
The Approach
The reminiscence group therapy approach is based on the idea that participants gather together in a group to share personal stories from the past with their peers (Gaggioli et al., 2014). It allows elderly individuals to recollect and review their past experiences and re-evaluate their lives with others, which allows them to gain clarity and perception, peace and understanding. This is something that they are unlikely to have access to especially if they are isolated for long and not engaged in routine socialization exercises. It can lead to self-acceptance, increased perspective, and even to the resolution of past troubles (Butler, 1974). According to Elias et al. (2015), the goal of this approach to alleviating depression for the elderly “is to perform a critical analysis of one’s life history and achieve ego integrity” (p. 372). By achieving ego integrity, the individual can possess greater satisfaction and joy with what one’s life has been.
The approach is based on a number of different theories, including disengagement theory, which posits that by focusing on reminiscence and memory the elderly person can distance himself or herself from the living and better prepare himself or herself for death. Another theory that is used is ego integrity theory, which posits that the individual can gain satisfaction and a sense of fulfillment by sharing stories about the past with others. Then there is continuity theory, which posits that by reflecting on the past, elderly persons can come to better prepare themselves spiritually for the future and for life in the next world.
The method for this approach is taken by having participants come together in one room where they are asked to share stories and experiences relating to specific phases of their lives—whether a time period in linear history or a period or in their own life history. The participants take turns telling their stories and listening to the others. The exercise is semi-structured and participants are permitted to ask questions or to comment on one another’s stories and they are encouraged to keep it positive and supportive (Elias et al., 2015).
Effectiveness
The effectiveness of the intervention is demonstrated by numerous researchers, from Liu et al. (2007) to Elias et al. (2015) to Tarugu et al. (2019). Tarugu et al. (2019), for example, found that the approach “resulted in an improvement of 66.7% in depressive symptoms, 33.3% in anxiety and 30.8% in loneliness” (p. 847). The approach has been found to be effective primarily because it promotes the interaction that lonely elderly people lack and it provides them with an opportunity to share with others details from their own lives that allow them the chance to reflect more deeply on what their own lives have been about, what they have meant, and why they are important, and this gives them meaning at a crucial point in their age.
The two types most often used are integrative reminiscence therapy and instrumental reminiscence therapy. The former focuses on addressing and accepting whatever effects from negative events from the past are still lingering in the elderly person’s life. The latter focuses on identifying goals enabling the elderly person to drum up courage and strength from the past in order to achieve those goals.
The elderly participants learn coping skills, give and receive counsel to and from one another. After 12 weeks of reminiscence group therapy, elderly persons are more likely to report significant decreases in depression levels than elderly persons who do not engage in this approach to therapy (Wu, 2011). Participants are more likely to report a greater satisfaction level with life overall.
Drawbacks
Drawbacks that may be experienced are that it requires the individual to be willing to engage in some sort of socialization. Some elderly patients may be so depressed that they do not want to engage at all and are beyond taking part in any sort of sharing exercise. Another drawback is that it depends upon the person having all his or her faculties in place so that recollections can be conducted. An elderly person suffering from dementia or from Alzheimer’s is unlikely to reap any benefit from this type of intervention as it relies upon a healthily functioning mind.
A Consideration for Nursing Practice
One salient consideration for nursing practice when working with a person from the population group with this mental health issue is that individual elderly persons need to feel supported, appreciated, and welcome in their environment. Any negative attention that they receive, particularly from nursing staff, is going to be felt personally by them and will likely result in feelings of offense and dislike. Elderly people have a great deal of life behind them and they want to feel like they are respected by others. They want to feel like their life has had value and that means they want others to appreciate that fact and reflect that value in the way they approach them.
Nurses therefore should show empathy and appreciation for what elderly persons have been through in their lives and especially if the elderly person is still dealing with some trauma or with some negative emotions from earlier in life. The nurse can recommend this intervention as a way for the elderly patient to address that trauma and put it to bed. The nurse should never force the depressed elderly patient into doing something that he or she does not want to do, however. That could lead to even more disappearance into the self and a further retreat into isolation and depression. The aim is promote positivity, mental health and recollection. If the nurse must take small steps in order to get the patient to a point where the patient is able to open up in small ways initially, the nurse should embrace that opportunity.
Conclusion
The elderly population is one of the largest populations in the world likely to suffer from some form of depression. This is mainly caused by a coupling of biological with mental and social problems. For instance, the body begins to break down, the mind begins to be afflicted, and social isolation sets in. All of this leads to a decline in joy and happiness and the individual can become depressed. To overcome feelings of depression, one intervention that can be applied is reminiscence group therapy. This therapy focuses on bringing participants together so that they can open up to one another, share personal stories about their pasts with one another, listen, and offer and receive counseling. The aim is to get the participants to find joy in sharing, to recollect and obtain meaning and perspective, and ultimately to come to terms of peace with themselves and with what their lives have been.


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