40% of the residents require assistance with feeding. The high numbers of non-ambulatory patients put this facility put it among only 10% in the state.
On May 10, 2004 the facility was investigated for a complaint which resulted in a substandard quality of care under Quality Indicator number 4, a prevalence of depression symptoms that also include two of the following; negative comments from residents, agitation or withdrawal, unpleasant mode upon waking, suicidal, weight loss or recurring thoughts of death.
I choose the number 4 Quality Indicator for Emotional/Behavior Patterns due to its effect on quality of life. It may also be the end result of the other deficiencies at the facility, which included a high percentage of indwelling catheters, excessive amounts of medications and lack of assistance with personal care. The Quality Indicators for Emotional/Behavior Patterns of agitation and suicide could be signs of overdose of antidepressant medications. Sadness and withdrawal might be symptoms of depression as well as thoughts of death or weight loss, which needs to be treated. Depression encompasses both physical and mental health and can alter the responsiveness to nutritional and physical therapy as well as medical treatments. This deficiency has a potential for more than minimal harm.
As per guidelines of the American Medical Directors Associ...
Blood tests should include a chemistry profile, complete blood count, serum levels for anticonvulsant or tricyclic antidepressants, thyroid test or other levels pertaining to the individual in question.
Before addressing pharmacogenesis of depression, however, consider another factor: Depression in the older adult if often more difficult to diagnose than in younger people. One reason is a prevailing misconception within general society, and even with the professional community, that older adults are supposed to be depressed, that it a natural part of getting older. In fact, an older adult's functional status, or level of impairment thereof, is often more influential than mere aging in shaping a person's mood. The residents of nursing homes usually have significant levels of debilitation, often arising from numerous chronic conditions. The complex nature of these conditions often frustrates physicians and treatment staff, often leading residents to have a sense of sadness or depression. (Garavaglia, 2006)
If psychological testing and laboratory testing demonstrate that the resident is in need of psychiatric services, medical treatment or a medication adjustment and those measures lead to improvement, then the nursing staff needs to monitor the behavior and attitudes of the resident to prevent any digression or reaction to prescribed medications.
If the depression does not appear to have a physical cause then assessment of the resident's environment and quality of life is the next step.
Nursing should ask a few questions to determine the Quality of Care Improvement Plan. Is the resident capable of doing more personal care for himself, but needs clothes laid out or some other measure to maintain some independence If the resident is