Impact and Presence of Depression within the Older Adult Population - Essay Example

Depression in Older Adults Depression in Older adults Introduction The paper seeks to have an understanding of various concepts related to mental health. Specifically, the paper will reflect on depression among the old adult population. The paper begins by describing the characteristic of depression in older adult population. Moreover, the paper addresses why depression has been an issue among the older adult population. In addition, the paper seeks to show the effects of depression on the age group described. Additionally, there will be a description of the effects of depression on family members and the nursing professionals. A variety of tools or methods that are used to assess depression within older adult will also be presented and discussed. Some of the relevant evidenced-based nursing strategies that have been utilized to address depression within the older adult population will also be presented and discussed. The last section will comprise the summary of key points that will be discussed. Impact and Presence of depression within the Older Adult Population Depression in older adult population has generated a massive attention. The attention has arisen due to the underlying effects in the older adult population. Although depression is prevalent in the age group, it is not a formal part of aging (Department of Health and Human Services, 2011). Rather, it is a medical problem tat affects many older adults, and it is possible to eliminate it through proper treatment. However, the problem needs to attract proper attention due to lack of recognition and effective treatment in older adults. On the other hand, it is essential to describe some of the common types of depression affecting older adult’s population. There are three common types of depression. They include major depression, minor depression, and dysthymia (Department of Health and Human Services, 2011). The major depression is characterized by lack of proper sleep, inability to eat, and lacks enjoyment in pleasurable activities (Department of Health and Human Services, 2011). The main symptoms of depression include depressed mood, loss of interest, disturbed sleep, weight loss, fatigue, and restlessness. On the other hand, minor depression does not have severe symptoms as other depression. It is usually characterized by depressed mood and loss of interest (Department of Health and Human Services, 2011). The other type of common depression is dysthymia and is characterized by long-term, chronic symptoms that act as a hindrance to normal adult functions (Department of Health and Human Services, 2011). The condition is characterized by persistent negative perspective and low mood. The presence of depression in the adult population leads to significant effects. First, presence of depression in the population may lead to amplification of effect to individuals with chronic disease. Such individuals may fail to follow guidelines available to medical treatment protocols (Klemenc-Keti, Kersnik & Tratnik, 2009). Failure to follow the laid guidelines may lead to difficult clinical courses. The complication may occur in terms of increased risk to complications and poor health outcomes (Klemenc-Keti et al, 2009). The statement is true as depressed individuals are less likely to remember the dosage required, time of taking drugs, and feeding habits required of chronic diseases such as diabetes. Secondly, there is a challenge in identifying depression in older adult population. Consequently, most of the condition goes untreated in the population. Failure of treatment leads to health status deterioration of patients with time. The effect is noticed by reduced work output, poor quality of life, reduced interpersonal relationships, and other medical conditions (Klemenc-Keti et al, 2009). The challenges are real as some of depression such as major depression affects individual functioning and quality of life. Hence, individuals that go through this depression without being noticed will be affected significantly. In addition, the depressions are also likely to increase the effect of disabilities associated with many medical conditions (Klemenc-Keti et al, 2009). As a result, the individuals health status may worsen. The possibility of these effects is that such individuals will be unable to take care of themselves, as is the case of normal patients with no mental condition. Impact of the Presence of Depression in Older Adults on Family Members Depression in older adults affects family members in various ways. As a result, it has become a subject of concern to both individual patients and society. First, a depressed individual requires an increased attention from the family members. Most of the depression results in patients being unable to take care of themselves (Klemenc-Keti et al, 2009). As a result, individual affected by depression at an old age are usually too weak to take care. Therefore, family members are forced to dedicate most of their time in taking care of the affected individual (Singh & Misra, 2009). On the other hand, taking care of such burdens leads to enormous social and emotional burden. Therefore, caregivers in the family are most likely to be affected by the condition just as the individual affected. The condition may get complicated if a person is also suffering from chronic diseases (Klemenc-Keti et al, 2009). The reason is that extra care and attention will be required from family members. Secondly, family member’s emotions may be affected significantly. Taking care of elderly parents may affect the family members (Singh & Misra, 2009). Moreover, those taken care of are also affected. For example, a parent being taken care of may feel depressed or traumatized by changes in health and independence (Singh & Misra, 2009). At the same time, changes in mood will affect those who care for them. Moreover, mental illness in old people affects their spouse in significant ways. Research shows that a mental problem of one partner is most likely to lead to illness on the spouse (Robinson, Rodgers & Butterworth, 2008). A study carried out showed that major depression was twice likely to occur in spouses whose partner had major depression as compared to other healthy collaborates (Robinson et al, 2008). The argument on the study was that spouses are subjected to similar environment and experiences. The correlation arose as a mental problem on one spouse affect mental health of their spouse due to difficulties in their relationship arising out of depression (Robinson et al, 2008). The difficulties may arise due to effect on economic and living conditions, or the increased burden of the spouse caring for the other. Additionally, having parents with mental illness may affect children in different ways. The main effect can result for children having to take care of their parents. Children may also be affected indirectly through impacts on their social and emotional health and wellbeing (Robinson et al, 2008). In fact, the problem may be worse if the children are at their tender age. Moreover, other aspects of the children may be affected significantly. For example, a depressed father may be unable to meet the responsibility in the family sand this may lead to aggravated social problems. Such children may also be at risk of developing mental health problems (Robinson et al, 2008). Children may also face challenges in terms of expressing their feelings, emotions and reactions because of having a mentally ill parent (Robinson et al, 2008). Impact of the Presence of depression (in Older Adults) on the Nursing Profession There are various reasons that motivated research on this particular topic. One of the reasons is the increased number of people seeking help. Moreover, the number of an aging population has been on the rise in the countries. As a result, it is expected number of people seeking professional help on the condition will increase in the future. Therefore, having a deeper understanding on causes and effects of mental illness will help prepare an individual for any eventuality. In addition, a deeper understanding will help in equipping nurse with the necessary knowledge required to take care of patients. The rise of depression in older adults has overriding consequences on the nursing profession. First, the increase of mental health condition on older people has led to shortage of mental health professionals (Hartford Foundation, 2011). As a result, the number of nurses available to older people is few. The situation will worsen as the number of adults with depression continues to increase (Hartford Foundation, 2011). On the other hand, there are challenges on certain profession required to take care of patients with mental conditions. The individuals that enroll in some of the professions related to care of patients are faced with challenges of inadequate training. For example, geropsychiatric nursing is subjected to uneven and often inadequate training on geriatric mental health (Hartford Foundation, 2011). The poor form of training exits while these professional are essential in the provision of mental health care to patients. Moreover, there is little progression in the profession as only few graduates programs are available for advanced practice geropsychiatric nurses (Hartford Foundation, 2011). The consequence is the availability of few professionals in this field necessary for improving care for older adults with mental challenges. Moreover, there is reduced teaching on gero-psychiatric content to nursing students (Hartford Foundation, 2011). In addition, there have been few programs related to depression in old adult. In fact, only few programs in the nursing field cover significantly the aging concepts (Hartford Foundation, 2011). There is also no examination that can ensure one gets a certificate for specialty in geriatric psychiatric nursing (Hartford Foundation, 2011). As a result, there are no adequate nurses prepared in the filed. This means that nurses in other professions are forced to take care of individuals that could have gotten care from professionals in the field of psychiatry. Hence, most of the nurses are overworked due to the ever-rising number of depressed old adults seeking professional help and care. In addition, there has been a rise of negative perception on those working with older people. The perception is high on professionals working with older adults with mental challenges such as depression (Hartford Foundation, 2011). The effect has seen the reduced number of people willing to work with old people. Therefore, an increasing number of depressed old people act as a strain to few professionals that have specialized in the field. Moreover, there has also been limited funding for individuals willing to specialize in taking care of the old generation in the society (Hartford Foundation, 2011). Moreover, depressed individual constantly visits hospitals. As a result, they require constant care, and this adds additional wok to nurses. The problem may get worse if the depressed patient is suffering from other chronic conditions (McCabe et al, 2009). The depressed patients are likely to overstay in hospital leading to extra work for nurses. They also require specialized care and attention as compared to other normal patients. The individuals are also most likely to use more than normal medication due to multiple effects arising from the condition. Therefore, depression in old age acts as an extra burden to nurses in hospitals. There is also development of stress on professionals working with older people with mental challenges. The stress arises due to lack of adequate time for catering for the needs of the patients. Some of the care staff working with older people has limited time to devote in identifying the psychological challenges experienced by patients (McCabe et al, 2009). On the other hand, some of the nurses have inadequate training responsible for meeting the cognitive and emotional needs of the patients (McCabe et al, 2009). The stresses in taking care of the patients have led to limitation on the nature of care providing by the nursing staff. Assessment Tools/ Methods Utilized to Assess depression in the Older Adult Population There are common assessment tools/ methods used to assess depression in the older population. The tools/method helps in establishing the extent and nature of depression. There are two common tools used in the assessment. One of the tools used is geriatric depression scale (GDS) (Greenberg, 2012). The tool is most commonly used in the adult population. The tool comprises of the 30-item questionnaire that are posed to the participants (Greenberg, 2012). The participant is supposed to respond with either yes or no in reference to their condition of the body in the last one week. There is also the short form of GDS comprising of 15 questions (Greenberg, 2012). The answering of fifteen questions positively indicates the presence of depression in the participants (Greenberg, 2012). The short form is used in less severe form of physical illness and less mental illness. The tool may be used in with healthy, medically ill, or people with mild cases of mental challenges. The tool has significantly been used in community, acute and long-term care settings (Greenberg, 2012). The tool has been shown to have higher validity and reliability. This was obvious through various tests. Its evaluation has shown that it has a high specificity and sensitivity in relation to diagnostic procedure. For example, a test against diagnostic criteria showed that the tool had 92% sensitivity and 89% sensitivity (Greenberg, 2012). The two aspects have been affirmed through clinical practice and research. Moreover, the two forms have a high correlation in differentiating symptoms of depression. In fact, it is easy to distinguish depressed from non-depressed adults making the tool more valid (Greenberg, 2012). However, tool has strength and limitations. The limitation is that the tool cannot serve as an alternative for a diagnostic interview by mental health professionals (Greenberg, 2012). The tool does not assess for suicidality (Greenberg, 2012). The other common tool is known as a comprehensive assessment. The tool entails the use of interdisciplinary process (Australia Department of Health, 2010). Some of the process includes history taking, observation, measurement, testing, and evaluation. The processes are used based on medical, physical, social, and cultural dimension of the need. The focus of the tool is to diagnose the exact nature of problems (Australia Department of Health, 2010). Hence, one is able to plan and deliver appropriate preventions, intervention, and management strategies. In a person centered assessment, both the patient and family or care provider are involved (Australia Department of Health, 2010). The strength of the tool is its diverse nature. As a result, the tool can be used by any health care provided with sufficient knowledge and skills. The assessment is usually completed with the 24 hours after patient admission in the hospital (Australia Department of Health, 2010). Example of the assessment tools includes InterRAI Comprehensive Assessment Tool and Caulfield Hospital Interdisciplinary Assessment Tool (IDAT) (Australia Department of Health, 2010). The assessment tool should be used for the following purpose. The purposes include knowing the patient, identification of nature of the problem, prescription of risk minimization; reduce risks, and facilitation of care planning. The author acknowledges that the information obtained must be used to develop appropriate treatment, care, and promotion of optimal recovery for normal functioning (Australia Department of Health, 2010). Evidence-based Nursing Strategies Utilized in addressing depression in the Older Adult Population There are various nursing strategies used in addressing depression in older adult population. However, there are four common approaches in addressing depression in the population. One of the strategies is psychotherapy interventions (Department of Health and Human Services, 2011). In this strategy, mental health disorders are treated by talking about mental health problems and underlying issues with the mental health practitioner (Department of Health and Human Services, 2011). The strategy may also be viewed as a form of counseling the individual affected. The strategy helps in identifying the problem of patient through interactive discussion. The other strategy involved administration of drugs. The strategy employs the use of antidepressant medications. The drugs help in normalizing chemical substances found in the brain known as neurotransmitters that are usually disrupted in persons with depression (Department of Health and Human Services, 2011). The strategy is of the essence as it helps in offering specific intervention. The third strategy is known as multidisciplinary geriatric mental health outreach services (Department of Health and Human Services, 2011). The strategy provides services outside the hospital setup. The services are taken to the homes of older adults or in the places where older adults spend most of their time (Department of Health and Human Services, 2011). Two models are highlighted in this strategy. They include Psychogeriatric Assessment and Treatment in City Housing (PATCH) and Program to encourage Active, Rewarding Lives for Seniors (PEARLS) (Department of Health and Human Services, 2011). PEARLS are usually focused on home based practices. The process entails an in-home counseling session (CDC, 2009). The strategy helps in reaching most of the affected individuals that cannot make to go to health care institutions. The other strategy is known as collaborative and integrated mental and physical health care services (Department of Health and Human Services, 2011). In this strategy, mental healthcare is provided in the primary health care setting (Department of Health and Human Services, 2011). The success occurs out of cooperation between mental health and physical health practitioners. The strategy employs two models. They include Improving Mood, Promoting Access to Collaborative Treatment (IMPACT) and Prevention of Suicide in Primary Care Elderly (Department of Health and Human Services, 2011). In IMPACT, the participants are identified by primary care provider or through regular screening. In the initial contact with the participants, the depression care manager assesses the participants and educates them on depression and available treatments (Centers for Disease Control and Prevention (CDC), 2009). The participant is also encouraged to choose the preferred form of treatment. Moreover, the individual is encouraged to take place in physical activities and pleasant events (CDC, 2009). The strategy helps in ensuring treatment is offered through emotional and physical exercises. The strategy used depends on the clinical interventions. For example, in specific clinical intervention both psychotherapy interventions and antidepressant medications are recommended (Department of Health and Human Services, 2011). On the other hand, mental health outreach services and collaborative and integrated mental and physical health care are effective in service delivery models (Department of Health and Human Services, 2011). Moreover, some of the interventions have been proven effective in the treatment of depression. They include psychotherapy interventions and antidepressants medications. In some situations, the strategies are effective when used in collaboration. The implementation of EBP’s is based on various factors. First, one has to make a decision in identifying the best strategy to adapt to a particular patient. In implementing the strategy, one has to ensure there is sufficient need for the strategy in any population. The need for any strategy depends on identification of a specific problem in an individual. A strategy may be affected by funding, staff availability, and resources for training practitioners (Department of Health and Human Services, 2011). Conclusion The effects of depression have been rampant in old adult population. The effects have been due to the increased incidence of the condition among the old adult population. The effect is then transmitted to the family members and society. In the family set up with depressed individuals, members are affected in various ways. The effects are common in the spouse of affected individuals, children, and communities. The most common effects are loneliness, mental breakdown, as well as strained financial conditions. On the other hand, the nursing profession is affected in significant ways. The most common effects are stress and lack of ample skill to care for the depressed individuals. In addition, it is clear there are valuable assessment tools for the condition. The most significant are GDS and comprehensive assessment. Moreover, various strategies have been shown effective in addressing the condition. The strategy seems to be related to the condition of the affected individual. Understanding various aspects of depression may help heath care providers in addressing challenges faced by individuals. As a result, proper training of health care providers such as a nurse is crucial in management of the condition. References Australia Department of Health. (2010). Assessment. Retrieved from http://www.health.vic.gov.au/older/toolkit/03Assessment/index.htm. Centers for Disease Control and Prevention. (2009). The State of Mental Health and Aging in America. Retrieved from http://www.cdc.gov/aging/pdf/mental_health_brief_2.pdf. Department of Health and Human Services. (2011). Depression and Older Adults. Retrieved from http://store.samhsa.gov/shin/content/SMA11-4631CD-DVD/SMA11-4631CD-DVD-KeyIssues.pdf. Department of Health and Human Services. (2011). Selecting Evidence-Based Practices. Retrieved from http://store.samhsa.gov/shin/content/SMA11-4631CD-DVD/SMA11-4631CD-DVD-Selecting.pdf. Greenberg, S. (2012). The Geriatric Depression Scale (GDS). Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf. Hartford Foundation. (2011). Mental Health and the Older Adult. 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