Therapy With Older Adults Essay

Therapy With Older Adults Essay

Therapy with Older Adults

The client in this case study is a 69-year-old, widowed, African American man. He is self-referred to the clinic to get help with his anxiety and depression. After listening to the clients concerns and getting his background information, I would give him the diagnosis of major depressive disorder (MDD). The complete diagnosis with coding would be major depressive disorder, recurrent episode, severe, without psychotic features, with anxious distress, and melancholic features (Association, 2013). According to the DSM IV, in order to be diagnosed with MDD there must be five or more symptoms from the list of criteria, it should represent change from the individuals usual behaviors and be present over at least a two week time period (2013).Therapy With Older Adults Essay

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The client is experiencing at least eight symptoms, making the MDD severe, from the listed criteria that have negatively impacted important areas of his life and are not directly correlated with a substance or medical condition. His history does not indicate that any of the symptoms he is currently experiencing can be classified as a mixed episode, manic or hypomanic episodes, and he is not showing signs of schizophrenia or any psychotic features (Substance Abuse and Mental Health Services Administration, 2016). This is also recurrent; the client has had episodes of depression and anxiety in his past. He reports that he feels depressed at least most of the day which is also noticed by his son, he has lost interest in activities that used to bring him pleasure like volunteering at the nursing home and being with his family, the client is experiencing insomnia which is exhibited by him stating that it is hard to fall asleep at night, he is experiencing psychomotor changes exhibited by feeling like he is moving in slow motion, he says that he feels tired all the time, during the assessment it is noted that he is showing signs of guilt and rumination, he states that he has been having trouble concentrating while reading, and he also very preoccupied with the anticipated death of his father and previously his own death when he was diagnosed with prostate cancer (Substance Abuse and Mental Health Services Administration, 2016). The symptoms that he is experiencing fit the criteria for the diagnosis to be specified as anxious distress and melancholic features.Therapy With Older Adults Essay

Diagnosing and identifying the severity of MDD accurately and in a timely manner is imperative to initiate treatment. There are several physical exams and diagnostic tools that are routinely used to rule out other medical conditions, confirm a diagnosis of MDD, and identify the severity. Physical exam that focuses on the neurological and endocrine systems should be done to rule out any medical causes for the depression that the client is experiencing, and blood tests to check for anemia, thyroid function tests, levels of calcium, hormones, and vitamins should also be completed low levels of these can cause depressive symptoms (Giannelli, 2020). Diagnostic tools include the Patient Health Questionnaire-2 (PHQ-2), Patient Health Questionnaire-9 (PHQ-9), the Beck Depression Inventory (BDI), and the Geriatric Depression Scale (GDS) (Ng & et al., 2016). The PHQ-2 is a two-question tool that can be used in a busy primary care setting. The PHQ-9 is usually more readily used as the results are easily interpreted and understood, it is easy to administer, and highly accurate (Costa & et al., 2016). The BDI cover affective, cognitive, and somatic aspects of major depression, it is typically used in the outpatient setting it is also highly sensitive to accurately identifying MDD (Ng & et al., 2016). And finally the GDS has been proven to be reliable when screening and identifying major depressive disorder specifically in the elderly population, it is rather lengthy which would make it difficult to use in a busy office setting (Ng & et al., 2016). I would use the PHQ-9 for this client, I am familiar with this assessment and find it useful in detecting depressive symptoms.Therapy With Older Adults Essay

Differential diagnosis to consider would be persistent depressive disorder, adjustment disorder with depressed mode, and sadness. The has been experiencing these symptoms over a long period of time, feels hopeless, and is having trouble concentrating (Association, 2013). Psychoeducation should be provided to the client and his family, it should include depression signs and symptoms, the side effects of the pharmacological intervention, and information about the different treatment options to give the client the opportunity to be actively involved in his treatment (Guatam & et al., 2017).Therapy With Older Adults Essay

There are different treatment options for management of depression which includes antidepressants, electroconvulsive therapy (ECT) and psychosocial interventions (Gautam & et al., 2017). The success of any of these treatment options requires compliance and cooperation from the client. All antidepressants have been proven to be effective, but they all work differently depending on the client. Selective serotonin reuptake inhibitors (SSRIs) are typically the first line of antidepressants used, they are relatively safe and have less severe side effects (Gautam & et al., 2017). The client has been prescribed three different SSRI’s and two NSRI’s over the years which he reports as having little or no effect. The client denies suicidal ideations his safety is not in immediate danger currently. However, the immediate initiation of an antidepressant is warranted in this situation. I would start him out with a low dose of Trazodone at bedtime and taper up, it has been shown to cause drowsiness in some individuals which can aid in treating the client’s insomnia as well as his depression (Jaffer & et al., 2017).Therapy With Older Adults Essay

“Cognitive behavioral therapy (CBT) and interpersonal therapy are the psychotherapeutic approaches that have the best documented efficacy in the literature for management of depression” (Gautam & et al., 2017). As the PMHNP I would recommend using IPT to treat the client’s depression. The goal of this treatment is immediate symptom relief, improved relationships with his family, and to give the client tools and tips that he can use when stressors arise after treatment (Wheeler, 2014). IPT is structured and time limited acute treatment, usually 12-16 weeks of treatment is recommended (Cuijpers et al., 2016). Depression is common in the elderly, but it is not a normal part of aging, recognizing the symptoms of depression in older adults can sometimes be difficult but treatment of this disorder is imperative (Wheeler, 2014).Therapy With Older Adults Essay

Mental Health of the Elderly The elderly represents a large amount of the population in our society and continues to grow each day. As the population grows, it is important to meet the demands and resolve the challenges that we encounter in regards to the overall quality of health and well-being of the elderly. Mental health of the elderly is a major issue but majority of the time goes unnoticed and untreated by caregivers and loved ones. About 20 percent of adults 55 and older are suffering from some type of mental health disorder, and one in three elderly adults do not receive any type of treatment (The State of Mental Health, 2008). Those suffering from mental illness are hesitant to seek out help or any type of treatment because of the stigma, services and cost for care that then comes with mental health disorders. Mental health issues that affect elderly include dementia, delirium, and psychosis. Some of the most common conditions include anxiety, mood disorders such as depression and bipolar disorder and cognitive impairment such as Alzheimer’s disease. Therapy With Older Adults Essay
Late life depression affects about 7 million Americans 65 and older, but only 10 percent seek out and receive treatment (Depression in the Elderly: Symptoms, Causes, Treatments). Depression symptoms are different for every individual and sometimes the elderly can confuse mental illness to be side effects of medications they are currently taking. Medications such as steroids, benzodiazepines, and beta blockers may cause symptoms of depression. Also end of life changes such as loss of independence, being alone, and grief from a loss of a spouse are commonly linked to depression of the elderly. As individuals grow in age, neurotransmitters associated with well-being and happiness such as serotonin, dopamine, and norepinephrine begins to diminish (Elderly Depression: Depression and

This assignment aims to identify a public health need related to the authors’ current practice and a health promotion strategy to address the need. The health need chosen is Depression intervention in older Adults in the borough of Enfield. This health needs is derived from NICE, (2011) Depression in Adults Quality Standard, which highlights the identification, assessment and clinical management of depression symptoms. In addition, epidemiology data of the borough of Enfield highlighted the health need of this population group and the risk factors related to their ill health to increase awareness on preventive measures and to promote health.Therapy With Older Adults Essay

Rationale

The author is a district nurse and has chosen this health need due to her nature of work which includes dealing with a significant number of patients who live alone with persistent feeling of loneliness, sadness and loss of interest in her current practice. Due to increasingly ageing population worldwide, identification and treatment of depression in older adults becomes progressively more important, especially as older patients may have different presentations and needs than younger ones.

Depression is a serious medical condition in which a person feels very sad, hopeless, and unimportant and often unable to live in a normal way. In other words, it is a mood disorder that causes a persistent feeling of sadness and loss of interest. (Craig and Mindell, 2007).Depression in older adults is an important public health problem. It is associated with increased risk of morbidity, increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, all of which are in turn associated with increased mortality ( Blazer, 2003).Therapy With Older Adults Essay

Depression is part of aging process but it becomes a problem when it has an impact on the older adults daily functioning (Godfrey et al, 2005).Due to increasingly ageing population worldwide, recognition and management of depression in older adults becomes progressively more important, due to the fact older patients may have diverse presentations and needs than younger ones (Hasin et al, 2005). 10 to15 per cent of older people have depression symptoms; however, major depression is relatively rare in older adults (Hasin et al, 2005).

In 2011/12, Enfield GPs had 17,508 people over the age of 18 – 65 on their registers recorded as suffering from depression, equating to 7.99% of adults on GP lists in Enfield. This was below both the England and London rates of 11.68% and 8.07% respectively, though Enfield still had the 12th highest rate of recorded depression amongst all London boroughs.Therapy With Older Adults Essay

Depression can be mild, moderate or severe depending on the individual’s ill condition. Mild depression accounts for 70%, moderate depression 20% and severe depression 10% of all cases. It is estimated that depression is two to three times more common in people with a chronic physical health problem (such as cancer, heart disease, diabetes or a musculoskeletal, respiratory or neurological disorder), occurring in about 20% of this population.McCrone et al, (2008) estimated that the number of people identified with and requiring treatment for depression will increase by 17% to 1.45 million in 2026. The annual costs of depression as commonly quoted from two studies are being £9 billion in the UK (Office of National Statistics, 2009).

Health promotion strategy

District nurses can play a major role in health promotion. District nurses, more than any other sector, have the ability to prevent the development of many chronic diseases. Health promotion is defined in the Ottawa Charter (WHO, 1986) as the process of enabling people to increase control over, and to improve, their health as well as to reach a state of complete physical, mental and social well-being, an individual or group must be involves public policy change and community action to enable people to make changes in their lives.Therapy With Older Adults Essay

Health promotion is aimed at improving the health of an individual, community or changing behavior that may have a negative influence on health. A Strategy in health promotion is a plan of action that anticipates barriers and resources in relation to achieving a specific objective (Green & Kreuter 1991) cited in Egger et al. (2005). Although everyone feels sad sometimes, later life can give you more reasons to feel down. You may have to deal with: Stopping work, arthritis and other health problems or the death of love ones (Craig and Mindell, 2007). Older people often posses inaccurate knowledge about ageing and may under report symptoms as they believe these symptoms are attributed to normal aging (Robert and Baldwin, 2014).Therapy With Older Adults Essay

There are five different approaches in health promotion and these are: Medical or Preventive, Behaviour change, Educational, Empowerment, and Social Change. All of the approaches to tackle depression in the older adult in the day-to-day practice of district nursing will be discussed and comprehended in different ways of working. The Educational approach provides knowledge and information, and to develop the necessary skills so that people can make an informed choice about their health behaviour (Naidoo et al, 2009). (Ref) argues that, this may not result in behaviour change if the individual have not got the ability to use the information given.Therapy With Older Adults Essay

The educational approach consists of three aspects of learning. The cognitive aspect is the provision of information such as leaflets, booklets or one-to-one advice to patients so they can make an informed choice about their health behavior. The affective aspect provides opportunities for patients to share and explore attitudes and feelings. The third aspect of the educational approach is the behavioral aspect, which entails developing decision-making skills required for healthy living.

The behavioural change approach aims to encourage individuals to adopt healthy behaviours in order to improve their health. Naidoo et al, (2009) agrees that this approach is popular since it views health as a property of individuals. However, the older adults may feel they are been told what to do.Therapy With Older Adults Essay

Social change approach on the other hand relies on changing the environment to facilitate healthier life style. This approach has been indicated successful in previous health promotion, besides it can reduce the individuals’ freedom of choice and due to regulations and may discourage the individual from taking responsibility.

Empowering helps to identify any changes wished to be made to their lifestyles and enables priorities to be identified with support to help the older adult make changes tit her situations. Conversely, this might only be considered if the individual identifies them as concerns.

District nurses work in partnership with patients, families and carers to provide skilled nursing care at home, promote and maintain patient independence and provide education, advice and support to this targeted population group. All of the approaches encompass different ways of working. The most appropriate approaches identified to tackle depression in older adults in the day-to-day practice of district nursing which is the medical approach seeks to use treatment or screening to reduce ill health of the individual (preventive model). It aims to influence health through advice, instructions, persuasion, this requires relevant knowledge and expertise and helps to assess for the individual needs. However, preventive medical measures ignore the root causes of ill health. These will require exploring various top-down and bottom-up approaches to health promotion as stated by Beattie (1991).Therapy With Older Adults Essay

There are various health promotion theories that will influence the authors’ health promotion strategy as mentioned above. Beattie (1991) believes that, one can successfully take a recommended health action if they have (self efficacy). Beattie’s model of health promotion is a complex systematic model that acknowledges that health promotion is surrounded in wider social and cultural practices Wills and Earle (2007). Governments and health care professionals typically work in a ‘top down’ approach, through legislative action and health persuasion techniques. Here, advice and recommendations are handed out, and policies and interventions designed to increase uptake of these recommendations are established. The aim of this is to protect individuals and communities.Therapy With Older Adults Essay

However, both of these approaches on their own may disempower individuals through a ‘victim blaming’ culture and may therefore result in only limited change (Thomas and Stewart 2005).It showed the different ways in which education can put across different methods, which can help an individual’s health and wellbeing (Piper, 2007). The model identifies four paradigms: Health persuasion, Personal counselling, Community development and Legislative action. They contribute to achieving a whole picture when developing local action plans for partnership working (Piper, 2007).Besides District nurses should be cautious as it’s hard to identify the cause of a particular health problem as this model is generalised and not specific. Furthermore the model suggests that patient’s individual’s health related knowledge; behaviours and attitudes are the key determinants of their health status, as well as relationship between Health Care Professional (HCP) and patient Beattie, (1991). Beattie’s model supports this notion, by allowing us to analyse the complexities of health promotion approaches and by demonstrating that many agencies with many different approaches across all quadrants and axes are needed for well rounded health promotion policies and practice.Therapy With Older Adults Essay

When visiting a new patient, district nurses should carry a comprehensive holistic assessment to identify all the needs of the client. This involves getting to know the patient, family and their community while forming trusting, confident and mutual relationships (REF).Some adults with depression speak up and some remain silent however, there are things to look up to identify when people are depressed. Cognitive Behaviour Therapy (CBT) is a type of psychotherapy that looks at how you think about yourself, the world and other people around you affects your feelings and thoughts. It can also be helpful to look at the way our thoughts and feelings affect our bodies, and the physical sensations we can experience.Therapy With Older Adults Essay

CBT aims to get you to a point where you can “do it yourself”, and work out your own ways of tackling problems (REF). NICE (2009) recommends that any patient who may have depression (especially those with a past history of depression or who suffer from a chronic physical illness associated with functional impairment) should be asked the following two questions: During the last month have you been feeling down, depressed or hopeless? During the last month have you often been bothered by having little interest or pleasure in doing things? Other assessments include Geriatric Depression Scale, the fifteen items (GDS-15) and 4 item (GDS-4).The systematic use of (GDS-4) helps identify depression among the elderly.

The original GDS was a 30 item questionnaire which was time consuming and challenging for some patients (and staff). Depression assessments such as the 4 item Geriatric Depression Scale are easy and quick to perform with a high sensitivity and specificity. Patients who screen positive for depression should be considered for antidepressants and be reassessed cognitively when their depression has lifted. Although screening tools are useful, they should not be a substitute for clinical judgement. The patient’s history, family history and the existence of co morbidities should be taken into account when diagnosing or assessing depression (ref). Referral can be made to the GP due to the fact that one in six older people with depression discuss their symptoms with their GP, Therefore based on the District nurse’s assessment, this targeted population group will receive adequate treatment.Therapy With Older Adults Essay

How to consult the target population

The target population for district nurses will be the patients already on the caseload including their families, new referrals and residential care home patients and staffs.

The actual target for change will be identified with the individual for planning and setting of goals, (Lucas and Lloyd 2005). A qualitative study will be carried out in order to measure effectiveness before and after health promotion (Polit and Beck, 2012), as well as for confidentiality and anonymity. Thus looking at results to compare the before and after effect. A small size purposive sampling of patients from the caseload will be used. This will be achieved through face to face interviews with individuals. This step allows assessment for level of need and readiness to engage with the intervention. The nursing team will work together to implement the strategy through consultation, planning and delivery of person centered care. A team of six nurses will be involved to consult with 12 housebound patients who live alone, bereaved or have co-morbidity within the caseload. Each nurse will be allocated two patients to closely work with throughout the trial of the strategy. This will allow the nurse to build a rapport with the patient and have a good nurse patient relationship (ref).Therapy With Older Adults Essay

According to the Nursing and Midwifery Council (NMC) (2008), nurses should actively engage in person centred care and empower people by involving them in assessments and care in planning. This is further affirmed by GB NICE (2011). Individual face to face interviews will be conducted to and the level of need and readiness to engage with the intervention. Eager et al (2005) posits that face to face communication has a potential to influence and to build trust. (GDS-4) will be used to assess depression level. This scale will later be used to evaluate the impact of intervention. Information on available services, treatments will be discussed for choice of care and informed decision. Health education will be delivered using evidence based practice (ref). Health risks related to awareness of symptoms or not seeking for an intervention will be discussed. This will help the person to be aware of the severity of depression to their health and may consider the help available.Therapy With Older Adults Essay

Key stakeholders and resources

Stakeholder is a person or group with an interest, involvement or investment in something; Key stakeholders will be District Nurses, Carers and informal carers, GP, Local council Social workers, Mental Health services, Residential care homes, Families Clinical Commission Groups, Community leaders’ e.g. Religious leaders, Health and wellbeing board, Age concern, voluntary organizations, human recourses and commissioners. This will be a key for successful health promotion strategy which will be available due to the target group of people and good accessible resources (Linsley et al 2011) and is a useful comprehensive approach. Staff training will be required to implement this strategy. For example the recognition of the first three symptoms that are regarded as particularly important which include Depressed mood Loss of interest and enjoyment in the things the older adult enjoy doing most, (REF).Therapy With Older Adults Essay

Even though the district nurses have a very busy caseload, time will be required to be allocated deliver support which might have an impact on recourses as nurses will still have to deliver care to patients and clinical duties. Nevertheless nurses are required to deliver health promotion on every patient contact, a more passionate person specific service such as the age concern will be more effective as it engages both the nurse and individual to work very close to achieve the set goal (Ref) Patients who need input from other agencies will be referred for example, community psychiatric nurse and GP for home visits. Although, this strategy is for housebound patients, carers, families and friends might benefit as well as nursing care is holistic and looks at a person as a whole including their family and environment.Therapy With Older Adults Essay

Patients and local communities will be involved as stakeholders to ensure services are relevant to the local context (Naidoo and Willis, 2005) and to encourage people to feel empowered and to be able to measure satisfaction. The community Commissioning will be sought from the local health services provider who will be the key stakeholders. Communication and liaison will be made as required with the stakeholders for progress and update on the program.

Outcome

The uptake of the service aims to increase awareness, improve quality of life and reduce stigma in depression within the local community and it is anticipated that at least three quarters of the participants will identify early onset depression in older adults. It will also reduce the annual cost of treatment depression. The outcome measurement can be biased due to possible exaggeration of costs. The long term outcomes will be to reduce prevalence of depression in older adult by 10% in 5 years. The evaluation of the strategy seeks to determine whether the program has had an impact on health knowledge, empowerment and behaviours and whether it has contributed to reduction in health risks and society. It is also for the commissioners to decide on the continuity of the programme and for the nursing team to determine if this is the best approach for the target population.Therapy With Older Adults Essay

Linsley et al (2011) affirm that it is imperative to evaluate a program to determine its usefulness to service users or commissioners and deciding on whether to continue with the program or to highlight any need for improvement. Team members and the managers will work together in evaluating impact of care on quality of life of patients. This information will be needed after a year. However, the process evaluation will be performed every three months or as required to allow for improvements on effectiveness, safety and ensuring that the aims of the strategy are being met (Siriwardena, 2009). Also the commissioners might be interested in knowing the cost effectiveness of the programme and whether it’s sustainable. They may want to compare with other programmers running in local community centers.Therapy With Older Adults Essay

Face to face in depth interviews and evaluation questionnaires will be used to collect data about the impact and outcome of the strategy. Mead et al, (2008) recommend qualitative research in gaining information about patient satisfaction for purposes of improving care. This is further supported by Holloway and Wheeler (2010) who appraise its holistic approach in individuals. However, this method is costly and data analysis can be difficult (Siu and Comerasamy, 2013). Validated questionnaires will be used and support will be given to participants who need help reading and understanding question due to visual impairment or language barrier. Information on program implementation, whether patients felt empowered and in more control over their health and if their relationship with the nurse contributed to their openness. As such, increased knowledge will be included in the questionnaire. Depression level will be assessed on those who were involved in various activities and programmes and compared with baseline assessment. Nurses will continue to monitor and observe patients during routine visits and offer support as needed. Information gained will be used to improve the strategy and in decisions regarding sustainability and continuity of the programme.Therapy With Older Adults Essay

Conclusion

This assignment has highlighted the early identification of depression in the older adult. It has demonstrated that the use of health promotion theories and approaches can help nurses and individuals during the stages of education, social change and empowerment. The evaluation of the strategy will be used to develop services tailored to meet the needs of communities.

Depression in older patients has become an issue of concern due to the nature of its prevalence. One in every four elders has been noted to exhibit symptoms of depression. In the nursing profession, there are the treatment practices that are currently used. There have also been certain innovations and calls for research in various treatment methods. There are however certain barriers when it comes to the diagnosis and treatment of depression in these patients due to the nature of relationship between the patients and their caregivers or health officers in residential homes.Therapy With Older Adults Essay

Treatment of Depression
Older patients who exhibit depression are usually given anti-depressants. These drugs are suitable for patients that have moderate to severe depression. The choice of the depressant will depend on several factors such as the patient’s reactions to other anti-depressants and any side effects of the drug (Katz, 1996). The patients can also be treated using electroconvulsive therapy (Pridmore & Turnier, 2004).Therapy With Older Adults Essay

Aside from the medical treatment, the patients can also undergo psychological treatment approaches such as cognitive behaviour therapy and interpersonal therapy. The medical approaches tend to deal with severe situations while the psychological approaches focus on addressing social factors (Crowe & Luty 2005).

In the recent past, it has actually been preferred that the nurses or health officers should use a combined treatment method where the person undergoes therapy even as he takes the anti-depressants. This combined treatment has been found to be quite effective (Hollon, Jarrett, Nierenberg, Thase, Trivedi & Rush, 2005). Psychological treatment approaches are also prescribed to patients who have not responded well to the medicine and for those who are facing low social support or other environmental challenges. Therapy is also crucial as it assists the patients after the discontinuation of the anti-depressants (Cathy, Christensen & Griffiths, 2005).Therapy With Older Adults Essay
In therapy strategies, activities such as reminiscing have been found to uplift the patients and reduce depression. The nurse communicates with the patients on his past life and they discuss previous work and family life. There can be the use of photographs, scrap books and other items that help the patient to remember.

The nurses may also choose to mobilize social support for the patient (Chan, 2009).. This may require the nurse to contact direct family members and other relatives and convince them why it is important that they visit the elderly patients. The feelings of isolation and uselessness will start to decrease once the patient realizes there are people who are actually concerned about his or her health (Cummings, 2004)

Resident and Caregiver Relationships with Patients
There are several barriers when it comes to the treatment of depression. First of all there is the traditional stigma associated with the people who have mental diseases (Haralambous, Lin, & Briony, 2009). The patients may be reluctant to report to the medical officers when they have symptoms that indicate mental challenges or depression (Andrew & Dulin, 2006). Due to the stigmatization and fear, sometimes the patients choose not to continue with the medication or they do not take the treatment as often as is recommended. They may also be less willing to attend the group therapy sessions.Therapy With Older Adults Essay

They will also tend to prefer to go to the general care treatment centers instead of the mental health specialty centers. The patients who are at home need the family to provide an environment where the patient does not feel stigmatized or discriminated against.

There are also other barriers when it comes to receiving healthcare for the patients who are at home. The centers for treatment and therapy may be located in unsuitable locations causing the family to face practical challenges in terms of cost and transport when taking the patient for check-ups. If the family does not seek to improve the situation, they may give up on being consistent and the patient will miss out on important treatment affecting recovery.Therapy With Older Adults Essay

There needs to be more initiatives where the people are generally educated about mental health and the treatment approaches available. It is also important to communicate the benefits of the treatment to the older patients and their family members. There are also discriminative attitudes towards the elderly where people generally avoid them and do not pay to them adequate attention even in the homes.

The health officers may tend to patronize the older patients or listen less to what they are trying to communicate. Anything they say is simply seen as just one of the signs of aging and not any other another medical condition (Koritsas, Davidson, Clarke & O’Connor, 2005). . The risk of undiagnosed depression is higher in the male population because the women will probably narrate to the heath officer of any crying spells or any other affective symptoms. Physical symptoms or conditions will also compete with depression to get the health officer’s attention. The officer is more likely to pay attention to the physical conditiond leading to misdiagnosis and eventual lack of treatment (Mitchell, Woodward & Hirose, 2008).The nurses may also be reluctant to uncover mental issues where they lack the skills and they have no access to educational facilities or mental health specialists.Therapy With Older Adults Essay

In the industry, there has also been a tendency for the individuals to prefer not to specialize in old age care. There are therefore few professionals in the industry who have specialized in their care and are equipped to diagnose and offer the right treatment.

In the recent past, there has been the development of certain screening tools that have been found to be more effective than simply relying on the caregiver’s judgement (Chan & Parker, 2004). The screening tools include such resources such as the 9-item patient health questionnaire which has been found to be quite effective. It guides the carer on which questions to ask and based on the response how to determine whether the depression ranges from moderate to severe depression.Therapy With Older Adults Essay

One of the challenges for caregivers and the residential staff may be the lack of skills to notice the depression symptoms. Caregivers should be equipped with the knowledge on how to diagnose depression in older patients. The symptoms of depression range from inability to sleep, feelings that one is overwhelmed and disinterest in activities that the older patient used to love. There is also fatigue that is not related to age or medication. The individual may feel that they are not useful at all especially now that they are old. Due to these low feelings, the individual loses interest in grooming and maintaining personal hygiene practices.

There is also forgetfulness, anxiety or irritability and inability to manage or perform the usual tasks. The patient may decide to increase his use of drugs and alcohol. There may also be joint pains and general loss of appetite. There are many causes of depression in older patients. One of the major causes may be the severe change in their lifestyle. They find that they can no longer drive their car and they have to depend on someone else to completely take care of them especially when it comes to going to use the lavatory facilities. There are other factors such as living in isolation and those elderly people who have been segregated from their families and now live in homes have a higher risk of getting depression (Eisses, 2004)

There are those who have lost a spouse and other family members and the loneliness is overwhelming. The individual also realizes that he has reached retirement age and he can no longer contribute to the success of the company he used to work for (Alpass, Towers, Stephens, Fitzgerald, Stevenson & Davey, 2006).. There are those who have had to give up the family home to other relatives or sell it because it is no longer safe to live in the house or it is too much work or expensive to maintain the family home. There are also other causes of depression such as vitamin or other deficiencies, dehydration or thyroid complications. The progression of a terminal disease also causes depression due to the loss of control or power that the patient experiences.Therapy With Older Adults Essay

A lot of focus should be paid due to the severe impact that misdiagnosed or undiagnosed depression can have on a patient. Researchers have found that depression reduces the recovery of the patients from conditions such as strokes, broken hips, heart diseases and Parkinson’s diseases. If not treated, the depression also interferes with the treatment of diabetes and dementia (Abbott, Wong, Giles, Wong, Young & Au, 2003).

Depression also increases the mortality rates of the elderly especially when they suffer from conditions such as heart disease. Depression has also been found to increase the risk of suicide in older patients. There are those who have been successful and that are why the intervention strategies that can improve the current situation need to be conducted well.Therapy With Older Adults Essay

Conclusion
Many older people are increasingly becoming affected by depression. Many factors have been noted to contribute to this. It is therefore critical to note that this a treatable disease and people going through it need to seek help to overcome. Thus, through improvement of the care to people who exhibit certain behavioral disorders that can be lined to depression, there is a likelihood of more depression cases and improved quality of life which can in turn lead to a reduced economic and social burden that are associated with the condition. By improving the care of behavioral disorders, health plans can save, extend, and improve the quality of members’ lives, and reduce the societal and economic burden of depression.Therapy With Older Adults Essay