Depression and the Elderly: A Communicative Approach - Essay Example

Depression and the Elderly: A Communicative Approach I. Depression in Late Life Depression is an abnormal reaction to life circumstances and absolutely not a normal functioning of the aging process. On the contrary, a good number of older people feel fulfilled and contented with their lives. However, it is established that late life is obviously a period of substantial losses. People more than sixty confront losing a lot of essential aspects of their lives such as death of their spouses, their friends and sometimes even their children. They have to face the likelihood of diminishing vitality, weakening health, and at times declining financial stability. Because of these painful losses for the elderly, suicide rates among the aged were continuously increasing, but symptoms of depression are seldom recognized and treated in this vulnerable population. It could be then that out of ten older people only one receives treatment for their depression and the rest are ignored (Ainsworth, 2000, 37). According to the Epidemiologic Catchment Area Study (ECA) funded by the National Institute of Mental Health (U.S.) in the latter part of the 1980s, depressive indications take place in more or less 15 per cent of people over sixty five years of age. At the minimum, 3 per cent of older people endure severe depression, particularly those who live in nursing homes, where the incidences of depression are higher than the average 15 per cent (ibid, 37). Sadly, depressed elderly people spending the remaining days of their lives in nursing homes may appear to be whiners and be given no treatment for their miserable condition. Their depression are concealed since the actual nature of the sickness is masked behind a shroud of physical grumbles, or else the elderly person keeps away from interpreting the symptoms for anxiety of being called insane. Elderly patients generally endure mild memory lapses and dawdling mental activities, both circumstances resulting from physical causes. As soon as depression develops beyond this mild brain dysfunction, the outcome frequently appears to be an advanced case of dementia or “old-timer’s disease” (Cohen, 1990, 26), for which the mournful family believes there is no possibility to be treated. However, with proper diagnosis and therapeutic procedures for the treatment of serious depression, elderly patients often get rid of the symptoms of this pseudo-dementia and experience progress in both brain processes and quality of existence (ibid). II. Caregiver Depression For diverse causes, different cultures have begun to witness a remarkable boost in the need for family members to become concerned in the care of their elderly next of kin. It was predicted that by 2030, an approximately 20 per cent of the U.S. population will be aged (Koizumi, 1998). While the aged population continues to mount in numbers, an increasing burden has been placed on the shoulders of family caregivers by reduction in health care financial support and in indemnity coverage that have curtailed the availability of outpatient and home-based health care services, through shortened medical and psychiatric hospital confinements. Between 1988 and 1996, the population of caregiving households in the United States increased manifold to an estimated 22 million. By 2003, an approximately one-fifth of U.S. households will give care (ibid). Nevertheless, behind these statistics regarding demands in caregiving, it is rather important to examine caregiver burden and its impact, with specific concern to how caregiving elevates the caregiver’s risk for depressive order. In this paper, caregivers pertain to both the family members and nurses or other health care professionals in geriatrics. Caregiver burden indicates “physical, psychological or emotional, social and financial problems that can be experienced by family members, friends, and health professionals caring for impaired older adults” (Llindick, 1986, 28). Caregivers provide support to aged patients with physical health problems such as stroke, cancer, heart disease, diabetes, arthritis, Parkinson’s disease, and other health disorders. Psychiatric illnesses that may necessitate provision of caregiving include depression, Alzheimer’s disease or dementias, panic disorders, anxiety, and psychotic disorders such as schizophrenia (ibid). In the contemporary period, caregiving by nonprofessionals has been common hence the need for caregivers themselves to obtain care has turned out to be a foremost concern. Family members compelled to provide health care in order to adjust effectively to declining hospital confinements and limited home-based health care services too effortlessly become unknown patients themselves (Andolsek, 1988). These caregivers then become a vulnerable population who are at risk of health complications. Caregivers of patients with mental problems such as dementia, and other diseases such as AIDS, cancer, have received substantial attention nowadays, yet there is minimal public awareness of the burden put up with by those who provide care for elderly patients suffering from depression. While the limitations and requirements of demented patients may be voluntarily be recognized by the public and by health care professionals, it is regularly more complicated for caregivers to understand the depressed elder’s needs, which may call for similar levels of sustenance and time (ibid). III. Communication between Health Care Professionals and Depressed Elderly Patients The fastest increasing segment of the population in the United States is composed of older people over 75 years of age. It is estimated that by 2010, the overall population of this age cohort is predicted to be greater than 18 million (U.S. Bureau of the Census, 1991). Roughly 86 per cent of all the aged suffer from one or a multiple of chronic illnesses such as depression. The mass of this vulnerable population reside in the community; a mere 5 per cent of older people over 75 live in nursing homes (Harper, 1990, 25). The anxieties of aging will be experienced not only by the depressed elderly patients but also by the people and society accountable for their care and wellbeing. Normally, older adults are more cynical of psychiatric services, judging that an individual should be capable of “pulling oneself up by the bootstraps” (Moore et al, 1996, 5). Ageism, which is persistent in the American society, or perhaps in other highly industrialized nations, has resulted in the propensity to perceive the elderly as unbeneficial entrants for mental health interventions. Consequently, the aged are regrettably underserved (Turner, 1992), even though mental health professionals estimate that 18 per cent to 25 per cent of elderly people, at any given time, possess some mental health symptoms for depression and other illnesses (Cohen, 1990). Quality of life concerns in the elderly are an issue that may and should be dealt with by mental health nurses through effective communication. In the latter part of the 1970s, nurses at the Newton Massachusetts Health Department staffed elderly drop in centers, which were intended to provide health support and educational programs to older people. While the nurses became familiar with patients and a positive connection developed, the patients talked about their medical, social and emotional problems with them. The nurses distinguished there was minimal time to facilitate depressed elderly patients who had lost spouses or were overwhelmed by a current medical predicament, and realized that a program was considered necessary in which mental health nurses could dedicate their time completely to mental health concerns of elderly patients. To acquire financial support for the program, the nurses successfully applied for a medical grant (Moore et al, 2002). As a health care provider, the nurse has an exceptional opportunity to assist depressed elderly patients. Most of these older adults suffering from chronic depression view nurses as accommodating and nonthreatening care providers. While elders may view a disgrace in looking for psychiatric help, it is somewhat trouble-free for them to permit the nurse into their confidence. The common medical routine of monitoring a blood pressure frequently serves as a serene admission into the therapeutic nurse-patient relationship (Hamilton, 1990). Monitoring an elderly patient’s medication routine is an essential function for the mental health nurse, particularly those who conduct home visits. Side effects and interactions of medication treatments definitely contribute to a patient’s mental and behavioral functioning. One instance is a couple in their 80s who had been given an assortment of various prescriptions for each of them. In reviewing the medications, the nurse found out that each was taking the other’s medicine, including the psychotropic drug prescribed for the wife. Regular visits of nurses can create a genuine difference in elderly patients’ lives (ibid). One incident frequently encountered by nurses in older adults’ homes is accrued litter, often indicating a worsening in physical and/or mental capacities. For instance, Mr. T, a 67-year-old bachelor, was referred by his medical doctor due to complaints of chronic depression because of continued seclusion and loneliness. He survived and lived alone, even cared for himself. When the nurse conducted a home visit she found out that Mr. T lived in a huge ramshackle mansion. The three cars parked in the garage were very old. Newspapers and magazines in the sitting room were five years old. The mansion looked like a haunted house. The kitchen was full of vast heaps of amassed cartons of egg, milk and oatmeal (Moore et al, 2002). At some stage of the home visit the nurse can communicate with available family members and observe their interaction with the elderly patient. Family members frequently perceive the nurse’s visit as an opportunity to obtain assistance for them and/or to talk about their personal dilemmas. The nurse can integrate family members in the therapeutic process, or recommend them to an appropriate psychotherapist (Ainsworth, 2000). Such family participation was vital to Mrs. D, who subsequent to caring for her seriously debilitated husband at home for a protracted period of time, and fatigued by the burdens of his care, had finally made the decision to confine him in a nursing home. Their son, who had lived with them and involved himself in his father’s care, more often than not present during an important part of each visit. Primarily, Mrs. D’s lad disagreed to the decision of taking his father in a nursing home. He looked-for help in perceiving the duty his mother was enduring in abiding to home care. Moreover, he needed to lament the loss of attachment he had felt with his father when he was the one fulfilling the health care. Both Mrs. D and her son eventually decided to resolve the sentiments involving Mr. D’s sickness and placement (Moore et al, 2002). These home visits provided the nurses the prospect to guide the patient on safety issues around the home, an essential convenience for the elderly. A patient’s distress regarding the necessity to get up regularly at night to urinate can be an opportunity to talk about the importance of a night lamp, or installation of a bedside commode (ibid). Depressed elderly patients commonly lack an intimate relationship with another person because of bereavement for the loss of spouse and acquaintances. The speaking in confidence nature of the nurse-elderly patient relationship, as one of the variety of intimacy, advances mental health through decreasing heights of depression and improving self-esteem in such patients (Hamilton 1990). Elderly patients are enthusiastic for a caring listener and will oftentimes express how precious and meaningful the visit has been. Conveying and sharing their anxieties appears to alleviate their depressive condition (ibid). A 91-year-old woman was referred to a home visit program by her niece because of escalating anxiety. The old woman had lived an energetic and fulfilled life until her deteriorating eyesight and destabilized legs confined her to her home. Since she discovered herself with an unused amount of time, she started to ponder about her future. Visions of her concluding days and death troubled her sleep and even her waking hours. She was given anti-anxiety medication by her physician and it proved to be of much help, but her niece had observed that the old woman was still suffering from depression. The nurse then under a home visit program initiated weekly visits and permitted the old woman to articulate her fears, something her family was awkward doing (Moore et al, 2002). Through heartily listening to the old woman, opening up some certainty into her visions, and asserting her strong personality traits, the nurse was able to assist the old woman gain some control over her anxieties hence lessening her depression. As the tempo of life suddenly slows, memories can take over a considerable portion of the waking hours. Recounting the memories with another person tends to establish intimacy, which improves the patient’s sense of self-worth. Reminiscing life’s achievements gives emphasis to one’s life value and meaning. However, reminisces can also produce negative outcomes to the elderly patients. Some of them may confront unsettled conflicts from the past that are somewhat painful and upsetting. Dynamic lives may have tolerated these conflicts to be restrained, but they can reemerge in a disruptive manner during the more inactive lifestyle of the elderly person. Nurses can investigate these conflicts with patients in an unbiased manner, persevering to help them resolve the conflicts or to obtain relief from the anguish that such conflicts often create (Ellison & Verma, 2003). A couple fled from Nazi Germany on the eve of the closing of the German frontiers. When the husband was arrested, the wife secured his freedom through bribing the Nazi guards. They boarded the last train, leaving behind the wife’s parents who had declined to leave with them. The wife didn’t see her parents again and she is frenzied with thought of their terrible deaths. The wife narrates her fearful experience often, attempting to make sense of the madness that triumphed during that time. While the wife perhaps won’t completely resolve her painful past, the continued support and recognition by the nurse seemed to provide some form of release (Moore et al, 2002). Nurses have the capabilities necessary to guarantee that the elderly are beneficiaries of quality mental health care and can support them in their home environment with home-based health care services. The nurse’s talent to maintain interaction and shape interventions based on the particular needs of the elderly patient account, for the most part, to the accomplishment of home visit programs. With increasing health care and nursing home expenditures, accompanied with larger than ever populations of older adults, programs such as home-based services can offer cost-effective options to hospital confinement (ibid). IV. Recommended Best Practices for the Treatment of Depressed Elderly Patients The simple naturalistic prescription which is also the most critical in dealing with elderly patients suffering from depressive disorder is effective communication between the nurses or other health care professionals and the elderly patients. The process of talking, discussing, sharing sentiments and thoughts, and imparting information, even giving out questions without a clear answer, is certainly a powerful medication regimen of sustaining a healthy and restorative psychological attachment with the older patient despite of several cognitive impairment due to chronic depression (Ellison & Verma, 2003). Many older adults seek help from a psychotherapist at the request of another, probably a physician or a significant other. The patient may appear to a certain extent doubtful of the process, perhaps by no means having consulted a therapist before or having had a record of negative encounters with the mental health care system. Moreover, there may be a degree of irritation at having been forced into this visit, or at least some suspicion or doubt of this professional, who may well be qualified as their children. And yet the good manners so typical of this vulnerable group may hamper expression of any of these sentiments or hesitations directly to the therapist, particularly in the premature stages of treatment. Aware of this, it is practical for the therapist to believe that any or all factors may be contributing, in spite of the patient’s appearance. Moreover, it is of overriding importance that the therapist be wary of his or her own behavior and preconceived notions regarding aging. Therefore, new geriatric clinicians must educate themselves about a variety of attributed of aging process, identifying stereotype from reality (ibid). One technique in eliminating therapist lack of knowledge about the experience and behavioral symptoms of elderly patients is to provide the patient his or her knowledge in concerns of aging. Specifically with regard to group issues, “the therapist must recognize the likelihood of his/her ignorance or misunderstanding, and must convey to the patient a sincere respect for assistance in remedying this ignorance” (Kivnik & Kafka, 1999, 114). Erikson et al (1986) go beyond to emphasize that while the elderly patient is using therapy to amend and restore symmetry around a number of previously unsettled psychosocial periods, the deficiency in the therapist’s personal resolution of any of these psychosocial aspects may weaken the effectiveness of the entire process. Aging is obviously an indispensable part of every person’s existence. The associated mental illnesses with aging such as depression are a normal phenomenon in every culture. The only difference with regard to the condition of the depressed elderly patients is the competence of the mental health care system in alleviating the agony and misery of the aging population through fostering constructive and therapeutic communication between the health care professionals and the elderly patients. Works Cited Ainsworth, P. (2000). Understanding Depression. Jackson, MS: University Press of Mississippi. Andolsek, K. (1988). Prevalence of Caregiving. Family Practice . Cohen, G. (1990). Normal Changes and Patterns of Psychiatric Disease. Rahway, NJ: Merck, Sharp & Dohme Research Laboratories. Ellison, J. M. & Verma, S. (2003). Depression in Later Life: A Multidisciplinary Psychiatric Approach. New York: Marcel Dekker. Erikson EH, Erikson JM, Kivnick HQ (1986). Vital Involvement in Old Age. New York: Norton. Hamilton, G. (1990). Promotion of Mental Health in Older Adults. Geropsychiatric Nursing , 38-65. Harper, M. (1990). Mental Health and Older Adults. 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