Introduction
Depression may be used to refer to a wide range of effects from transient sadness to persistent symptoms to a clinical diagnosis (Ainsworth, 2000). Symptoms of depression increase with age. The increase can be attributed to the age-related changes in risk factors rather than to aging itself. It is not the process of aging per se that leads to mental ill-health (White, 2001). Older people are more susceptible to the risk factors implicated in depression such as chronic ill-health, disability and bereavement.
Statistics indicate that depression is common in individuals with other chronic ailments such as diabetes and arthritis. Depression is often identified as the most prevalent psychiatric disorder in the elderly and is usually determined by symptoms that belong to somatic, affective, and cognitive categories (Ainsworth, 2000). These symptoms can affect a person’s daily physical and social functioning and can result in severe consequences if not addressed adequately.
Many people with depression are usually taken care of at home and treated by general practitioners, while others require more intensive attention and ongoing care by mental healthcare professionals (Marriner-Tomey & Martha, 2006). This paper seeks to discuss depression in older patients from the patient’s/ caregivers/relatives/carers’ perspective. The paper will also discuss the implications for and innovations in nursing care regarding depression in older patients.
Depression in older patients
Many older persons often show chronic illnesses. Depression is recognized as the most common complication of chronic illnesses and is classified as dangerous because it tends to worsen the chronic condition (Greenglass, Fiksenbaum, & Eaton, 2007). Studies indicate that the prevalence of depression in older patients with chronic conditions is approximately 30% worldwide. Persistent depression is problematic and is often associated with potentially harmful symptoms. As people grow older their ability to function decreases and many of them become unable to do things that they used to do for themselves. Studies indicate that certain demographic factors are associated with loss of function. These factors include age, female gender, and chronic ailments such as diabetes, arthritis, hypertension, and heart disease (Jeon, 2004).
Additionally, certain chronic conditions may also become more prevalent as people grow older and they include “stomach ailments, vision and hearing problems, and respiratory conditions” (Burgess, 2006, p. 45). General symptoms for depression include the presence of a depression mood; lack of interest in different recreational activities; reduction in body energy levels; poor concentration and attention; low levels of self-esteem and confidence; feeling guilty and unworthy; negative views regarding the future; self-harm ideas, including those of suicide; sleep disturbances; and a diminished appetite (Greenglass, Fiksenbaum, & Eaton, 2007). Depending on the number and type of symptoms observed, a patient can be categorized as having a mild depressive episode, moderate depressive episode, or severe depressive episode (DePaulo, Raymond, & Leslie, 2002). Additionally, the patient must have presented with this symptom for approximately two weeks.
Older people who show the above-mentioned conditions are likely to be depressed. These categories of individuals need resources in terms of coping strategies and social support. The support provided should be adequate to help the patient reduce distress. Previous research indicates that greater social support results in a significant reduction of depression and helps the elderly to attain better mental health (Solomon, 2001). It has also been established that older adults who are actively involved in social activities tend to have higher levels of physical and mental health, which includes lower incidences of depression, than those who are less socially active (Bacorn, 2003). Thus it’s advised that aging persons should select emotionally supportive relationships for them to successfully adjust to the problems related to aging.
Relative/caregiver’s role
Having an older relative with depression can be stressful and burdensome to family members. The immediate family members and other carers are integral in the provision of care for such patients and will often spend hours with their sick loved ones providing the support required (DePaulo, Raymond, & Leslie, 2002). Carers/caregivers are thought to play an important role in helping older adults to cope with aging diseases and the resultant depression. There is little research concerning the participation of family members in the hospital care of older depressed adults (Jeon, 2004). Coping as used in this paper refers to a “multidimensional process that involves cognitive, behavioral, and emotional efforts to deal with stressful events that create demands on a person” (Greenglass, Fiksenbaum, & Eaton, 2007, p. 61).
Community and mental health nurses also share in the role of providing care for older depressed patients. Most family members/ caregivers require the support of a community nurse to effectively supplement the care provided to their relatives. Indeed research shows that the family caregiver appreciates the presence of a nurse and often feels comfortable.
Most family care providers who look after the older depressed relatives generally perform the following tasks: being there to provide moral support; maintaining the patient’s connection with the outside world; giving reassurance and emotional support; engaging in religious activities such as praying; informing other relatives on the patient’s progress and bringing the different things requested by the patient; assisting with drinking, eating, bathing, going to the toilet, moving about and dressing; providing important information regarding the patient to the healthcare tram; ensuring that the healthcare team provides everything that is requested by the sick relative; working with the healthcare team to care for the family member; and giving an opinion on different decisions about the patient’s care (Nay & Sally, 2009).
Family caregiving is often challenging for nurses and other healthcare professionals as it demands a significant amount of tolerance. Some caregivers use culturally specific methods that may not be agreeable as per the established healthcare standards. Nurses are required to ensure the development of mutually beneficial relationships with caregivers. Additionally, they are required to talk to the caregivers and understand the kind of care that will be offered once the patient is discharged from the hospital or rehabilitation center (Miller, 2008). Thus before discharging older frail patients, the medical team should ensure that proper family arrangements are made for home care.
Implication for nursing care
Nurses from different specialties will often encounter depressed patients. Most nurses have been equipped with the basic approaches to care for depressed and physically ill patients. Nursing care for older depressed patients should ensure that synergy is established between the support provided and coping to result in better physical functioning. This can be achieved through effective relationship building, giving the required support and information, and thus facilitating a change in thinking patterns, activity, and skills (Gail, Shaffer, & Parmelee, 2000).
The nursing care needed for older depressed patients should be guided by the following principles: thorough assessments of the depressive symptoms should be carried out; a multidimensional approach that entails social, psychological, and physical approaches should be used; care should be provided in a coordinated manner; interventions used should be well-timed; physical conditions should be well monitored and any issues solved promptly; finally, the nurse should involve family members and other carers in the care of depressed patients (Marriner-Tomey & Martha, 2006).
Registered mental nurses may use a generic approach that is developed regarding specific assessments that may include risk assessment; detailed interventions that may comprise psychological treatment and management of different medications indicated; the registered nurse may additionally offer coordination of care functions, advice, and supervision of other healthcare professionals (Demitri, Demitri, & Janice, 2007).
Generally, nurses are required to have good personal qualities for them to offer effective care to depressed patients. The nurses should be able to understand how the patient is feeling and communicate the same to the patient in a warm, positive and accepting attitude (Jeon, 2004). Evidence-based practice indicates success rates are high when a nurse genuinely shares his/her feelings with older depressed patients.
Nurses are required to use their counseling skills to help older depressed individuals express how they are thinking or feeling. Such expression will result in relief and will also help the nurse assess the mental state of the patient. Some physical aspects of care that need to be put into consideration include monitoring of food and fluid intake; provision of preferred diets regularly but in smaller quantities; weight monitoring; sleep enhancement and assistance with personal care (Ainsworth, 2000).
Community mental health nurses should additionally establish a sound personal relationship with other caregivers as they all share a common goal of helping the patient to recover (Greenglass, Fiksenbaum, & Eaton, 2007). Such nurses who work in rehabilitative or community home settings should be able to see through the eyes of other caregivers who are supporting older depressed patients. Nurses should initiate the process of establishing constructive mutuality with caregivers/ carers through validation of their attitudes, action, and interactions; transformation of practice through activities such as formal meetings and informal talks (Nay & Sally, 2009).
The process of seeking mutuality with caregivers should involve the acceptance of the presence and open willingness to resolve negative emotions. Research shows that good working relationships between nurses and caregivers help nurses to pursue a professional position based on mutuality. As a result, the caregivers will be able to appreciate the presence of nurses and feel comfortable.
Generally, nurses should use evidence-based approaches to provide sufficient care for older adults suffering from depression and other associated ailments.
Conclusion
This paper sought to discuss depression in older patients from the patient’s/ caregivers/relatives/carers’ perspective. The paper has also discussed the implications for and innovations in nursing care regarding depression in older patients. Depression has been identified to be one of the most common conditions affecting older people. It is mostly associated with the chronic ailments acquired due to aging. Carers/caregivers play an important role in helping older adults to cope with depression. Nurses on the other hand use their professional skills, to assess, treat and offer effective care to depressed older patients. Evidence-based approaches must be utilized by nurses to ensure that depression is effectively tackled for best treatment results.
References
Ainsworth, P. (2000). Understanding Depression. Mississippi: University Press of Mississippi.
Bacorn, B. (2003). Nurse As Educator:Principles of Teaching and Learning for Nursing Practice. New York: Jones & Bartlett Learning.
Burgess, W. (2006). The Bipolar Handbook:Real-Life Questions with Up-To-Date Answers. New Jersey: Penguin.
Demitri, P., Demitri, P., & Janice, P. (2007). The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder. New York: Broadway Books.
DePaulo, R., Raymond, D., & Leslie, A. H. (2002). Understanding Depression:What We Know and What You Can Do About It. New York: John Wiley & Sons.
Gail, M. W., Shaffer, D. R., & Parmelee, P. (2000). Physical Illness and Depression in Older Adults:A Handbook of Theory, Research, and Practice. New York: Springer.
Greenglass, E., Fiksenbaum, L., & Eaton, J. (2007). The relationship between coping, social support, functional disability and depression in the elderly. Anxiety,stress and coping journal , 19(1) 15-31.
Jeon, Y.-H. (2004). Shaping mutuality: Nurse-family caregiver interactions in caring for older people with depression. International Journal of Mental Health Nursing , (13): 126-134.
Marriner-Tomey, A., & Martha, R. A. (2006). Nursing Theorists And Their Work. London: Mosby/Elsevier.
Miller, C. (2008). Nursing for Wellness in Older Adults. New York: Lippincott Williams & Wilkins.
Nay, R., & Sally, G. ( 2009). Nursing Older People:Issues and Innovations. Sydney: Elsevier Health Sciences.
Solomon, A. (2001). The Noonday Demon:An Atlas Of Depression. New Jersey: Scribner.
White, L. (2001). Foundations of Nursing:Caring for the Whole Person. California: Cengage Learning.