Depression, Dementia, and Delirium in Older People
Critical Thinking Exercise Psychological and mental health problems observed in older patients influence the specifics and nature of care delivered to these persons. The purpose of this paper is to discuss different aspects related to gerontological nursing which are associated with such problems as depression, mental health disorders, dementia, and delirium in older people. The paper will provide answers to the basic questions related to mental health and psychological problems in the context of working with older patients.
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Depression Purpose, Reliability, and Methods of Using the GDS The Geriatric Depression Scale (GDS) was developed to conduct assessments of older people to prevent the development of depression. Thus, the purpose of the GDS is to help healthcare providers identify symptoms of depression in older people concerning the earliest signs of the problem. The scale is effective to assess the level of older people’s satisfaction with their life. The GDS is easy to use because it is represented as a questionnaire, and respondents are expected to answer only “yes” or “no” to the provided questions. The number of certain answers to specific questions helps professionals indicate the presence of depression and its intensity: mild, moderate, or severe depression. The scale’s sensitivity is 92%, and its specificity is 89% (Greenberg, 2012). Thus, the scale is discussed as reliable because it was actively used and tested by specialists. The reasoning for Implementing the GDS It is possible to use the GDS while working with older people to guarantee that they will receive the on-time assessment, and efficient care will be provided. The reason for using the GDS is its simplicity combined with high sensitivity and specificity. When it is necessary to assess older people’s depression in general, without referring to deep mental health assessments, this scale is most appropriate (Greenberg, 2012). Furthermore, the results of this assessment are important to be compared to other test results to conduct complex evaluations. From this point, the GDS is an effective screening tool used to determine symptoms of depression to propose further assessments and interventions. Physical Effects of Depression Depression can have even physical effects on older people because of their vulnerable state and changes in their daily life. These effects can include changes in diets and eating habits which lead to obesity or geriatric anorexia and changes in daily living because of decreased energy levels (American Psychological Association, 2017). Furthermore, physical changes in older people which are provoked by depression also include insomnia and cases of memory loss. As a result, those people who have depression can be characterized by longer reaction times and problems with attention and concentration. All these aspects can finally lead to developing severe forms of cardiovascular diseases and worsening chronic conditions among other consequences. Four Symptoms of Depression It is possible to identify several symptoms of depression in older people. Much attention should be paid to such key symptoms as the feeling of hopelessness, the feeling of helplessness and worthlessness, the loss of interest in usual or preferred activities, and suicidal ideations (Centers for Disease Control and Prevention, 2017). If an older adult feels hopeless and demonstrates pessimism, it means that he or she cannot cope with some aspects of one’s life and feels depressed. These symptoms are clear indicators of problems in an older adult’s perception of oneself. Furthermore, some situations associated with aging can make older people feel helpless and guilt because of their impossibility to perform certain activities easily and behave as it was previously. In this context, it is possible to speak about signs of depression and a person’s impossibility to accept one’s status. The loss of interest in usual activities is also an important symptom to indicate that a person feels uncomfortable and even depressed. The most critical symptom of depression is suicide attempts or revealed suicidal ideations which indicate the presence of deeper psychological problems. Prevalence of Depression in Older Adults In older persons, depression is not very common, but the actual proportion of depressed older people depends on their physical health and living conditions. The rate of depression in those older persons who live in communities is usually about 1-5% (Centers for Disease Control and Prevention, 2017). However, the number of depressed persons is higher while speaking about those older people who need continuous healthcare (more than 13%). In addition, more than 11% of older persons who live in hospitals or nursing houses also have depression (Centers for Disease Control and Prevention, 2017).
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Differences in Depression in Older and Younger Adults It is possible to state that symptoms and signs of depression in older and younger persons are rather different. Thus, older people are at a higher risk of developing depression because of feelings associated with their chronic conditions and diseases. These people are often limited about performing certain activities. Furthermore, the problem is that older people can be even undertreated because their depression is not diagnosed appropriately, and they do not receive the required assistance (Centers for Disease Control and Prevention, 2017). Moreover, many older adults often ignore their psychological problems and feelings thinking that such perceptions are typical of those older persons who have certain health conditions. Depression in Older People is Treatable It is important to pay attention to the fact that depression in older persons can be treated effectively. Although depression is a severe psychological problem, it is curable, and there are many approaches to addressing this problem while working with older adults. The focus should be on the fact that the treatment is provided to avoid situations when depression is viewed as normal for older people. To treat depression, it is possible to refer to such methods as pharmacological treatment with the help of antidepressants, psychotherapy, and electroconvulsive therapy (Geriatric Mental Health Foundation, 2017). These methods are applied to cope with mild, moderate, and even severe depression which can be cured effectively. Recovery after Using Antidepressant Medications To achieve good results and treat depression successfully, older adults are expected to take medications for six or twelve months. However, it is important to note that obvious results or outcomes of the treatment can be observed after about four-twelve weeks of taking antidepressants. Therefore, older people will feel better after about a month of pharmacological therapy (Geriatric Mental Health Foundation, 2017). If there are no positive changes in an older adult’s state after a month or two of taking medications, it is necessary to consult a physician to decide what other methods of treatment to apply to the case. Mental Health Disorders, Delirium, and Dementia Factors That Contribute to Developing Mental Illness in Older Adults Specific factors that can contribute to developing mental illnesses in older people include severe and chronic diseases which affect individuals’ daily activities, retirement, deaths of close people and relatives, sensory deficits, and social isolation because of lost connections with relatives and friends (Eliopoulos, 2013). Thus, persons experience significant psychological pressure when they become older and such aspects as the loss of relatives, the loss of status, the loss of health, and the loss of certain functions can influence persons significantly. They become more dependent on other people, as well as more vulnerable. One more factor is the awareness of a person’s mortality. Alcoholism in Older People It is important to note that there are situations when signs of alcoholism in older people can be missed or ignored by healthcare professionals. The reason is that older adults often do not look like abusers of alcohol. On the one hand, alcohol abuse is often unexpected in older people. On the other hand, alcohol abuse can have symptoms associated with other disorders, including hepatitis or chronic infections among others. While concentrating on stereotypes related to alcohol abusers, nurses can fail to identify addicts among older people because of their differences (Eliopoulos, 2013). Much attention should be paid to signs of alcohol abuse to address the problem effectively. Questions and Observations to Identify Mental Health Problems While conducting interviews with older people, nurses should focus on certain questions and observations which are important to uncover possible mental health problems. First, general observations should include focusing on older adults’ appearance and clothes to determine whether they wear appropriate clothes and whether they are dressed neatly. It is also necessary to observe an adult’s posture and movements which should be normally active, without tremors and other problems. Facial expressions should be examined to notice signs of fear, stress, or pain. It is also important to examine the level of consciousness and determine to what stimuli a patient can respond. Interview questions should be oriented to learning the following information: communication of an older person with other people and friends, older adults’ perceptions of oneself and people around them, possible changes in mood and feelings, possible changes in sleep and eating patterns, the level of life satisfaction, health problems, thoughts about suicide, and possible hallucinations (Eliopoulos, 2013).
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Reasons to Be Suspicious Older people can often be suspicious, and the reasons which cause this state can be non-associated with a paranoid disorder. The problem can be related to the development of delirium and dementia. Furthermore, the problem can be associated with functional changes and older people’s hearing or visual losses (Eliopoulos, 2013). Thus, they can be suspicious if they are unable to hear other people’s conversations and feel comfortable while interacting with strangers. In addition, this problem can be caused by memory loss which is stressful for older people. Mental Health Conditions in Older Baby Boomers It is possible to state that the lifestyles of baby boomers differ significantly from the lifestyles of their parents and previous generations of older adults. This aspect can affect baby boomers’ process of aging and the development of mental health conditions in these people. According to the researchers and experts in the field, it is possible to expect that baby boomer can suffer from not only dementia and anxiety disorders while becoming older but also from abusing alcohol and substances, as well as from depression (Eliopoulos, 2013). The progress of dementia can be associated with general increases in the prevalence of this disorder. Anxiety disorders can become typical of older baby boomers because of traumas related to retirement and giving up usual activities. The abuse of alcohol and substances can also become a problem for older baby boomers because of their habits developed during their life (Eliopoulos, 2013). Finally, depression can become a reaction to losses of functions, health problems, and living alone, without children’s support. Hospitalizations of Older People, Surgery, and Delirium When older patients are hospitalized for surgery, some situations can provoke the development of delirium. Severe pain, possible infections, and hypoxia associated with certain health problems and preparations for surgery can cause older patients delirium. In addition, the inattention of the staff, possible dehydration, and decreased functions can cause significant emotional stress and fear which can, in their turn, provoke the development of delirium. More problems can be caused by changes in environments and the absence of familiar objects around patients (Eliopoulos, 2013). Therefore, nurses need to pay much attention to the needs of older patients to relieve their pain and create comfortable conditions to decrease stress and fears associated with the situation of hospitalization. Impact of Diagnosis of Alzheimer’s Disease Diagnosing Alzheimer’s disease in an older person can be a significant stress for his or her spouse, children, and grandchildren. There are risks that potential caregivers will experience shock, deny observing symptoms, and feel helpless because they do not know how to help their family members. Furthermore, children and grandchildren can fear that this disease will also affect them when they become older (Eliopoulos, 2013). Therefore, nurses should provide education for families and caregivers to teach how to assist older people with Alzheimer’s disease and how to cope with their depression, guilt, or frustration. Denial of Spouse’s Diagnosis There are cases when persons deny or do not accept signs of dementia in their spouses. They can try to explain the unusual behaviors and moods of their spouses while proposing a range of reasons. People can also avoid consulting healthcare professionals, hoping that certain symptoms will disappear in some time. Furthermore, spouses can continue communicating with older patients without adapting their behaviors or proposing necessary support while ignoring obvious changes in individuals’ mental health (Eliopoulos, 2013). Risks for Single Older People with Dementia If an older person with mild dementia lives alone, it is possible to speak about certain risks. First, single older adults are at a high risk of developing suicidal thoughts and making suicidal attempts. Second, single patients can rely only on the assistance of social workers, as a result, their safety is also affected (Eliopoulos, 2013). People with dementia need continuous assistance and control to guarantee that they eat and drink regularly, their physical needs are addressed, and they do not feel discomfort or pain. Thus, when older people with dementia live alone, there are risks associated with their care and safety.
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Conclusion This paper responds to certain issues associated with caring for older people who have mental health problems. Nurses’ support and consultation are important to assist not only older patients but also their families. Much attention should be paid to delivering care to those older patients who suffer from depression, dementia, or delirium. References American Psychological Association. (2017). Aging and depression. Web. Centers for Disease Control and Prevention. (2017). Depression is not a normal part of growing older. Web. Eliopoulos, C. (2013). Gerontological nursing (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Geriatric Mental Health Foundation. (2017). Depression in late life: Not a natural part of aging. Web. Greenberg, S. (2012). The Geriatric Depression Scale (GDS). Try This, 4. Web.