presented by: wanda murray-goldschmidt, ma, bsn, rn-bc ltc nurse consultant educator
Post on 18-Jan-2018
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Recognizing and Responding toDEPRESSION
Presented by:Wanda Murray-Goldschmidt, MA, BSN, RN-BC
LTC Nurse Consultant & Educator
Objectives:• Define depression & discuss its prevalence in older
adults & those in long-term care• Describe the impact of depression on mental and
physical health• Discuss the ABCs of symptom identification• Identify care approaches to address depressive
symptoms • Discuss what needs to be documented regarding
depressive symptoms and why documentation is important
What is depression?• Mood disorder with persistent empty feeling,
or feelings of sadness, loss of interest & loss of pleasure
• Affects how you think, feel, and behave• Leads to a emotional and physical problems• Can interfere with ability to function in daily
routines and responsibilities• At its worst, can lead to suicide
Why are we talking about depression?
• CDC reports that 10-20% of people 65 and older have experienced depression
• 16% of suicide deaths are for those 65 and older
• The prevalence of depression in older adults is 15%-20%; in nursing homes 17% - 35%
• Medicare beneficiaries with depression have significantly higher health costs
What contributes to depression?• Loss of loved one(s) and/or friends• Loss of social roles• Change in health• Sensory losses• Change in lifestyle• Changes in independence/ loss of control• Pain• Cognitive changes• Stress
The ABCs of Depression ppearance
ehavior
onversation
ppearance - • What does depression look like?
ehaviorDemonstrate:• Decreased energy• Slowed movements• Slowed responses• Withdrawal• Loss of interest in usual
activities• Change in appetite• Change in sleep patterns
• Difficulty concentrating, focusing, or making decisions
• Tearfulness• Increased irritability,
anger, or anxiety• Neglect of self-care
onversation• Increased physical
complaints/often vague• Expressed feelings of
worthlessness, guilt, hopelessness, negativity
• Suicidal thoughts
• “I’m not well. Everything hurts.”• “I don’t know why I’m still
here.”• “I’m not good for anything
anymore. I’m just a lot of trouble for other people.”
• “I wish I would just close my eyes at night and never wake up.”
• “If I had a gun, I would shoot myself.”
How to respond…• Report what you
see/hear• Do further assessment• See psychiatric
evaluation/ intervention
• LISTEN – acknowledge resident’s feelings
• DOCUMENT**
Assessing symptoms:• Residents often deny
depressionConsider the whole picture• Overall appearance• Facial expression• Tone of voice• Responsiveness• Use other terms “down in the
dumps”, “sad”, “blue”• “Are you happy?” “Are you
enjoying life?”
Responding to Depression• Provide emotional
support• Recognize/encourage
use of strengths• Practical assistance with
problem solving• Maximize resident’s
control
• Encourage/assist with exercise
• Provide for pleasurable experiences/activities
• Positive reminiscence• Spiritual support/pastoral
care• Spend time with person
other than to provide physical care
• DOCUMENT**
Person-centered Care
The PERSON includes:• Biological self – physical
& medical needs• Individual self – history,
experiences, beliefs, values
• Social self – roles, responsibilities, and relationships r/t others
We are responsible for caring of all of these aspects – not just biological
Documentation• We know that documentation of physical/ medical
care is important r/t the reimbursement system• Documentation of mental health care is just as
important in capturing the reimbursement for services provided
• Whether or not depressive symptoms exist makes a difference in how reimbursement levels are calculated
• Documenting your care and attention to mood status gives credit for what you do so you can be paid accordingly
We have been taught in recent years to address pain as the 5th vital sign.
Consider mood status as the 6th vital sign.
• Temperature• Pulse• Respiration• Blood Pressure• PAIN
• MOOD
Questions?
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