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?