Introduction

Depression is a common and major clinical disorder that comes with severe symptoms that affect how a person feels, thinks or even handle their normal activities like eating, sleeping or working.  Depression among the elderly people can be related to Psychotic Depression or Bipolar Disorder. Psychotic Depression involves an individual having some kind of psychosis like delusions, seeing things that are upsetting with some depressive themes like illness. Bipolar disorder may differ from depression but it’s associated with the condition because a person experiences very low moods episodes that can be considered depression.  The biological changes resulting from aging occur slowly over time which means that at whatever age people may be considered elderly, they may experience depression. Due to the related devastating consequences, depression in late life is an important issue in public health. The condition differs from the depression experienced when people are younger in obvious and subtle ways.  The level of Depression has also been found to be more common among the elderly people who are placed at healthcare home homes and can come in form of functional impairment, increased medical illnesses and pain.  Even though older adults are at higher risks of suffering from depression, it is a medical condition that can be treated since it is not a part of normal aging process.

Problem Statement

There is a higher risk of elderly people to suffer from depression given that normally, almost 80 percent of older are undergoing at least one health condition that is chronic and 50 percent will have at least two health conditions (Sözeri-Varma, 2012).  In addition, depression is found more among those individuals who suffer from other diseases like cancer or heart disease and whose body functionalities are limited (C. D. C., n.d).  Around the globe, the population is rapidly aging and it is estimated that the 2015-2050 period will see the world population percentage of people over 60 years almost double to 22 percent from 22 percent. This indicates increased risk of more people suffering from depression (Mental Health America, 2018). In US even though the proportion of older individuals suffering from depression and living within the community is between 1 percent and 5 percent, it tends to rise to 13.5 percent among those individuals who are in need of home healthcare and increase to 11.5 percent of elderly patients in hospitals.  The proportion of older patients who shows depression related symptoms normally have about 50 percent more healthcare costs than elderly people who are not depressed (Mental Health America , 2018).  Depression has also reported to be a great predictor of suicide cases among these individuals. A comparison of the 13 percent of United States population, people who are 65 years older or above make up a whole 20 percent of the reported suicide deaths especially among the white males (Mental Health America , 2018).  There is lack of sufficient knowledge about this condition among the older population and some do not the issue as a health problem. Only about 68 percent of 65 years and above adults have little to no knowledge about the condition. Also only 38 percent of these see the condition as a health problem (Mental Health America, 2018).  This means that older adults suffering from depressions are more likely to take care of themselves than other groups in the population. This calls for a health plan for informing the individuals and their families about depression, the need for personal care and available solutions.

Current solutions

 Caring for the elderly people with depression is done by various healthcare facilities and community organizations with Centers for Disease and Control Prevention playing a significant role especially while trying to incorporate mental health and the overall public healthcare.  The healthcare services are provide through a collaborative approach, where the Healthy Aging Program by CDC has been linking the various departments of public health with a network of aging services offered for the aging people with mental health problems (C. D. C., n.d).  The CDC plays a role of collecting information with an aim of monitoring the impact of depression on elderly people, assisting various states to access data at local and state level, collecting evidence used in community-based programs and facilitating interventions that are evidence based and which can assist the older people to maintain their health outcomes (C. D. C., n.d).  The public health community consists of healthcare facilities and community-based organizations which come with many benefits to geriatric patients.  The healthcare services are offered through many local Community-Based organizations like Area Agencies on Aging, Senior Centers, Day Centers, Faith- based Organizations and Social Services Agencies (Coleman, Whitelaw & Schreiber, 2014). These organizations provide healthcare services to elderly people with individuals more effectively given their convenient locations in a community and such services are tailored to older population’s individual special needs (Coleman, Whitelaw & Schreiber, 2014).  

The Public Health Community also collaborates with various ageing services and providers of mental health so that they can readily reach the older adults suffering from depression.  In the health care facilities, regular and systematic screening is done since they can effectively point out adults with depression and then, the patients are directed to seek appropriate treatment. An important aspect in caring for these individuals involves the use of Behavioral Risk Factor Surveillance System that involves a questionnaire. As the largest telephone system for healthcare survey, it is used to track any risk behaviors or health conditions in US (C. D. C., n.d).  This tool includes a question about number of days people experience depression and stress and thus highlighting the trend of condition among the older people.  Collecting information from organizations such as U.S Surgeon General has helped in determining the effectiveness of ht available interventions for mental disorders like depression and the causing factors like bereavement (C. D. C., n.d).  

The use of home-based care management for depression or clinic based care has been recommended by these bodies using the evidence collected about the condition.  Previous the federal government through White House Conference on Aging implemented a decision on the enhancing the identification, evaluation and treatment of depression among the elderly in Americans.  The attention given to mental health issues like depression among older adults has ensured that there is collaboration between Mental Health Systems and public health (C. D. C., n.d). Before then , public health emphasized on surveillance for various chronic diseases like depression so as to come up with public healthcare programs , which had led to field of mental health using a different system to collect data . Such a system focused on measuring the prevalence of the disease and use of health care. The new approach aimed at incorporating all systems have comprised of addition of measures of chronic disease. The use of Identifying Depression, Empowering Activities for Seniors (Healthy IDEAS) is a model for Depression Care Model is a major model used by healthcare community (C. D. C., n.d). The focus of this program is on adults who 60 years and older in the community and who are considered frail and underserved and in need of Care Management Services. The depression care for the participants is provided by the program in their homes.  It involves providing the education necessary in the process of depression related assistance in linking with mental health and primary care providers and self-care to participants and caregivers. It also offers support and coaching while the client is engaging in various changes in behavior that would enable management of depression and pursuit of meaningful activities.  This intervention does not require professional licensing and normally includes an on-site training for these individuals (C. D. C., n.d).

 Another solution involves the use of Improving Mood Promoting Access to Collaborative Treatment (IMPACT), a program that offers Depression Care Management that is clinically based for depressed older adults.  The care givers involved in the program comprises of a trained nurse, a psychologist, social worker and primary care doctor (C. D. C., n.d). The Psychologist teachers the participants on various techniques for solving problems and the doctor can administer the necessary anti-depressant medications. Another intervention program involves the use of Program to Encourage Active, Rewarding Lives for Seniors ( PEARLS) that involves provision of Depression Care Management that is home-based to adults with 60 years and above , who have been beneficiaries services offered by community agencies at their homes (C. D. C., n.d).  The program provides 8 counseling sessions, and about 3 to 6 phone calls for follow-up maintenance.  The program is ran by a Depression Care manager who has the right training and mostly consists of a counselor and social worker , and involves the employment of problem-solving treatment , planning of physical and social  activity and also planning of pleasant-event. The care manager works in collaboration with a psychiatrist who is also a supervisor (C. D. C., n.d).

Analysis of Local Solutions

 The Kathrine’s place, an organization that cares for the elderly also provides care services for those suffering from depression.  The Depression Care Management program at the organization involves the collection of data about elderly individuals’ physical, social, emotional status and particularly their health conditions. This information assists in understanding the mental health of the person and whether they are suffering from depression. Correction of data or information on the health status of elderly people is the first step in developing programs that allows for personalized healthcare in the organization.  The questions in this tool are important in understanding the different functional characteristics that define the extent to which a person is suffering from depression. These ranges from  difficulties in reading and carrying out personal chores such as dressing , eating , complex tasks like finances , health issues such as fecal and urinary incontinence and even speeches.  The Depression Management care at Katherines Place involves providing an environment for socialization to prevent isolation, engaging individuals in various activities to keep the patients busy and thus, direct their attention away from their problems such as bereavement. In extreme case, where the depression level is high, the care givers provide the depressed elderly people with medications to ease the condition or even enable them to eat properly. The program is also based on collaboration with the family members of the elderly people so they are visited regularly which goes a long way in reducing the feelings of Isolation.  The collaboration with the family members also helps in improving the care given to these individuals.  

There are various barriers that prevent program to reach many old adults in the community for treatment of depression. The barriers keep program used by the organization from being used. A major barrier is social stigma especially against individuals who are mentally ill. Some people in the community consider depression as a character flaw or personal weakness which makes the older adult to be reluctant in seeking mental health care. The older persons also have negative attitude towards seeking help for mental health disorders and related treatment which they may view as shameful and/ or relate this to personal failure. Given that an individual’s loss of autonomy has been observed to be a major risk factor for depression, these individuals may resent seeking help from the center as they attempt to take care of themselves or regain their freedom.  Hence, they can even deny having mental health problems and embark an attempt to personal care.  Another issue involves cost of care, since insurers such as Medicare only provide depression cover only if the care is offered by psychologists or physicians and any RN practitioner.  Without enough funds, it becomes hard for care givers to provide care givers who are well trained and under supervision. This means that as much as the Katherine Place Depression Care Management program is focused on assisting these individuals in the community, they may not have the capacity and the capability to provide appropriate care to the patients, which hampers the adoption of the various programs.

Conclusion

There is a higher risk of elderly people to suffer from depression than any other group in the population. Due to the related devastating consequences, depression in late life is an important issue in public health. The current solutions involve collaboration in public health community, between CDC and the various Community Based Organizations and agencies to implement various programs for caring for the depressed elderly people. The CDC collects evidence on elderly people suffering from depression and such information is used in development of care giving programs.  Since depression can lead to more complications for other diseases among the elderly people, it is important to have effective and personalized care that is evidence based. The Depression Management Care should also address the stigma, attitude and cost barriers that prevent organizations from reaching more elderly and depressed individuals in the community. This should involve intensive education of the participants about the need for seeking healthcare and epically change their attitude on loss of personal autonomy.

Part 2

Public Service Announcement

We cannot control or prevent ourselves from aging, put we can control out experiences of the aging process. By undertaking tests on depression and seeking professional assistance, we can embrace our late lives positively but not as a sign of personal flaws. For more information contact the nearest care giving center or agency.

 

 

References

At, C. D. C. (n.d). "CDC Promotes Public Health Approach To Address Depression among Older Adults."

 

Coleman, E. A., Whitelaw, N. A., & Schreiber, R. (2014). Caring for seniors: How community-based organizations can help. Family practice management, 21(5), 13-17.

 

Centers for Disease Control and Prevention. (2012). Depression is not a normal part of growing older. Healthy Aging.

 

Mental Health America , (2018).Depression In Older Adults: More Facts. Retrieved from: http://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts

 

Sözeri-Varma, G. (2012). Depression in the elderly: clinical features and risk factors. Aging and disease, 3(6), 465.

 

 

Appendix

Interview Questions - Summary

 

1. Do you believe depression is a major problem among the elderly persons today?

Yes - Just as Some residents are depressed

 

2. How do depressed older people behave different?

   Symptomatic – anger, harsh to staff

 

3. What are the Risk factors to depression among the elderly?

 

Change in health standards and living standards where can no-longer care for themselves

Illnesses that affect comprehensions of things including their surroundings

Loss independence, loss of family, friends

Loss of autonomy – They do not want help and keep it to themselves

Other complications such as Bi-polar disorders which makes them confused and upsetting to people around them

Those who served in combat war, PTSD, recurring nightmares, horrific experiences

Women – if it’s a couple , the husband is declining faster than wife and she starts worrying, she cannot care for him – showers , meals , medications but experience him sleeping away , comparing their situations with those of others

  

4. What is the Role of nurses in reducing risk factors among aging population?

 Conducting Good assessments , being vigilant , collaborating with residents regard to symptoms ,such as change in eating and sleeping habits ,

• Encouraging families to visit often , engaging older people in activities , ensure they are having friends to prevent isolation

5. How is insomnia related to depression among the elderly?

-Less sleep become clumpy, more confusion, confused nights and sleeping all days, not enough rest

 Is depression more common among aging women or men?

There more depressed women in nursing homes

15 women but more men at Katherine’s place

7. How do you perform Screening and administer treatment?

Screening everyone for depression, check their level, monitor them on how there are doing socially, preventing them from being Isolated, XOLOft, PROZAC, sleeping medication

Medication – so that they eat well