Depression in Elderly

Question: Discuss about the Depression in Elderly. Answer: Introduction Every individual has self- identity; self- respect, self- dignity and self- esteem in their life as it values a person. If any of these values are affected, it may lead to the development of negative imaging about self that lowers self- esteem resulting in anxious or depressive disorders (Orth, 2012[i]).The same is observed in Mrs. X with depression who is residing at an aged- care home. I have conducted an in- depth interview (face- to- face) with Mrs. X who is an 80-year old woman and explored her perceptions about life and found that Mrs. X shows depressive symptoms. She was reluctant to share her views with interviewer. Her self- esteem seems to have affected making her to think to be powerless as well as less competent about them. In addition to that, poor self- esteem acts as a risk factor to develop depression, which is one of the common disorders affecting the older people. This case study explains about the problems of Mrs. X, theories of ageing related to depression, models of care to control depression and strategies of care to overcome her problems. Overview of the topic It is evident from the world statistics that there is constant increase in the population of elderly because of advanced science as well as technology and enhanced life expectancy (Park, 2014[ii]). The needs of the elderly people have increased due to the changes in demographic with scientific profile and if they are not met appropriately, they may result in unexpected consequences such as depression, anxiety, dementia, insomnia, etc (Steiger, 2014[iii]). According to Australian- Bureau of statistics (2008[iv]), depression is one of the most common disorders of elderly affecting nearly one million people in Australia. An Australian study conducted by Pirkis et al (2009[v]) suggests that the prevalence rate of depression was found to be 8.2% (in a sample of 22,252 people) in community- living elderly people which is lower than that of the prevalence rate of depression with 34.7% in the elderly residing in residential aged- care homes (Snowdon, 2008)[vi]. These findings imply that depr ession is most common in elderly, which is examined in the following case study. Case study Mrs. X, 80 year old woman who was residing in aged- care home was interviewed. Her inner feelings, perceptions and esteem level were analyzed. During interview, she was found to have lost her husband recently and is alone. She was cared by her daughter who visits her once in fortnight. She has feelings of isolation and loneliness. She belongs to a middle- class and was living in the aged-care home for past one month. She was a staff nurse and had 7 siblings. She was having diabetes mellitus, hypertension, polymyalgia rheumatica (PMR) and ischemic- stroke. At the time of interview, she was assessed to have inability to express her emotions and feels reluctant to share her views. She feels inferior and is hesitant to interact with other people because of her disabilities. Mrs. X always feels unworthy and has no meaning for life. She curses herself because of her inability. She feels isolated and no one supports and encourages her to perform activities. Interconnectedness of literature with Mrs. X Several reasons for developing depression has been described in the literature that includes lonely or isolated feeling, medical illnesses (dementia, Parkinsons disease, Alzheimers disease), side effects of certain medications (Tab. Prednisolone), mental or physical disabilities, societal causes, economically low status and cultural causes as stigma, un-married or feeling shame (Zhang, 2014[vii],Fairfax, 2014[viii]).This is similar to Mrs. X having feelings of isolation and loneliness because of her husbands death that has lead to depression. Her chronic physical conditions such as diabetes- mellitus, hypertension, PMR and ischemic- stroke and their treatment modalities might have contributed to her development of depression. Moreover, PMR has lead to features as joint- stiffness in shoulder- girdle, pelvic girdle, etc, muscle pain, fatigue, anorexia, weakness with decreased joint- movements that had lead to immobility issues causing difficulty in performing daily activities. In addi tion to that, intake of Tab. Prednisolone for several years to control PMR has contributed to her depressive condition (Zukerman, 2013[ix]). Persons with depression are at increased risk for denial by family members and care- givers and might have tendency to feel withdrawn. This might affect the inter-personal interactions leading to declined attachment, reduced support and satisfaction with family relations. Finally, this depression might lead to develop challenging behavior that is characterized by the behavior of a person that puts themselves or others (care- takers) at risk and leading to a poor quality- of- life. Theories related to ageing and depression Various theories were quoted in the literature that relates ageing of a person with depression. According to damage or error theories, not only a single mechanism but rather multiple mechanisms are involved in the deterioration of normal cell function and reduction of normal responses to stressors contributing to various chronic diseases and death. This is similar to Mrs. X with chronic diseases such as diabetes mellitus, hypertension, polymyalgia rheumatica (PMR) and ischemic- stroke that has lead to the development of depression (Jin, 2010[x]). Additionally, she has features of PMR as joint- stiffness, muscle pain, tiredness, anorexia, weakness along with reduced movements in joints that has lead to immobility problems causing difficulty in performing daily activities. Further, the disabilities caused by her multiple diseases, has increased her stress and made her to dependent on others for support. This has increased her feelings of worthlessness, insomnia, etc causing depressive feelings. According to disengagement theory, the persons will start withdrawing as well as isolating from social interaction as the age increases. It adds that growing older leads to decline in certain degree of discontinuity of a person from previous life activities and experiences leading to physical with mental alterations which are evident in Mrs. X with physical (multiple diseases) and mental (depression) disorders. According to immunological theory, the functions of immune- system are gradually declined as age increases leading to increased risk for diseases such as hypertension, Alzheimers disease, PMR, cancer, cardiac- vascular diseases, etc causing depression which is evident in Mrs. X with multiple chronic diseases. The cross- linking theory suggests that when a persons age increases, the cross- linked proteins might be accumulated causing injuries to the cells as well as tissues leading to the slowing down of bodily functions resulting in inability to carry out activities. This is evident in Mrs. X as she is 80- years old with gradual reduction in her bodily processes leading to inability to perform her daily- care activities, which has lead to the feelings of inability, powerlessness, hopelessness and worthlessness causing withdrawn and depressed. Based on structured- dependency theory, societal aspects such as retirement, institutionalism and loss of personal as well as societal roles may increase the dependency of elderly on care- takers leading to the feelings of inability causing depression. The same has happened in Mrs. X who is a retired staff nurse and is institutionalized in this residential- care home shows the feelings of depression as lack of interest in life, hopelessness, helplessness, etc (Jin, 2010x). Person- centered care The person- centered care is the best care approach to manage depression which involves providing individualized care to Mrs. X based on her needs, wishes, believes with preferences. Few studies suggests that the person-centered care might help to decrease the symptoms of depression in Mrs. X. Person-centered approach involves valuing others, giving respect, enabling social-relationships, enabling choices, providing opportunities to her to stimulate as well as recognize Mrs. X as a whole (Stokes, 2007[xi]). A plan of care and support with her choices of care was drawn after identifying her care needs. Mrs. X has experienced a greater degree of loneliness and isolation. It is due to various reasons as loss of spouse, living alone, lack of support, relocating to care agencies and inability to perform activities due to physical as well as psychological limitations. Additionally, ageing is inversely related to networking, size of network, primary- group network and interactions with netw ork- members (Cornwell, 2009[xii]). Therefore, these factors were determined at the initial stage to prevent further consequences in Mrs. X. Various strategies were developed to promote psychological health of Mrs. X based on her issue. In regard to Mrs. X, I have gathered all the residents of home in a group and I have given an exercise and allowed them to talk and share their views that were found to be highly effective. Varied positive methods were taught to both Mrs. X and care-givers to enhance their self- esteem (Jang, 2014[xiii]). It was observed that depression is highly contagion and it easily spreads from one to another in regard to both health and their productivity (Cuijpers, 2012)[xiv]. Hence, her care-takers were educated about the relationship between the methods to tackle depression. Physical exercise was given to control depression. Moreover, health promotional and prevention activities and strategies were developed to focus on Mrs. X to control depression (Lai, 2008)[xv]. It is evident from the literature that multiple strategies are needed to handle depression. They include educational, psychological, pharmacological psycho- therapeutic, dietary interventions and life style modifications. Psychotherapies such as cognitive- behavioral, supportive, group, family, reassurance, inter- personal psychotherapy with drugs (imipramine) were given to Mrs. X to decrease depression. The core components of collaborative- management programs were framed to focus Mrs. X that includes measurement-related care, tar get-treatment as well as stepped- care. These approaches might promote client satisfaction and outcomes (Unutzer, 2012)[xvi]. Legal and ethical issues Various issues has to be considered while caring elderly persons. Autonomy is considered as the most important ethical aspect in caring elderly of Western societies. This involves giving complete independence and freedom to elderly to take decisions about their treatment, care choices and other life decisions based on their own desire (Vanlaere,2007[xvii]). They should be treated with dignity and respect. The following ethical principles has to be followed while caring an elderly person such as treating them as a person, respecting their confidentiality, treating them fairly and equally and respecting their basic rights. Recommendations In regard to Mrs. X, it is recommended to encourage, educate and counsel such clients to promote their trust and self- confidence. They should be given with enough space to help them to interact with others even in external circle to share their emotions with friends, colleagues and family members. It might promote their self-confidence and esteem giving them a chance to control depression. The elderly organizations should develop community- care and societal support- networks to implement preventative programs for depression in older aged people. These types of programs might introduce positivity in the minds of older people and help them to behave positively with relatives and help them to gain some meaning in their life. Additionally, Nation- wide laws and policies could be developed in regard to rights of elderly people to make people bound to care the elderly population as well as to solve their issues (Lai, 2008xv). Moreover, the risk factors for getting depression in elderly such as disturbed sleep, isolated feelings, elder abuse, physical disabilities due to chronic neurological disorders, etc should be clearly determined. Further research is needed to generalize the etiology for depression in elderly. This approach might improve the focus on prevention and interventional strategies and enhance collaboration between various sub areas of its prevention (Cuijpers, 2012xiv). A characteristic in regard to resilience in depressive patients is needed to focus on targets for resilience- promotional interventions (Southwick, 2005[xviii]).Cognitive- psychological regulatory strategies to re-focus planning, lesser rumination and reassessment might help in the resilience of elderly with depressive disorders. Conclusion Depression is the most common disorders in elderly people because of multiple etiologies. The case study of Mrs. X with depression is analyzed and various models and theories were used to explain the relation of ageing with depression. These models will help to develop management and prevention strategies to develop self- confidence and trustful relationship of older people who is most needed for society. Elderly should be counseled and encouraged to overcome depression. 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