“Early detection and treatment of depressive symptoms in the elderly

living in residential homes”

Nienke van Haaster

&

Michel Ronkes

April 2010

Mental health care in the Netherlands

1. Welcome and introduction

2. Group experiences

3. Signs and symptoms

4. Measurement tools

Break

5. “Depression in the elderly’’ a short film

6. Nursing diagnoses

7. Nursing interventions

8. Other help?

Content

1. Introduction, cause, purpose

Introduction:

Cause:

Depressive symptoms in the elderly are highly prevalent. • Own experiences• Previous studies

Golden, J. et.al. (2009), Eikelenboom, P. et.al. (2008) & Krupinski, J. & Tiller, J.W.G. (2001)

Purpose:

At the end of this workshop you will be able to:

• Explain the relevance of this workshop;

• Identify signs and symptoms of depression in the elderly living in care home;

• Describe measurement tools to detect depression in an early stage.

2. ‘Group experiences’

• Please make subgroups of 4 or 5 persons • Share your experiences about depressive symptoms in the elderly • Write some keywords on a flip-over

• Present your findings to the whole group.

3. ‘Signs’ and...

• No expression• Negative thinking • Disorganized environment• Clothes and hair looks sloppy• Thoughts to give up life• Loss of weight• Nothing to do• Wants to be alone, without contact• Loss of energy, tired • Bad medication compliance• Lack of interest for help

..... ‘Symptoms’

DSM-IV main symptoms:

1. Depressed mood2. Loss of interest or pleasure Other symptoms:

3. Weight and appetite 4. Sleep disturbance5. Motor activity: agitated or slowed6. Thoughts of death, suicide or suicide attempt7. Feeling worthless or guilty8. Indecisive, loss of concentration9. Loss of energy

4. Measurement tools

Scales that can be used to confirm your presumption:

• GDS-15 geriatric depression scale (most frequently used all over the world). Easy to use 15 yes or no questions. However, a diagnoses of clinical depression should NOT be made on the GDS results alone.

Other examples:

• Zung self rating depression scale

• Depression Anxiety Stress Scales (DASS)

• Hamilton Rating Scale for Depression ( HRSD)

• Beck Depression Inventory (BDI)

Break

5. Depression in the elderly

A short film

6. ‘Nursing diagnosis’

• Low self respect• Changing thinking process• Hopelessness/ loss courage• Thoughts of death of suicide • Sleep disturbance• Loneliness • Loss of interest and pleasure• Fear / Look up to everything • Ineffective coping • Compliance problems with medication • Inadequate feed and liquid consumption• Loss concentration• Reduced self care

Herdman, H.T.(2009)

Herdman, H.T. (2009)

7. ‘Nursing interventions’

‘Nursing interventions’

• Small talk improves quality of life• Exercise helps against depression

Help with exercise!• Cassette for medication• Daily activity programs• Suitable support for self-care• Social support• Relaxation training • Stop negative thinking:

Speak about thoughts and behavior • Search for options for better food and liquid reduction

Nurses and nursing assistants: speak out and share!

And last: Always ask patient and family: they know best!

Bulechek, M., et. al. (2007)

8. Other help?

Questions?

Thanks for your attention and active participation during this workshop!

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