Thursday, November 19, 2009

Depressed Elderly?!

I work with the elderly almost on a daily basis, and when you work with people all the time you tend to notice things, and it does help that I am a nurse. I have seen depression in the elderly population and the little to help them. I can tell you if you are in your 20's, 30's, 40's, 50's and even early 60's and you live at home that you will be probally treated differently for depression then if you were living in a nursing home in your 60's, 70's or older. In the general population you call the MD and make the appointment to talk to the doctor about what is going on, the signs and symptoms. Then if they feel you are displaying signs of depression they will refer you out to see a therapist. So that  you may explore the feelings, the root of the issues that may take years to find or months to surface but you are there and want to feel better so you take the risk and develop that therapist / patient relationship that becomes so vital to your well being. This relationship is one that you know in a moment of crisis you can pick up the phone and the one that you talk to will know you, what is going on inside you because you have shared the past and the emotions that goes with all the pain and hardship with them already. So when you are in a moment of need, real need that goes beyond your husband, wife, girlfriends, and all other family members you reach out to them for a word of direction, you know they are there no matter what and will not laugh at you, tell you that you are crazy, rather listen and get you through the moment, hour, or minutes what ever the case may be at the time to bring you back to the place where you are able to function again  in your life, then they will see you in the office usually that day or the following day depending on the time that your crisis occurs. Then you build that relationship til you have the skills to function and live as your need to without feeling as if life is always in the toilet, knowing in the back of your mind that if you need to see the therapist again in the future they are there a phone call away. But what happens if you are sad and in a nursing home, if depression sneeks up on you there now what do you do? Do you dare talk to the nurse? Do you want to have the staff think your crazy, what will your family say? Will they tell your family? Will they be disappointed? After all they are an adult, and they should know how to handle things being they are now old right and have lived all their life and now they are depressed? What do they have to be depressed for they have people all around them all the time, they have relaxation to the max.  Why would the elderly be depressed or have symptoms of depression?  Yet the elderly is a population that depression is rapid in and often can lead to suicide. I cannot say that I have ever heard of a elderly person committing suicide in a nursing home, but the elderly living on their own it has and does happen. The staff in the nursing home start to notice things about the resident and tip them off to the possibility of depression. They then have to call the doctor and get a referral for the resident to see the Psychiatrist. Now, before they resident can run off and talk to the Psychiatrist the family has to be notified and they have to agree to their family member seeing the new doctor (psychiatrist). If their family mainly their power of attorney say no there is nothing that the staff can do other then monitor them, talk to social services and see what they can do on their end. Unless the resident makes threats to harm themselves or others, but you then have to take into account do they have dementia? Is this there dementia talking or is it an expression of their true feelings? The key here is the consistency of staff, knowing  your residents, paying attention to them as their nurse. Talking to them and building that Nurse - Patient relationship. This relationship is vital at this moment, because you are there to take care of them, and that is so much more then passing the medications, and doing dressing changes. This nurse - resident relationship in a nursing home is vital to them and vital to your care of the resident. The nurse in this situation is key, because if you are working and you don't have that vital relationship established, because you are only there to deal with medical issue, pass the medications then you are missing what nursing is all about, it is about taking care of the residents. Yes, that does include the whole person, physical, mental, and spiritual issues. You have to talk to them, get to know them so you can care for them they way that they deserve to be taken care of, you have to care about them in order to reach them and talk to the doctor about the mental health matter that is at hand. So after all the careful consideration you call the family and talk to them about their loved one and they agree that their family member is down, or not acting right and agree for them to see the Psychiatrist. In other cases they were just waiting for the nurse to say something, because they have noticed a change yet were unsure how to approach the subject matter with the nursing staff. So when you finally bring it up they are relieved that they will get the help for their loved one. They agree to them seeing the Psychiatrist to find out what is going on, so then we get the consent signed, and make the appointment. Now depending on the facility the resident may go out or the Psychiatrist may come in to the facility and talk with the resident in their room. After they are seen the Psychiatrist will make recommendations based on their findings when they spoke to the resident. They may recommend a new medication or two, then the Nurse will take the orders and process them, but before anything can be filled, we have to have permission again. The nursing staff will have to call the residents power of attorney and speak to them about what the doctor has recommended for their loved one. If they agree then we get the consent and start the new medication(s), and they sign the paperwork for the new medication(s) when they come in to visit their loved one. Simple right, well not always, sometimes the family refused the medications and then the nurses hands are tied, they can just talk to the resident and their family and refer them to social services. Also if the family doesn't call often or visit often it can take a week or longer to get the consent verbally for the new medication(s). Meanwhile the resident is sad, anxious or what ever the case may be at the time, and the nursing staff cannot help other then talking to the resident or calling and having social services talk to the resident. One thing that is very different is the elderly in the nursing home usually do not have any form of talk therapy. So this is the nurses job to talk to them, help them deal with recent losses in their abilities, death of friends and residents that they are close with along with any other issues that they are experiencing. Again that Nurse - Resident relationship has to be there otherwise they are not going to open up to you as the nurse. The Psychiatrist will follow the resident and monitor the resident's progress, monitor their behaviors, are they getting better, has the nurse and staff seen an improvement in the residents behavior. They will monitor the medication(s) and make the necessary adjusts to the medication(s) as needed. Yet, if there is a change in dosage, frequency then the nurse is calling the power of attorney again to discuss the change and get the consent(s) signed for any changes that need to be made so the resident can enjoy life to the fullest even if they are living in a nursing home. It is a different world if you live in the nursing home and you are depressed, but their is help, if the nurse and staff take the time to know the resident and are not there just for the paycheck. Nursing in a Nursing home is different then any other setting we are more involved with our residents, because we have to be and should want to be for the care of the residents.

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