Tis the Season

Did you know that:

• 13% of the U.S. population is aged 65 or older but account for 20% of all suicide deaths, with white males being particularly vulnerable?
• Suicide among white males aged 85 and older is nearly six times the suicide rate in the U.S?
• Women are more susceptible than men to depression?
• Only ten percent of depression in the elderly is treated?
• Primary care physicians accurately recognize less than one half of patients with depression resulting in prolonged hospitalizations?
• A Gallup poll published December 4 indicates that Americans mental health ratings fell to a new low?

How’s that for a little holiday cheer?

There are many contributing factors to depression in the elderly. Diseases and conditions such as Diabetes, Alzheimer’s disease, Parkinson’s Disease, Cancer and arthritis have all been associated with Depression. Many medications may also contribute to depression.  Other risk factors for depression include the loss of a loved one, change in body image, substance abuse, family history, pain, loneliness and fear of death. Covid isn’t included in most studies but isolation is and with Covid comes isolation.

Treatment is often delayed or omitted because many people believe that depression is part of the normal aging process. Some people suffering from depression don’t recognize the way that they are feeling as depression. Many patients of prior generations may believe that depression is a sign of weakness and that medications cause unacceptable side effects. This may explain why physicians often miss the diagnosis of depression. When patients are asked if they are feeling down or sad, they respond as though everything is as it should be.

Nurses often miss it, too. On comprehensive assessments, the PHQ2, very rarely has a response indicating possible depression. It’s amazing how patients who are isolated from their families and friends, have difficulty breathing and pain and need help with just about everything never feel down, depressed or hopeless.

And still, the holiday season has begun before the pandemic is over. This is a problem, folks. For many patients, this is likely their last Christmas and even though you are too polite to mention it, they know it.

Nurses can help. The most important thing that you can do is take your time with the PHQ2 screening. When a patient with multiple risk factors denies feelings indicative of depression or says that they have not lost interest in doing things, pause. Most people will fill the silence. Often that silence is filled with misconceptions about depression. ‘Everyone gets a little blue during the holidays.’ or ‘this joint pain wears me out.’ Ask the doctor for a prescription or further guidance if you are unsure.

Remember that the PHQ2 screening tool is a standardized tool so it may not be altered. This doesn’t mean that you can’t document behavior that is contrary to the responses that the patient gave in the PHQ2. Crying during an admission is not normal. Patients who are lonely because family members are absent may believe they are simply being ignored. If a patient isn’t sleeping or is running out of certain medications like Benzo’s and pain relievers, document it. When family is available, inquire about recent losses the patient may have experienced. Ask about changes in appetite, sleep or behavior and document the responses and the source of information.

A full 80% percent of depression in the elderly is treatable. Although antidepressants are not free of side effects, remember that the ‘old school’ antidepressants caused major side effects. Reassure your patients that the side effects of new antidepressants are manageable and mild in most people and that there is a whole menu of antidepressants if the first one doesn’t work.

If the physician orders an antidepressant, schedule a few extra visits. It may take a while for the full effects of the medication to work and during that time, frequent checks, even by telephone, are important – especially if the patient lives alone.  

After the medication begins to work, your plan of care might add exercise, emphasis on diet and hygiene and other things that the patient didn’t care about while depressed. Being involved in their own treatment will give them a feeling of control.  Patients may need to be reminded of their rights and responsibilities because  they may be afraid they will have not choice in the treatment.

So, bring a little cheer to your patients this holiday season even if it comes in a bottle – a pill bottle. Please don’t bring your patients alcohol. Also remember that maybe the most valuable gift they may receive this Christmas is a kind ear that listens to them and is able to take action. Five minutes of your time is precious to many patients.

Any other ideas are welcome. Email us or leave them in the comments. I know they are special to you. Let’s make it a priority for them to know it, too.