This doesn't surprise me: National Nursing News | Depression in LTC Often Goes Untreated

Older adults living in long-term care face a sad state of affairs. As many as 50% of residents of LTC have depression, and only about 25% of them are identified and receive treatment, according to Neva L. Crogan, RN, PhD, GCNS-BC, GNP-BC, FNGNA, secretary of the National Gerontological Nursing Association and research associate professor, University of Arizona in Tucson.

Not only does untreated depression lower quality of life, it can have significant negative effects on an older adult’s physical health. These include increasing pain and exacerbating chronic conditions.

“They are not going to want to eat or get out of bed, which impacts their ability to care for themselves,” says Crogan. “If it is not addressed, depression could lead to weight loss, malnutrition, and even death.”

Older adults living in LTC are at risk for depression for a number of reasons. Factors include medication side effects, untreated or undertreated pain, and/or medical conditions, such as cardiovascular disease or stroke, which often go hand-in-hand with depression. In addition, LTC residents also face a number of losses that can result in feelings of isolation and dependence and contribute to depression. These include the loss of friends and loved ones and the loss of their ability to live in their own homes and their sense of independence.

LTC facilities and nurses do not routinely screen residents for depression. In addition, nursing assistants, who often interact the most with residents, are not educated to know the signs and symptoms of depression in older adults, according to Crogan, who has worked as a state surveyor of LTC facilities. “Nurses don’t always know how to assess for depression, either,” she says.

Another barrier to better recognition and treatment of depression in LTC is the commonly accepted misnomer that depression is a normal part of aging. “Many of the signs of depression, such as constipation, insomnia, fatigue, weight loss, low activity levels, and uninterest in activities, often are attributed to other problems, or worse, assumed to be part of being old,” says Charlotte Eliopoulos RN, MPH, PhD, executive director, American Association for Long Term Care Nursing.

Crogan and Eliopoulos stress that depression in the older adult is not normal and is recognizable and treatable with antidepressant medications and psychotherapy.

Educational programs designed to improve the care of LTC residents with or at risk for depression are available. One such program is the Wellspring Program, a part of the Beacon Institute in Columbia, Md. “We have educational programs that address depression, but equally important is the holistic — body, mind, spirit — considerations in all the topics that are taught,” says Eliopoulos, director of the program. “There is an emphasis on promoting purpose, honoring individuality, and instilling meaning in residents’ lives.”

Additional resources available to help LTC nurses improve recognition and treatment of depression include those provided by The National Gerontological Nursing Association and the Hartford Geriatric Nursing Initiative of the Hartford Institute for Geriatric Nursing, NYU College of Nursing.

Other efforts are beginning to transform LTC culture to improve quality of life and minimize depression for its residents. They are expanding restorative nursing programs that focus on such elements as nutrition, exercise, and creative and social activities in order to optimize physical, mental, and psychological functioning.

However, Crogan cautions that these types of programs have been around for decades and that, by themselves, they simply haven’t been enough to effectively address depression in LTC. “Yes, a culture change absolutely has to happen, but I would also like to see organizational change,” she says. “LTC settings are still very task oriented, and the old way of team nursing is not working for its residents.”

Typically a nurse oversees care, passes medications, and completes the LTC Minimum Data Set assessment on each resident, but nursing assistants often perform most of the hands-on care. To better address depression, Crogan says that the LTC LPN or RN needs to return to the bedside. “It’s the only way that we can get away from the nurse not knowing what’s actually happening to their residents,” she says.

The part about losing friends and loved ones really is true; think about it!

Also see this post: http://www.ultimatenurse.com/forum/f...elderly-27710/