Community psychiatric nursing and depression in elderly people

Patient’s and general practitioner’s different views on patient’s depression

Differences between patient's and general practitioner's view on patient's depressive syndromes was investigated in a prospective birth cohort study of 70 year old people (n=1032) in Turku City, Finland. The aim of this study was to find factors which are typical for people having depressive syndromes in old age and help medical and nursing staff to identify depressive syndromes in the general aged people. The study consisted of a structural postal questionnaire including patient's perception of his depression, an interview made by a public health nurse included mini-mental state examination (MMSE) and the self-rating depression scale of Zung, an interview and comprehensive clinical examination by a general practitioner. Out of the 847 persons who completed the depression test, 12.6% showed symptoms of depressive syndrome. The views of those who scored more than 45 points in the Zung depression scale on their own depressiveness differed from the general practitioner's opinion. In the general practitioner's examination and interview 58% of the subjects had no depressive symptoms even though the test results indicated that they were depressed. The depressed group stood out most clearly in two questions: Do you feel you are needed and do you have future plans? When the same questions were repeated 5 years later, the difference was still statistically significant between depressed and non-depressed group (P<0.0001). The data indicated that medical and nursing staff should take self-assessments seriously and look into them in closer detail. General practitioners and nurses should learn to ask right questions and use short depression scale systematically in order to facilitate the detection of depressive syndromes.

Psychiatric nursing for promotion of mental health and prevention of depression in the elderly: a case study

The aim of this case study was to describe and analyse the basic pre-conditions for an intervention programme focusing upon mental health promotion and prevention of depression in an elderly community group and to discuss the psychiatric nurse's community-oriented health promotion work. The intervention programme, which was led by a psychiatric nurse, was built on intersectorial co-operation between public and voluntary organizations, development of social networks to promote social support, and target group participation. The nurse's function in the community-oriented work was to act at the individual, group and society level, as well as to mobilize resources among individuals and organizations, in order to create a favourable interaction, resulting in health and empowerment for the individual. Pre-conditions for leading this work were: knowledge of health and mental all health among the elderly, investigation methodology, knowledge about the local society, as well as pedagogical, supervisory and social competence.

Loneliness in elderly people: an important area for nursing research

The phenomenon of loneliness occurs in people of all ages but may be a particular problem in the elderly. It is acknowledged that loneliness is not a necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in elderly people. However, there is a relationship between ageing and loneliness. Four major theories of loneliness are reviewed and their utility for application to research in the elderly is examined along with a consideration of the ways in which loneliness can be measured. While causal relationships are difficult to determine, there is evidence that loneliness is associated with a number of physical and psychological pathologies and the relevance of these to nursing is discussed. There is a growing awareness of the phenomenon of loneliness in elderly people in the nursing literature and some evidence that nursing intervention can be beneficial in this regard both at alleviating loneliness and reducing some of the adverse effects of loneliness. Finally some directions for nursing research are presented which are aimed at improving the assessment and nursing intervention for loneliness in elderly people.

A spiritual well-being model: use with older women who experience depression

Although evidence exists to suggest an integral influence of one's spirit on one's mental health, few nurse theoreticians have attempted to delineate and include the concept of spirituality in their nursing models. In making practice decisions related to spiritual matters, mental health nurses require knowledge about the interface between spirituality and mental health. Many symptoms of depression, the most common mental health problem of older adults, parallel indications of spiritual distress. The author presents a spiritual well-being model that provides a framework to discuss the antecedents, symptoms, spiritual needs, and holistic treatment of depression as it is experienced by older women.

Geriatric depression: a survey of nurses' knowledge and assessment practices

A sample of 149 registered nurses were surveyed to determine their knowledge of the symptoms of depression in the elderly and their assessment practices. Respondents were able to identify not only the traditionally associated symptoms but also two other behaviors, irritability and blaming others, which are not usually designated by other health care providers as associated with geriatric depression. These additional observations may reflect nurses' providing extensive physical as well as verbal care over much longer time periods for patients in inpatient and home settings than do other professionals. Recent findings in nursing research support the presence of these other behaviors as symptoms of depression. An additional finding revealed that nurses were not assessing their patients for depression even though they had a knowledge base of the symptoms.

Mental illness in late life: the neurobiology of depression

The majority of elderly adults negotiate late life free from significant psychological disability. However, depression is one of the most common and distressing mental health problems they face. A number of factors associated with mental health, illness and depression in older adults is reviewed. In addition, an overview of selected psychological and biological theories related to depression are presented with the focus on genetic studies and the neurobiologic nature of stress to demonstrate the interaction between brain, behavior, cognition, and emotion. Psychiatric mental health nurses are challenged not only to examine the complex interaction between physical, mental, and social factors, but to integrate this knowledge into the discipline of psychiatric-mental health nursing, its practice, research, and education.

Community psychiatric nurses for the elderly: well tolerated, few side-effects and effective in the treatment of depression

Depression in elderly people is a common yet treatable psychiatric problem. The Gospel Oak depression study researched this much overlooked group and has shown that a community psychiatric nurse (CPN) was able significantly to improve the mental state of depressed elderly people. A multifaceted package of care was co-ordinated and delivered by one CPN over a study period of 3 months. A detailed account is given of those interventions implemented, highlighting those which were of most benefit for the patient. Outcome was assessed independently and it was found that those patients allocated to CPN care improved significantly compared to the non-intervention control group. Ways in which nurses can enhance care given to patients in the community are discussed.