183 Mental Health Concerns and The Older Adult
care worker assesses for depression. De- pression is not part of the aging process, and not all older adults experience de- pression (CDC, 2021b). The healthcare worker must be able to identify risks for the older adult. The NIA (2021b) lists the risk factors for older adults as physical conditions (most notably stroke and can- cer), genetics (familial history increases risk), stress (being a caregiver can cause greater stress), sleep difficulties (falling asleep or staying asleep), isolation and loneliness (assess the root cause of it if found and the subjective impact), seden- tary lifestyle, limited physical functioning (struggling with ADLs), and alcohol ad- diction. Older adults can find themselves alone and socially disconnected. Lone- liness can contribute to depression and heightens the risk of suicide for the older adult population (NIA, 2021b). Loneliness is a common feeling experienced by old- er adults and is an indication for further assessment to determine the level of dis- tress. The healthcare worker needs an un- derstanding of the signs and symptoms of depression and can teach them to the older adult to empower them to speak up. Caregivers should also receive this in- tervention so that they can request early intervention when possible. Symptoms of depression include sad mood, per- sistent feelings of hopeless/worthless/ helplessness, an inability to find pleasure in regular activities (including sex), a low energy level, markedly slow speech (no- ticed by others), cognitive struggles (dif- ficulty concentrating/remembering/mak - ing decisions), problems sleeping (more or less than usual), changes in appetite (increased or decreased), and thoughts of death or suicide (NIA, 2021b). If mul- tiple symptoms are found and last more
than two weeks, the healthcare worker (if allowed within scope of practice) can consider a clinical diagnosis of major de- pressive disorder (MDD) in line with the DSM-5 (APA, 2013). Recent loss, grief, bereavement, and culture must be taken into consideration prior to diagnosing. Untreated depression can lead to phys- ical detriment for the older adult. Cop- ing inappropriately with food can lead to obesity or geriatric anorexia (APA, 2022f). Depression can also alter cognitive clar- ity. Depressed older adults have a slow- er reaction time to stimuli, increasing the risk and dangers of driving, cooking, and self-care activities such as medicating (APA, 2022f). The healthcare worker can use a self-reporting scale when assessing. Geriatric-specific depression scales are available, but documentation and scope of practice should be discussed with your place of employment. A strength assess- ment can help the healthcare worker find the older adult’s historical methods of coping and resilience. It can also high- light unhealthy coping mechanisms that can be discussed. Questions for assessing an older adult’s strength include the following (Boyd, 2017): ● How have you coped with depression or depressive symptoms in the past? ● What do you find relaxing? ● What brings you joy? Treatments and recommendations for depression depend on the health status of the older adult and their living situa- tion. Treatment may be necessary for old- er adults experiencing symptoms of de- pression that have a sustained impact on positive mental health: physical exertion, proper nutritional intake, regular restful sleep, social connection, and engage- ment in activities that bring satisfaction
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