How to recognize a depressed patient
How to recognize a depressed patient
Checklists and other tools provide guidance
Assessing depression in an older home care patient is not an easy task. "The patient may give you one answer at the admission visit and another answer a week later," says Lisa Sioufas, LCSW-R, ACSW, manager of the mental health program at Visiting Nurse Services (VNS) in Westchester in White Plains, NY.
An older patient's reluctance to admit to depression or anxiety is why nurses and therapists need to be prepared to ask questions, says Sioufas. Keep the questions non-threatening and matter of fact for the best results. Be aware that older home care patients still view an admission of depression as a negative, rather than as another illness, she says. "Our nurses will ask something simple, like how the patient's mood has been during the past week," she says. Once the patient admits feeling down, the nurse can gently ask other questions.
A two-question tool used by primary care physicians can be a starting point for questions.1 You can start the process of assessing depression by asking "Have you often been bothered by feeling down, depressed, or hopeless?" or "Have you often been bothered by little interest or pleasure in doing things?"
"We use the PHQ-9 (Personal Health Questionnaire Depression Scale) to assess our patients," says Sioufas. By asking about the following nine symptoms, then scoring the answers based on frequency of the symptoms, the nurse or therapist can determine if treatment for depression is needed. The tool also can be used to reassess the patient after treatment is begun. (For a free copy of the complete tool, go to http://www.americangeriatrics.org/education/dep_tool_05.pdf).
The nine symptoms to evaluate are:
little interest or pleasure in doing things;
feeling down, depressed, or hopeless;
sleep problems - sleeping too little or too much;
feeling tired or having little energy;
poor appetite or overeating;
feeling bad about yourself or feeling that you're a failure;
trouble concentrating on activities;
moving or speaking slowly or fidgeting;
thinking about being better off dead, or planning to hurt yourself.
In addition to medication, other recommendations that nurses and therapists make to relieve the symptoms include exercise, even if it is walking around the yard, and finding ways to socialize with others, says Sioufas. "If the patient lives in an assisted living facility, we encourage participation in the activities offered by the facility," she says. "If the patient lives alone, we involve the family and ask for them to make regular visits to the patient," she says. Asking for visitors is not something most patients will do, so it's important to initiate conversations with the family, she points out. "We also look for community programs, such as friendly visitor programs offered by local churches that can also increase the patient's opportunity to socialize."
Reference
1. Ebell MH. Routine screening for depression, alcohol problems, and domestic violence. Am Fam Physician 2004 May 15; 69(10):2421-2.
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