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many times with an older population the.assumption is that of course you should.be depressed.I've lost my spouse I've lost my.independence I have physical problems of.course I should be depressed then my.response to that is while you're here.you might as well have the best quality.of life you can have so yes we should.definitely treat the depression people.died from severe depression I've had.patients that died that have died.because the depression has reached the.point where it's been so severe that.they end up lying in bed they don't eat.they get dehydrated and the snowball.effect starts with geriatrics the gds.screening in this video is used with a.resident living in her own apartment in.a continuous care facility the resident.had been visited previously by nursing.students from a nearby community college.the students and their instructor have.returned together to visit based on the.students concerns about the residents.overall mood and comments please note.that the resident prefers to be.addressed by her first name you will.also notice that after the screening is.completed several follow-up questions.are asked these questions are not on the.screening form but are based on the.critical thinking of the practitioner.performing the gds screening and are.designed to obtain additional.information that can guide initial.recommendations for care I'm one of the.nursing faculty at Community College of.Philadelphia and I think you met Venus.and Rachel last week while they did.their clinical rotation when we first.came in that students had some concerns.that you had verbalize to them about how.you were feeling last week and I wanted.to just ask you a few more questions.about your spirits if that's okay.do you feel like you're basically.satisfied with your life I think so okay.have you dropped interest um have you.lost interest in activities that you.used to enjoy sometimes yes mm-hmm.Sheila do you feel like your life is.empty.yes like times I do mm-hmm do you often.get bored yet Sheila do you feel like.that feel like you're in good spirits.most of the time no I don't particularly.earlier in the day and morning used to.be the good time for Meghan is not.anymore are you afraid that something.bad is going to happen to you ah a.couple of months ago I was okay but I.don't feel that way today okay what did.you think was going to happen.perhaps it's somebody I knew was going.to die okay I'll get seriously ill do.you feel like half do you feel like.you're happy most of the time not really.I may put on a good fun but I'm really.not that happy do you often feel.helpless no I don't do you prefer to.stay home rather than going out and.trying new things.depends what the new things are do you.feel like you had the energy or the.interest in going out and trying.something else or do you feel like you.would just rather stay well I think I'd.rather stay home okay do you feel like.you have more problems than most people.your age in terms of your memory No.do you think it's wonderful to be alive.right now hmm uh for the most part yes.mm-hmm.do you feel pretty worthless the way you.are right now occasionally like in the.past week how y'all livin tongue I don't.know you do you feel like you're full of.energy not really do you feel like your.situation is hopeless yes I don't want.to be a burden on other members of my.family do you think that you're better.off do you think that other people most.other people are better off than you are.no I don't know after asking the 15.screening questions Lorene goes on to.ask a few additional questions based on.the results of the screening these.questions help her explore some.potential ways to treat the depression.sure what have you done what do you do.that makes you feel better what helps.you feel better in terms of your spirits.I think it helps to get out and get out.of the apartment and maybe a pleasant.apartment but there aren't any anybody.else here so it's necessary to meet.people from New York and chat or go to.the short story Club we have similar.interests in reading and discussing what.we read and do you find that you have.the energy to pursue those things some.days I do in Sundays I don't do you how.would you describe your mood today or.well today it's good like in the past.week how would you describe your mood ah.some days of being good and some days.will be bad.and down I think that because we've had.hot weather that had some effect right.because you can't go out and say flash.work this work do you feel depressed ah.sometimes yes can you remember a time in.your life that you have had trouble with.depression yes mm-hmm.more than one period of timing uh.probably about like I think mitad 20.years ago okay and were you treated then.yes I was with medication.yes medication if you could make two.things better in your life what would.those two things be oh my what a.question.oh yeah look if you can identify even.one thing yeah we won prove your quality.of life what would that be probably.being more with people nice people.mm-hmm do you ever have thoughts that.you would be better off if you weren't.living um occasionally occasionally ever.think about having any plan that you.would harm yourself uh 20 years ago when.I suffered from depression I can.remember thinking it would be nice to.stick my head in the oven okay how about.now no I think somebody talked me out of.a 20 years ago do you have somebody that.you talk with in terms of your mood and.when you feel low yes mm-hmm.a family member or a friend I have a.spiritual friend that I talked to do you.talk with your primary care provider.about how you're feeling in terms of.your spirits.yes mm-hmm and what are they and what.have they said to you what if they did.they talk to you about any treatments.they have mentioned that perhaps any.questions like I'll help you but you're.not on any medication.not right right now waiting and you.continue to have the symptoms and you.had them you said for a couple of months.that's what that's a long time yet yeah.not so good mm-hmm I should have some of.the symptoms that you described are can.be consistent with a depression and.we'll probably we will talk with your.doctor and one of the options is.medication and talking therapy would you.be amenable to treatment for the.depression if we find that this is in.fact a full-blown depression that really.might be some help yeah I could help.with your quality of life right.depression is a medical diagnosis that.encompasses many different symptoms.including concentration interest sleep.appetite mood subjective mood.irritability interest in activities that.one used to enjoy and there's a range of.symptoms the gold standard for diagnosis.of depression is the Diagnostic and.Statistical Manual of Mental Disorders.and they list nine criteria for.depression two out of the nine must be.present for any diagnosis of depression.minor or major and they are depressed.mood and loss of interest or pleasure.and activities that used to be.pleasurable to be characterized as.having a major depressive episode you.need to have five out of those nine.symptoms present over a two-week period.of time consistently and also.representing a change from baseline.usual functioning to have more of a.minor depression diagnosis is usually.this it's the same nine criteria but.usually it's less than the five but also.present for the two-week period of time.and having a change in function it is.not normal to be depressed when you're.old.it is quite prevalent and uncommon and.hence people sometimes think that it's a.normal part of Aging but it is not a.normal part of Aging.depression is quite prevalent among.older adults.approximately 15% of those over 65.suffer from depression often undiagnosed.and untreated long-term care being the.most prevalent ranging anywhere from.sixteen to thirty percent depending on.which study you're looking I've even.seen as high as forty three percent in.outpatient care the prevalence is.approximately ten percent in acute care.the prevalence is about twenty three.percent the geriatric depression scale.is a screening tool for depression that.was initially developed in 1983 by two.researchers yes of aaj and shake so it's.often known as the yes of our geriatric.depression scale it was it is a.screening tool it is not a diagnostic.tool the initial tool in 1983 was a.thirty item yes/no questionnaire it has.since been shortened in 1986 to be a 15.item yes/no questionnaire one of the.benefits of using the short form is that.it only takes approximately five maximum.seven minutes to complete sometimes with.the GDS when you're asking the questions.some people want to expand on the.answers which is perfectly normal when.you're asked some of those questions so.one of the challenges is just kind of.redirecting people constantly back to.the tool some of the other issues that.come up sometimes are people who are so.depressed and withdrawn that they don't.want to answer the questions they're not.able to answer the questions because of.the depression they have to be coaxed to.answer them I think it's really.important when we're doing that so one.of the things that increases the ease in.administering the test is developing.somewhat of a relationship with the.patient the cultural considerations that.usually arise are with some people who.don't feel comfortable answering what.they consider personal questions what I.might consider to be a personal question.somebody else might not consider that to.be a personal question so I think we.always need to be aware of that other.cultural considerations with the.geriatric population are that depression.might be perceived as a weakness so I.don't use the word depression I never go.in and say I'm going to do a depression.on you I'm going to use a depression.stool I will start with saying things.about I'm concerned about your spirits.um you said that you were feeling blue.let's talk a little bit more about that.I find that when unless the patient.brings up the word depression that board.can be used it can be a barrier at times.you.now that we've evaluated Sheila this.morning.I wondered Rachel and Venus if you had.any questions after the talk that we had.with her about her spirits I questioned.um how often should a health care.provider assess for depression generally.they should assess for depression with.an initial contact initial assessment on.the person and then yearly especially.with geriatrics and then also if there's.any suspicion that some of the symptoms.as we had with Sheila this morning might.be indicative of depression like a lot.of Sheila's answers to some of the.questions her frustrations and the.things I made her sad were things that.anyone might experience in her situation.like how do you differentiate between.that and someone who's genuinely.depressed well the tool that we used.this morning was just that it was a tool.it was not diagnostic so you're right.that many of the things that she talked.about you would expect a lot of folks.who are older to have frustrations with.the difference is that when a person.meets that process to meet the criteria.for depression so do you remember what.some of the symptoms of depression were.not enjoying activities that she used to.enjoy or just you know generally being.withdrawn from her regular activities.and concentration issues appetite issues.sleep issues I'm subjectively feeling.depressed so some of the questions on.this tool might seem repetitive but.sometimes that is because a person might.respond better to one question than.another question so yes to answer your.question that was a long answer but to.answer your question that was that this.is just a screening tool we would.continue to assess her as we did after.we did the tool today and at what point.do you decide based on her answers to.that assessment that you would need to.take some kind of further action or do a.further assessment when we do the.geriatric depression scale any score.that's 5 or above indicates that we need.to continue to evaluate for depression.and when we evaluated Sheila this.morning she had a score of 9 out of 15.on the GDS the geriatric depression.scale which indicates that we do need to.do some further assessments with her.and what would your next step be with.her next step would be to either refer.her to a psychiatrist or geriatric.clinical nurse specialist or nurse.practitioner who specializes in this or.sometimes her primary care provider.could continue to do the assessment.piece of it and once it's ascertained.that yes she does meet the criteria for.depression then we would start to talk.about treatment options what do you do.when you're trying to ask these.questions and you're just not really.getting a lot of feedback from the.person like how do you get what you need.which happens many times she was very.forthright and was it was easy to sort.of connect with her and develop a.relationship and talk with her sometimes.when people are more depressed and I do.think she'll had a depression but I have.seen people with more severe depressions.they become so withdrawn they don't want.to answer any of the questions and.they're not able to answer the questions.so you need to take more time and kind.of developing the relationship with them.some of what I do is look at pictures or.try to find some common ground that they.have some interest with other times.people answer the questions but continue.to explain what their answers are we.have to kind of keep redirecting them.back to the question because you really.do want a yes or a no which in a couple.of the questions that I asked her she.wasn't giving me a yes-or-no I had to go.back and ask the question again Sheila.was quite forthright in her answers but.also like you said was answering 50/50.to some questions then you had a.redirect her to try to give you a yes or.no based on how she was feeling in the.past week a common response is I don't.know from someone who's quite depressed.and she didn't say that at all but that.you'll see a lot and then again you can.redirect and say most the time in the.past week would you say more yes or more.no and redirect them to a yes or no.instead of I don't know or not answering.I noticed you added some questions of.your own just I guess to try to keep her.on track I did set to keep her on track.and order and also to do a continued.assessment so the tool is one piece of.it and once we suspect that someone does.have a depression then we continue to do.the assessment as I said earlier when we.did the geriatric depression scale on.Sheila she achieved a score of 9 out of.15 which sends red flags up and tells us.that there.good possibility that she does have.depression and in looking over some of.the questions that she responded to.which gave her a point were have you.dropped many of the activities and it.just used to like which indicates that.she has no interest in things that she.once enjoyed which is one of the major.symptoms of depression the other.question that she answered yes to was do.you feel like your life is empty yes.many times that looks at like the.hopeless helpless piece of it she also.spoke about feeling like she was a.burden to her family members and that.came out when we asked about do you feel.like your situation is hopeless.so again another symptom that could.indicate a depression the other thing.that she answered yes to was do you feel.like you are pretty worthless the way.you are now one of the other things that.Sheila said during the assessment this.morning was that she felt worse in the.morning and better in the afternoon.which many times we see with people who.are depressed this actually has a name.it's called a diurnal variation and she.said that in the morning the mornings.used to be her good time and now they.were even her bad time so I got the.sense that she was feeling even more.helpless about that she also spoke about.having some thoughts that she would be.better off if she weren't living but.what was your sense of that when she.when she said that I felt like she was.recalling feelings that she had in the.past about that but not necessarily that.she was thinking about suicide now right.she had what we we called more of a.passive suicidal wish or passive.suicidal thoughts versus active suicidal.ideation so do you remember what we.talked about if somebody has active.suicidal ideation and how would that.look well you want to find out if they.have a plan right if they have an intent.and they have a plan and if they have an.intent in the plan we never can leave.them by themselves they it's considered.an emergency so we would have to make.context keep them on one to one call.their primary care doctor their family.members they could not be left alone at.that point with shields permission I.spoke with her primary care provider.today.and he agrees he hadn't seen her in a.while and had not done a depression.screening but based on our findings he.agreed that it did sound like depression.he is coming out today to see her to.visit her and if he finds which he.thought that he would also that she does.have a major depression he was going to.put her on an antidepressant put her.back on an antidepressants because she's.responded to them in the past so I think.at that point or at this point we should.probably talk a little bit more about.her plan of care about what we should do.so when we we talked to Sheila this.morning we talked a little bit about.some of the things that she did enjoy.even though she said she wasn't able to.enjoy activities she once did she could.identify things like reading like the.walkers club she enjoyed the she told me.at one point she goes to the short story.club that they have here where they.discuss short stories but it sounds like.over the past couple months some of.those activities have tapered someone.she's declined in her ability her.desires to want to pursue the things.that she enjoyed most so part of her.care of plan the plan of care will be to.assist her we do meet with her once a.day in the mornings because it's.difficult for her when she gets up to.start to plan to organize right she said.her mornings weren't well they've been.tough for her they've been a little.harder so we do come in and we give her.the support and we give her one choice.we let her pick but she will keep to the.plan it helps her to have a plan and.she'll partake in one activity a day.such as the Reading Club the to pursue.this even further when we see her.progress we'll have one of her friends.come and pick her up and have her join.right now she's a little fragile and.it's a little easier for the nursing.staff to encourage her our goal is to.then have the friends come.and take her and eventually have her you.know as she once was fairly independent.in her choices of personal and social.activity and that's a really good idea.that's a really good way to approach it.folks who are depressed oftentimes feel.overwhelmed so if we give them the whole.list of activities you know you're like.too much they feel like I'm just going.back to bed I can't deal with it but one.thing is manageable and once they finish.it they also feel like they've.accomplished something absolutely it's.what we call short attainable goals and.we're treating depression we know that.treatment for depression responds best.to a medication piece and talking.therapy piece and the talking therapy.piece also involves getting folks.involved with other activities so her.medication the medication will have to.be evaluated for side effects and also.for whether or not she's responding to.treatment but the other piece of it is.kind of the environmental piece what are.some other things you can think of that.might help her I would say one of the.things that Sheila would actually do.well with is the Logan Club which is.something that she's you know very.interested in doing it meets three times.a week and if we really work with her.solely step by step with the nursing.staff to get her involved you know.getting her in the morning letting her.know where they're going what to expect.beforehand I think she'll do well with.it she even said that she likes to go.out and talk with people and to find.friends and be social so that's that can.be a great thing for her Sheila has a.good future to look forward to if we.continue with our plan the medication.piece is important I'm glad the.physicians coming out we will pursue the.social aspect the environmental aspect.taking in consideration the walkers club.small limited social groups initially.perhaps pursuing that further as she.shows you know a little bit more.independence and less depression a very.very important the one a very huge point.to all of this will be to reassess.Sheila I think one of the things that we.were talking about today related to.depression I think Sheila was an.excellent example is that it is a.treatable condition in older adults as.it is.it's not something to be ignored it is.something to be fully assessed and.treated and in this case evaluated in a.certain amount of time and then.re-evaluated as needed on that basis we.talked about some wonderful.interventions for Sheila and I think.hopefully in her case they'll work they.did last time she had depression and so.we have reason to feel optimistic that.this plan will will work and if not.again we can we you all can reassess as.you discussed but enhancing her quality.of life enhancing her social experiences.and interactions with others here with.her friends with the staff I think is.great getting her to a point of being.active and requesting different.activities down the road when she was.able to do more than one at a time is.fabulous enhancing her physical.abilities or cognitive abilities keeping.her stimulated will help increase her.function and enhance her life greatly.you.

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