According to World Health Organization, the most common mental -health problem is depression, which has been foreseen as the second main global cause of morbidity (Buck, 2008), and is distinguished by the following symptoms: reduced interest or loss of happiness in all or almost all activities, depressed mood, weight loss or gain, fatigue, insomnia or hypersomnia, agitation or retardation, unworthy feeling or inappropriate guilt, reduced ability to concentrate, and persistent suicidal ideation (Ames, 2010). Depression diminishes a person’s energy level and motivation to deal with his or her feelings and the reason from which they occur, and is very frequent in nursing-home residents. A study by Noel et al. stated that depressed patients are further functionally impaired, and their quality of life is pathetic than patients with additional chronic diseases (2004). Furthermore, in his study Noel et al. concluded that management for depression can bring about additional remarkable progress in functional condition, impairment, and quality of life than treatment for other chronic conditions among elders (2004). Screening for depression is the first step in identifying the patient with this problem, which can be done using simple tools with psychometric properties like geriatric depression scale.
Residents in Nursing-homes are more prone to get depressed as a result of the feeling of isolation and separation from family along with multiple co morbidities. However, studies have identified many causes of depression, for instance, interpersonal problems, developmental events, personality or cognitive causes, biological aspects, environmental aspects and religious reasons (Khalsa et al., 2011). Most of the patients in the skilled nursing facility, where I work, have a secondary diagnosis of depression. Even if they are not identified or diagnosed with depression upon admission, I have seen many patients getting depressed eventually in their course of stay in nursing home. Delay in improvement, other co-morbidity which directly impact the prognosis of the primary condition, feeling of separation from family along with other financial worries are some of the reasons which I identified, leading to depression, in these patients.
Recently, I treated a female patient who is 81 years old and obese with a diagnosis of femur fracture. She was non weight bearing upon admission, and her prior level of function was modified independent (MI) in ambulation with walker and was MI in activities of daily living. She was living with her elder daughter, and also has other five daughters. She was told that she could bear weight on her legs after 30 days, and until then she should receive skilled therapy intervention and was transferred to our nursing home. She was very cooperative and motivated initially; however, her condition declined due to manifestation of pneumonia along with urinary tract infection. Patient realized that her length of stay would be prolonged, and her daughter cannot take care of her with this condition. This slowly reduced her interest in activities, and was easily agitated, lost concentration, sleepy or lethargic all the time and finally started refusing to participate in therapy. I informed the social worker regarding her change in status and after initial screen; she was diagnosed with depression, and was referred for a psyche evaluation. The action plan was to initiate medication along with cognitive-behavioral therapy. We made sure that the family is more involved in our treatment plan by visiting her everyday to boost her confidence and motivate her. Our plan of care was successful as the patient improved significantly in her functional status. She started to participate in therapy, and long story short she was discharged to her home. If depression was not identified and addressed, this patient would have been ended up in ‘non-compliant’ category and had discharged