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Module #6 
Depression

Module #6 focuses on care for patients suffering from depression & anxiety. More than 1 in 10 older people experience depression. Geriatric depression is a mood disorder in older adults that involves a persistent loss of interest and feelings of sadness.  The 3 main causes of depression in older people are poor physical health, social isolation and loss.

Read carefully because at the end of this module is a quiz. There are 10 questions in total and 5 minutes to complete.  7 questions (70%) must be answered correctly. You have 8 chances to pass this module.

In-Service Exams provided by Essential In-Services for Home Health, 2021

Upon completion of this module, you should be able to:

Define depression and anxiety and their causes.

Understand the signs and symptoms of depression and anxiety.

Learn some ways to prevent depression and anxiety and how to care for people with depression or anxiety.

Learning about the warning signs of suicide and how to prevent it.

Depression
What it is:  Depression is a mental disorder marked by a sad or irritable mood lasting more than 2 weeks.

What it is not: Everyone gets sad or irritable from time to time, but for most people these moods only last for a few hours or a few days. When these feelings last for several weeks without improving , a person’s way of thinking can be altered and the person’ may become clinically depressed.

Who gets it: About 10% of US adults suffer from depression, but this number can increase with age, disability or illness. Some estimates of major depression in older people living in the community range from less than 1% to about 5%, but rise to 13.6% in those who require home health.

What causes it: Depression has many different causes. The following are some:

  • Medication side effects particularly from drugs used to treat arthritis, heart problem, high blood pressure or cancer
  • Illness such as Alzheimer’s disease, Parkinson’s disease, stroke, hormonal disorders and others.
  • Genetics – it may run in families.

Anxiety
What it is: Anxiety is a feeling of concern or worry and includes increased alertness or awareness. It can be mild, moderate, or severe; when very severe, it can become a state of panic.

What it is not: Mild to moderate anxiety is a normal part of living and can be helpful when we must focus on something urgent or important. As a normal reaction to stressful situations, it helps us to take action. When anxiety becomes a long-term condition or becomes severe, the person becomes overly focused on specific details and can’t think of anything else. In this case, most of the individual’s behavior is directed toward relieving the anxiety.

Who gets it: Anxiety disorders are the most common mental illnesses in the US, affecting more than 18% of the adult population. It is a very common disorder in the elderly and is more common in women than men.

What causes it: Some of the many causes of anxiety are:

  • Persistent stress
  • Extreme change
  • Illness, particularly cancer, heart disease and chronic illnesses
  • Chemical changes in the brain
  • Abnormal brain functioning
  • Medication side effects

Signs of Depression
If a person has four or more of the following symptoms lasting two weeks or more, he or she may be depressed:

  • Sad, depressed or apathetic mood. May cry a lot or complain of feeling empty.
  • Irritability, agitation, grumpiness.
  • Disturbed sleep – either difficulty sleeping or sleeping more than usual.
  • Fatigue and loss of energy.
  • Changes in appetite and weight – either increased or decreased.
  • Loss of interest or pleasure in normal activities such as self-care or social activities. Withdrawal from others.
  • Feelings of worthlessness, guilt, helplessness, hopelessness or self-reproach.
  • Thoughts of death or suicide, or attempted suicide.
  • Difficulty thinking, concentrating, focusing or remembering.
  • Slowed or agitated movements or speech.
  • Complaining of aches and pains, dizziness, blurred vision, racing heart, anxiety or vague discomforts.
  • Constant complaining.
  • Mood swings.
  • Excessive alcohol use.

Signs of Anxiety
There are five main types of severe anxiety, and each has different symptoms. The types are:

Generalized anxiety disorder: This condition involves excessive and unreasonable anxiety and worry lasting at least six months. Signs include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, shaking, crying, pacing, sweating, rapid breathing, rapid heartbeat, fearfulness, and sleep problems.

Panic disorder: People with this condition have recurring attacks of panic. They may have dizziness, faint feelings, sweating, trembling, chills, flushes, nausea, numbness, heart palpitations, or chest pain. These attacks occur suddenly and last several minutes.

Obsessive-compulsive disorder: This disorder causes recurrent and persistent thoughts, impulses or images that are unwanted and inappropriate. The person performs repetitive behaviors in response to these thoughts.

Phobias: These are irrational, intense fears of certain things or situations, which interfere with normal functioning.

Post-traumatic stress disorder: This occurs after a person experiences or witnesses a traumatic event. Symptoms include recurring memories, nightmares, and flashbacks

What Should Be Done?
Even though depression and anxiety are common, they are not normal, even among the disabled, ill or elderly. These signs should always be reported to a physician.

Other diseases can cause some of these symptoms, so the doctor will have to decide on a diagnosis and a treatment. We must never assume that these signs are a normal part of disability, illness, or aging.

Preventing Depression & Anxiety
Although many types of depression and anxiety cannot be prevented, there are some general things that everyone can do to lower the risk of developing these conditions. They are as follows:

  • Keep and maintain friendships and social activities.
  • Develop enjoyable interests or hobbies
  • Stay physically active. Exercise and stay physically fit. 
  • Stay mentally active. Read, take classes and learn new things. 
  • Maintain contact with family members. 
  • Eat a balanced and nutritious diet. Avoid sugar, caffeine and alcohol.

When taking medicines that might have depression or anxiety as side effects, follow the doctor’s directions on using the medicines to lower the risk of those side effects.

Depression │ The goal of care is to lift the person’s mood.

Caring for People With Depression or Anxiety
Encourage depressed people to express their feelings. Listen to what they say. Accept them as they are without making judgments. Give them time to get their thoughts together and to tell you what they are thinking and feeling. Help them feel valued.

  • Brighten the environment by hanging pictures, posters or family pictures. Make family photo albums easily available. Keep the environment neat and clean.
  • Encourage pleasant activities such as listening to music or performing a hobby.
  • Encourage socialization. Start with one-to-oneconversations, and gradually help them participate in larger social events.
  • Encourage daily exercise or activity. Even the disabled can usually move a few body parts.
  • Encourage as much self-care as possible. Help people gain a sense of control by letting them make as many independent decisions as possible.
  • Pay attention if people talk of self-injury or suicide. Always report this to a supervisor.
  • Be sure people take their medications in the correct way and at the correct time.
  • Listen to people’s fears and anxieties. Respond with reassurance and support.
  • The environment should be quiet and less stimulating than normal.
  • Many people will never become completely free from anxiety. Help them learn to accept and tolerate a certain level of worry and anxiety. If they believe that you will assist them with their problems and keep them safe, their anxiety may be relieved.
  • Sometimes anxious people can be distracted if you help them think about something pleasant or relaxing or have them picture a peaceful image.
  • Help people relax each muscle, guiding them to consciously and progressively relax every muscle from toes to head. Instruct them to breathe slowly and deeply.
  • Help anxious people recognize that although their feelings are real, their fears aren’t based on reality. Gently point this out: “You’re feeling anxious, but you are really okay.”
  • Ensure that medications are taken as prescribed.

Anxiety │The goal of care is to lower the person’s anxiety level.

The Warning Signs of Suicide

Sometimes anxiety and depression occur together, or one may lead to the other. People suffering from either one of these illnesses may decide they want to end their life. It is important to be alert to things that might indicate a person is seriously considering suicide. The suicide rate is twice as high in people older than age than it is in younger age groups. Untreated or mistreated depression can lead to suicide. Pay attention to the following warning signs and report them:

  • Talking about suicide. Statements such as “I have no reason to go on living” are danger signs.
  • Being preoccupied with death. Giving things away.
  • Stockpiling pills or obtaining some sort of weapon.
  • Refusing to follow doctor’s orders about medications or diet.
  • Taking unusual visits or calls to family and friends or saying goodbye to loved ones.
  • Getting affairs in order or making funeral arrangements.
  • Losing interest in things or people that used to be important.
  • Suddenly becoming happier and calmer after a period of depression or anxiety.
  • Talking about how worthless or helpless they are, saying they have no hopes or plan

Suicide Prevention

Some of the things you can do to help prevent someone from taking his or her life:

  • Recognize anxiety and depression in others and help them get appropriate treatment.
  • Assess the environment for any potential weapons. Request the patient/family remove and/or secure any potential weapons including firearms.
  • If you suspect someone is thinking about suicide, ask if the person is thinking about it. Don’t be afraid that you’ll be giving him or her ideas. If the person says yes, report it.
  • Be sure a depressed or anxious person is seeing the doctor as ordered and getting his or her medications.
  • Reassure a suicidal person of how much you care. Explain that depression is no one’s fault, that it can be treated, and that suicidal thoughts are temporary and will go away.
  • Don’t try to minimize the individual’s problems. Don’t say how hurt family members will be or that the person has everything to live for, because this will just intensify feelings of guilt and hopelessness.
  • If you suspect someone is thinking about suicide, always report your suspicions to the appropriate­ ate person. Don’t think that you are imagining things or getting worried for nothing. It is much better to be cautious in this situation.

If you are a direct caregiver in an agency, and one of your patients shows warning signs of suicide, contact your supervisor immediately. Time could be limited. If you are the family member or friend of someone you think is suicidal, help the person get to a physician at once. People commit suicide because they think it is the only way to stop the pain they are feeling. Our job is to help them find other ways to get rid of their pain, through appropriate care and treatment.