PSYCHOLOGICAL COMPLICATIONS

Rebecca Alice Rankin

Depression is a common mental disorder characterized by persistent sadness and a lack of interest or pleasure in previously enjoyable activities. Depression is among the most common mental illnesses affecting people aged 65 and older and can significantly impair this population’s functional ability and overall quality of life and increases the risk of mortality due to suicide. Depression in elderly patients is often difficult to diagnose because it frequently presents with somatic manifestations (Holzel, Bjerregaard, Bleich, Boczor, Harter, Konig, Kloppe, Niebling, Scherer, Tinsel, & Hull, 2018). 

 

As an Emergency Room nurse, I see many elderly patients who suffer from chronic illnesses and depression. Research consistently shows that people with chronic illness are up to three times more likely to experience depression than those without (Guthrie, Dickens, Blakemore, Watson, Chew-Graham, Lovell, Afzal, Kapur & Tomenson, 2016). One patient who stands out in my mind was a man in his early 80s. This patient’s wife had recently passed away. He was living by himself with family close by who would check on him daily. We saw the patient several times for symptoms such as shortness of breath, anxiety, and weakness which had been contributed to his chronic congestive heart failure and other chronic diseases. Every time the patient would present to the ER, he would make comments about feeling like a nuisance for having taken up our time and for bothering his daughter for having to accompany him to the ER. One night while I was working, the ambulance was paged to his address for reports of an unresponsive male. It turns out he had overdosed on prescription sleeping medication in an attempt to commit suicide. The patient recovered and spent several days in the hospital before willingly being admitted to a mental health hospital.

 

Looking back, I think the patient could have received help for mental health problems and depression prior to his suicide attempt. I personally recognized signs of depression and anxiety when he would present to the ER but assumed his family also noticed and that he was seeking help from his primary care provider since he had recently been prescribed an antidepressant. Elderly patients with depression are commonly treated solely in primary care but may also need psychosocial intervention (Holzel, Bjerregaard, Bleich, Boczor, Harter, Konig, Kloppe, Niebling, Scherer, Tinsel, & Hull, 2018). I learned from this situation that I should have voiced my concern to the family or the ER provider before this event. This may have helped him receive proper care before a crisis occurred.

Patients with depression, especially those who are elderly are particularly vulnerable. Legal and ethical implications for these patients include their right to proper care as well as confidentiality regarding their care and diagnosis. 

 

Guthrie, E. A., Dickens, C., Blakemore, A., Watson, J., Chew-Graham, C., Lovell, K., Afzal, C., Kapur, N., & Tomenson, B. (2016). Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness.  Journal of Psychosomatic Research,  82, 54–61. https://doi.org/10.1016/j.jpsychores.2014.10.002

 

Holzel LP, Bjerregaard F, Bleich C, Boczor S, Harter M, Konig H-H, Kloppe T, Niebling W, Scherer M, Tinsel I, & Hull M. (2018). Coordinated Treatment of Depression in Elderly People in Primary Care.  Deutsches Arzteblatt International,  115(44), 741–747. https://doi.org/10.3238/arztebl.2018.0741