1. Presented by: Wanda Murray-Goldschmidt, MA, BSN, RN-BC LTC Nurse Consultant & Educator

2. Define depression & discuss its prevalence in older adults & those in long-term care Describe the impact of depression on mental and physical health Discuss the ABCs of symptom identification Identify care approaches to address depressive symptoms Discuss what needs to be documented regarding depressive symptoms and why documentation is important

3. Mood disorder with persistent empty feeling, or feelings of sadness, loss of interest & loss of pleasure Affects how you think, feel, and behave Leads to a emotional and physical problems Can interfere with ability to function in daily routines and responsibilities At its worst, can lead to suicide

4. CDC reports that 10-20% of people 65 and older have experienced depression 16% of suicide deaths are for those 65 and older The prevalence of depression in older adults is 15%-20%; in nursing homes 17% - 35% Medicare beneficiaries with depression have significantly higher health costs

5. Loss of loved one(s) and/or friends Loss of social roles Change in health Sensory losses Change in lifestyle Changes in independence/ loss of control Pain Cognitive changes Stress

6. ppearance ehavior onversation

7. What does depression look like?

13. Demonstrate: Decreased energy Slowed movements Slowed responses Withdrawal Loss of interest in usual activities Change in appetite Change in sleep patterns Difficulty concentrating, focusing, or making decisions Tearfulness Increased irritability, anger, or anxiety Neglect of self-care

14. Increased physical complaints/often vague Expressed feelings of worthlessness, guilt, hopelessness, negativity Suicidal thoughts “I’m not well. Everything hurts.” “I don’t know why I’m still here.” “I’m not good for anything anymore. I’m just a lot of trouble for other people.” “I wish I would just close my eyes at night and never wake up.” “If I had a gun, I would shoot myself.”

15. Report what you see/hear Do further assessment See psychiatric evaluation/ intervention LISTEN – acknowledge resident’s feelings DOCUMENT** Assessing symptoms: Residents often deny depression Consider the whole picture Overall appearance Facial expression Tone of voice Responsiveness Use other terms “down in the dumps”, “sad”, “blue” “Are you happy?” “Are you enjoying life?”

16. Provide emotional support Recognize/encourage use of strengths Practical assistance with problem solving Maximize resident’s control Encourage/assist with exercise Provide for pleasurable experiences/activities Positive reminiscence Spiritual support/pastoral care Spend time with person other than to provide physical care DOCUMENT**

17. The PERSON includes: Biological self – physical & medical needs Individual self – history, experiences, beliefs, values Social self – roles, responsibilities, and relationships r/t others We are responsible for caring of all of these aspects – not just biological

18. We know that documentation of physical/ medical care is important r/t the reimbursement system Documentation of mental health care is just as important in capturing the reimbursement for services provided Whether or not depressive symptoms exist makes a difference in how reimbursement levels are calculated Documenting your care and attention to mood status gives credit for what you do so you can be paid accordingly

19. We have been taught in recent years to address pain as the 5 th vital sign. Consider mood status as the 6 th vital sign. Temperature Pulse Respiration Blood Pressure PAIN MOOD