Determinant factors of low mood depression in elderly people
Depression factor will be explored as mentioned in the introduction: I will start by looking at the psychological theory influencing this condition. In beck’s (1979) theory 2of depression we form assumption, beliefs or schemata about the future, the world and ourselves. This belief helps us to make sense of things going on, some of these beliefs are rigid, resistant to change, counter productive and dysfunctional. These beliefs are structured around three areas which are ‘I must not fail’, ‘if I do not pass, I am a failure,’ acceptance ‘nobody loves me’. All these negative feelings are thoughts that may influnce low mood in older persons due to cognitive distortions or faulty information processing and depressenogenic schemata. AA depressenogenic schema entails extreme emotions and unrealistic goals created by an individual that could not be possible fullfilled. This could trigger sad mood, lead to negative thoughts, affect the sleep pattern, appetite, and motivation. All these could lead to low mood in the elderly (beck’s 1979). Another psychological determinant of low mood in older persons could be physical pain, such as terminal illness, stroke, arthritis and cancer. Pain can cause fatigue, create physical disability, interfere with sleep pattern and these stressors can induce low mood the study of (keela, et aln1992) revealed that pain in elderly people is one of the depressive symptoms of low mood. In order persons negative feeling such as delusions that impart on the cognitive impairment such as memory loss. Looking at ythe client group in this clinical placement, all these theory seem to have significantly proven the reasons behind low mood in the older people and it is sometimes use to detrimental stereotype in judging the older people (Harrison, 1999).
Sociological factors influencing low mood
Stressful life event is stressors that have recieved much attention in the healthcare system. Older people tend to have very little social support and this could increase life stressors that could lead to low ,mood (Roy et al, 1996). The study of depressioncarried out by (Brown & Harris, 1978) indicate three main categories of determinant of social factors that could induce low mood in any person. These factors are provoking agent, vulnerability and symptom formation factors. Provoking agents are major life event that disrupts or ruins normal life activities, these agents could be inform of life threatening illness, housing problems, losing a loved one and so on. In ( Brown & Harris et al 1978) study it was found that in a 38 week period 29% non depressed women had suffered one form of life event or another, 61% of older depressed women also suffered a major life event, these shows the major life event were three times more common in depressed older women. The vulnerability factor, according to n(Brown & Harris, 1798) life event lead to low mood in the presence of some vulnerability factors such as financial difficulties, lack of confiding relationship and lack of protection. This factor cause most people to have low self - esteem, this risk of depression associated with low mood. The symptoms formation factors, is a psychosocial circumstance that also plays a major part in the cause of low mood in any person irrespective of their age. After the onset of depression, past event such as loss of partner, mother, father at very difficult times would influence low mood. (Brown $ Harris, 1978).
Cultural diversity
Social class could possible be a determinant of low mood in older people especially women (Achenson, 1999). The ethic diversity in London is great and it could also influence depression of all people. According to ( Achenson, 1999) 45% of all people from ethnic minorities live in the capital, they tend to experience a high level of social adverity with poor housing and financial problems. These factors are likely to increase mental health needs that could lead to depression. The need of the mentally ill people has not been met by the health care professional (Miller, 1995). The amount of time given to this group of client is so small despite the fact that trhe occurrence of the mental illness in this client group is serious enough and it requires diligent attention. Wykle (1985) stated older people have been neglected, they are hardly selected for therapy and this could be seen as stereotype. The negative feeling of this neglet could cause low mood in older people. given that socio- cultural background of family structure, religious vakue and belief are altered by city life - style. The lack of finance, reduce mobility or sensory impairment that is being experience by older people as the causes of these client in my placement has provend, reduce mobility of older people can affect their access to good, services and social cantacts (dept. of transport, 1994). This is a stressor to the older people particularly the disabled. The rate of crimes among the young people in UK today is quite alarming and older people are likely to become victim (Mirrlees- black, 1996) the thought of being victimized has restricted the older people opportunity to leave their homes. All this cultural change affects older people and can induce low mood depression.
Social policy
The government has raised concerns the steps to decrease the number of people suffering from mental illness (DOH, 1998). The introduction of the national service framework for mental health is meant to put a stop to decades of under investment within the mental health services, however the government resources are not enough to bridge the gap between services users and the agencies. The government has noted a relative deterioration in the income of poor pensioners who might be at risk of fuel poverty and be faced with extra cost of health care (Acheson, 1999).Therefore one of the measure to help reduce heating problem is the introduction of (£20) fuel subsidies given to older people once a year. Another possible incentive is the introduction of day centre were older people with depression can get therapeutic input. Quite a number of factors such as being stigmatised of receiving benefit and individual social class together with the physical difficulties in claiming process do affect the cognition of the elderly as were the case of this British affluent worker in our care. The problem of inequalities in the health care system could trigger low mood in the elderly (DOH, 1998). Part of the government initiative is to bridge together the services of all care providers also that both the primary and secondary health care setting can work together for the benefit of the client. Services available are as follows:
- Primary health care services consist of the general practitioners (GP), screening services, community nursing, counselling services, social services and continence advisers.
- Secondary and community health service consist of neuropsychiatry, accident & emergency, cardiology, ortopaedies, urology, gynaecology, surgery, rheumatology, oncology, rehabilitation, including physiotherapy, occupational therapy and the provision of hospice care.
- Voluntary and private sector consist of community transport, lunch on clubs, day centres, residential care, nursing homes, respite care, domestic care, counselling, leisure facilities, dental services and hospice. All these services are available and could be provided by primary, secondary, and voluntary or private sector depending on the local commissioning arrangement. Picking & Leger (1993).
The role of nurse and conclusion
It is important for nurses working with mentally ill elderly client to integrate psychiatric nursing skill with knowledge of physiological disorder of the normal ageing process and socio- cultural and families. Nurse should be aware of the effect of psychotropic medications on the elderly people and work closely with psychiatrist to monitor complex side effect of medications. Nurses can assess a patient’s cognitive, functional, physical, and behavioural status to monitor progress and medications effect on their client. During my placement on the geriatric psychiatric day hospital, a client with an episode of psychotic relapse had been prescribed an increase dose of his regular antidepressant medication, following the nurse’s observation of his mental state. It was noticed that he was increasingly sleepy, irritable and found it difficult to concentrate on his daily basic task such personal hygiene and remembering his meal times. This was assessed by the nurses as deterioration in his mental health functioning and reported it to the consultant psychiatrist, who reviewed his medications and adjusted it to the dosage more suitable for this client. This nursing observation and follow up was important to the stabilisation of this client and it also highlights teamwork in delivery of care. The relevant knowledge gained in this placement into the roles of nurses as a team player and the understanding of determinant of low mood depression in the elderly has helped me increase my knowledge of physiological, sociological, and social- factors prevalence to low mood depression. This knowledge will help me to reflect, understand team work and appreciate holistic care delivery in clinical practice with multi- disciplinary team working together.
