In one of my routine shifts at the hospital an elderly patient was checked into the hospital by his wife. The patient, Philip Holland, 72 years old had signs of acute confusion during his admission. He was unaware of his surroundings and requested that he needed to go home to see the wife. Health history as provided by the wife depicted that the patient had been diagnosed with diabetes at age sixty-seven. He had been taking his medication and engaged in healthy routines such as taking evening walks after work. Philip, a retired civil servant had continued running his private auditing consultancy firm even after retirement. However, in the last one month he had stopped his workout regime. The wife indicated that upon prodding him on the reason for halting his evening walk which they usually took together, he responded that work at the office had been overwhelming. He had then resulted to coming back to their home quite late into the night. Many were also the times that he had forgotten to undertake some tasks as requested by the wife such as doing the household shopping on his way home. His sleep patterns were disturbed often waking up sweaty and panting in the mid of the night. On admission, Philip complained of general body pain and fatigue (Hurley, 2019).
Different assessment tests were carried out on the patient. Complete blood and urine tests were carried out. The tests indicated no evidence of substance abuse. His blood sugars and pressures were also within the normal range. His body temperature was okay. His body weight was also fairly constant when checked against the recorded body weights for his routine medical checkups. Pain relievers were administered. By the next day morning the patient had improved but before discharge we sought to do further assessment as to the cause of the patients quite unique symptoms yet physical assessment indicated that he was healthy.
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My experience with a patient who had exhibited similar symptoms and turned out depressed informed my decision to screen for depression. Patient health questionnaire-2 (PHQ-2) was used to carry out the assessment ( Seematter-Bagnoud and Büla,2018). The questionnaire sought to establish the patient’s interest in doing things and whether he had felt hopeless for the past two weeks. The patient’s score was four out of the maximum six indicating a major depressive disorder. Patient Health Questionnaire-9 was used to carry out further assessment Seematter-Bagnoud and Büla,2018) . His overall score of 20 for the various questions posed which indicated that he was suffering from a severe depression. To eliminate any doubt in my assessment, I used the Geriatric Depression Scale (GDS) the short form version in which fifteen different questions were posed and the patient required to answer in the affirmative or negative. His score was 12 which indicated that he was suffering from depression. With the wife’s engagement, pharmacotherapy treatment using antidepressants was started (Hurley, 2019). Also, to help the patient to manage the disorder in the long term I recommended that the patient visits a mental health specialist. This was informed by the severe nature of his disorder. A mental health specialist would be helpful in administering psychotherapy treatment and collaborative management of the disorder (Hurley, 2019).
The patient’s depressive disorder had exhibited atypical presentations such as the acute confusion, apathy, sleep disturbances, general body pain and fatigue (Tatum III et al. ,2018). These symptoms would have been easily confused to be as a result of the patient’s diabetic condition. initial assessments however ruled out such illness and drug and substance abuse. My experience with a patient who had exhibited similar symptoms and upon screening for depression turned out to be depressed helped to overcome the atypical presentations and patient health questionnaires and Geriatric Depression Scale were used to carry out the assessment. An in-depth interview with the wife indicated that he had lost a lot of business in recent days. Their last-born daughter whom he was quite affectionate to had also moved out of their house and gotten married. These were seen as some of the potential causes for his depression alongside his chronic diabetic condition (Grover and Malhotra, 2015; Ishizawa et al., 2016) .
References
Greenberg, S. A. (2019). The geriatric depression scale (GDS). Best Practices in Nursing Care to Older Adults , 4 (1), 1-2.
Grover, S., & Malhotra, N. (2015). Depression in elderly: A review of Indian research. Journal of Geriatric Mental Health , 2 (1), 4.
Hurley, K. (2019). Depression in the Elderly: Not a Normal Part of Aging. Retrieved 1 January 2020, from https://www.psycom.net/depression.central.elderly.html
Ishizawa, K., Babazono, T., Horiba, Y., Nakajima, J., Takasaki, K., Miura, J., ... & Uchigata, Y. (2016). The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). Journal of Diabetes and its Complications , 30 (4), 597-602.
Seematter-Bagnoud, L., & Büla, C. (2018). Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach. Public health reviews , 39 (1), 8.
Tatum III, P. E., Talebreza, S., & Ross, J. S. (2018). Geriatric Assessment: An Office-Based Approach. American family physician , 97 (12).
