How to Deal with Senior Depression During the Quarantine

The project selected for this essay is seniors' depression during the quarantine. Depression among the elderly – also known as geriatric depression – is an emotional disorder and a mental disorder that affects older adults. While feeling occasional sadness is normal, geriatric depression is characterized by lasting "blues," which are not a normal part of the aging process. Older adults tend to suffer from subsyndromal depression, which does not usually meet all of the criteria classified as major depression. However, this does not mean that it should be ignored. If it is left untreated, it can turn into major depression. Depression is a significant concern for older adults because it increases the risk of suicide and reduces the quality of life significantly 

Goals and Objectives 

The topic that this issue falls under in Healthy People 2020 is 'Mental Health and Mental Disorders.' Although there is a separate topic for 'Older Adults,' this topic and its objectives focus more on physiological health than mental health. Thus, there are no objectives under the 'Older Adults' topic that correctly handle depression. Under the 'Mental Health and Mental Disorders' topic, however, there is an applicable objective: 

“ MHMD-4.2 - Reduce the proportion of adults aged 18 years and older who experience major depressive episodes (MDEs)” 

This project needs to tackle seniors' depression, especially in this time of quarantine, which would fall under this objective. With this in mind, the goals of this action plan are: 

Depression care management policy implementation in primary care facilities for older adults in the community 

Improvement of short-term depression outcomes in the community 

Process Objectives 

Active screening for depression for older adults within the community 

Case management of older adults with depression 

Implementation Plan 

The implementation plan for these objectives has 3 main steps. The first step is to carry out active screening for depression. This will assist in capturing cases of depression that have gone unnoticed or undiagnosed. Research shows that the presence of a pandemic, social isolation, and quarantine and other extreme forms of social distancing, has created an environment where anxiety and depression have been precipitated (Ventakesh & Edirappuli, 2020). Thus, there is a need for a more active role to be taken with regards to identifying depression, especially among older adults who are generally less active and productive, making them more susceptible to the development of adverse mental health outcomes. 

The second step is to develop measures and use them to devise measurement-based outcomes for the implementation. This means assessing the current prevalence of depression among older adults in the community, based on the screenings, including both new and pre-existing diagnoses. Then, the goal will be to establish goals for the implementation of the objectives. In this case, the objectives are to enroll all new cases in depression management care and assess the depression care management given to pre-existing cases for effectiveness or optimization. 

The third step is to ensure that all the ongoing depression care management identified and implemented in the second step is being carried out by trained depression care managers. Where there is a shortage or gaps in training, recommending training to the institutional administration to avail more carers will be the next step. 

Justification 

The stress that results from the knowledge that there is a pandemic is especially acute for older adults, who are more at risk of developing severe symptoms from COVID-19. The elevated stress levels affect and precipitate depression levels, especially among older adults ( Yang et al., 2015) . This elevates the need for early diagnosis of depression among this population. Furthermore, social isolation has been shown to expedite depression among older adults ( Franck et al., 2016) . Therefore, the social isolation that the pandemic creates puts older populations at a bigger risk of developing depression. Therefore, there is a need to especially concentrate our efforts as health providers in identifying and treating this population as its members are currently facing increased risks in terms of physiological health and mental health. 

Location and Timeline 

The intervention will be planned locally, at the health institutions available to the local community. Since elderly patients often require specialized care, the intervention will be centered on the health institutions with the largest population of older adult patients, and the most developed geriatric care departments in the area. Essential participants in getting the intervention off the ground will be local institutionalized care facilities and senior communities whose administration will be informed and trained on the intervention's need, the positive health outcomes associated with it, and the procedure. 

The timeline for the intervention is four months. Months 1 and 2 should be spent training nurses at the relevant local health institutions on older adult depression care management. During this time, the administration of care facilities and senior communities will also be reached out to, sensitized, and the relevant non-professional workers trained on administering the Geriatric Depression Scale correctly. During the third and fourth months, the plan will be implemented, and any new cases will be identified and enrolled in depression care management. Pre-existing cases will have their depression care management assessed and optimized where necessary. 

Teaching Materials 

The main teaching material that will be used for the intervention is the Geriatric Depression Scale. This 30 item tool is a self-reporting measure used to assess older adults for symptoms of depression. The correct way of administering this test will be taught to the non-professional care staff at homes and healthcare facilities, which will assist health professionals in screening and detecting new cases of depression. 

Recommended Nursing Interventions 

The recommended nursing actions/interventions to improve the health concern and achieve the stated goals and objectives are: 

Inclusion of older adult depression screening to every primary care visit 

Receiving training on older adult depression management 

Providing training for older adult depression management for qualified practitioners 

Training non-professional care facility workers on the administration of the Geriatric Depression Scale 

Public and Private Partnerships 

The public partnerships that could be formed to implement these recommendations are with the local health facilities in the area catering to older adults and their caregivers. This includes fully established hospitals as well as smaller clinics. These partnerships will allow a wider range of potential patients to be reached and allow caregivers to be sensitized to the needs of their older adult dependents. 

The private partnerships that could be formed with senior communities and institutionalized care facilities that are privately owned. These areas represent important geographically dense areas with regards to the specific population that this intervention targets. In the same vein, private practices specializing in older adults' care are also potential partners to consider. 

References 

Cole, M. G., McCusker, J., Sewitch, M., Ciampi, A., & Dyachenko, A. (2008). Health services use for mental health problems by community-living seniors with depression.  International Psychogeriatrics ,  20 (3), 554. 

Crabb, R., & Hunsley, J. (2006). Utilization of mental health care services among older adults with depression.  Journal of clinical psychology ,  62 (3), 299-312. 

Franck, L., Molyneux, N., & Parkinson, L. (2016). Systematic review of interventions addressing social isolation and depression in aged care clients.  Quality of Life Research ,  25 (6), 1395-1407. 

Venkatesh, A., & Edirappuli, S. (2020). Social distancing in covid-19: what are the mental health implications?.  Bmj ,  369 . 

Yang, L., Zhao, Y., Wang, Y., Liu, L., Zhang, X., Li, B., & Cui, R. (2015). The effects of psychological stress on depression.  Current neuropharmacology ,  13 (4), 494-504.