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Essay ELP5 Sample Assignment

Final Assignment Essay ELP5

Introduction

During the later years of life, it is most common to encounter depression, specifically in individuals with chronic illness. In the delicate setting of a hospital, depression can be found linked with poor results such as compromised care and increased duration of stay. The diagnosis and recognition of depression is consequently a major initial step in coping depression within the general hospital (Delbaere et al., 2010). To handle depressive mental situation, an appropriate screening instrument might be helpful. This essay attempts to provide a discussion regarding depression experienced amongst elderly individuals within the hospital setting, on the basis of a systematic review containing evidence (Fiske, Wetherell and Gatz, 2009).

Depression or depressive disorders can be associated to people suffering from chronic illnesses like diabetes, stroke and individuals with permanent disabilities. Around 12% of older population within the community is found to have been suffering from depressive disorders (Dennis, Kadri and Coffey, 2012). However, this rate manifolds when older people are hospitalized with an estimates from 5 to 58% an average occurrence of 29% (Dennis, Kadri and Coffey, 2012). Moreover, the depression associated to old age has been found to be more assorted as compared to that noted amongst younger people in symptoms, prognosis and etiology. Thus it is excessively necessary to evaluate the symptoms of depression in older hospitalized patients as it will assist to lessen the suffering from the condition. The identification of depression will also help in declining the chances of suicides and even provide economic gains for services in provisions of reduced span of stay. Is it widely accepted through evidence that depression adversely impacts the results of an assortment of medical conditions and is associated with higher rate of mortality, impacts compliance with intervention and results in impaired reaction to rehabilitation? The presence of depression leads to loss of dignity, lack of interest in any activity amongst individuals and the depressed person, specifically old individuals carry a sense of load as they have to rely on others for their existence (Fiske, Wetherell and Gatz, 2009).

The healthcare professionals are usually found busy on medical wards and lack skills and experience in diagnosing depression. Hence it remains undetected and thereafter untreated illness. Though it has been accepted to be prevalent among most hospitalized old individuals, still it remains to be a neglected illness. The diagnosis and detection of depression within the hospitalized old aged patients can create specific issues. It happens primarily due to the symptoms of depressive disorder, specifically somatic which include weight loss, loss of appetite, fatigue, disturbed sleep and decreased energy levels are alike to symptoms of other physical disorders. It is additionally complicated by the reality that the old patient usually reject low mood and healthcare professionals on duty are usually too much occupied to take time and have enough interaction with the patients to have an assessment of their emotional status and self esteem.

Though there are fewer interventions done to prevent or detect depressive disorders amongst hospitalized old aged patients, certain treatments procedures that are less invasive can be introduced to minimize the chances of depression to occur like introduction of physical activity into daily routine or introduction of any social interaction that may help in social intermingling of these individuals. It has been evidenced that excessive levels of exercise can help elder individuals in lowering the chances of developing continual diseases like diabetes, stroke and heart diseases (Benedict et al., 2013). Whilst it is well established that physical activity results in enormous health benefits, research suggests that the elderly people who connect in forceful exercise can stave off disability, chronic disease and mental impairment for 10 years. It was noted in the research that over the period of decade, those elderly individuals who engaged in the greatest levels of exercising i.e., much more than the prescribed minimum level, had 100 percent more likely to stay protected from chronic illnesses like heart disease, cancers, diabetes, stroke and angina and keep the most favorable mental and physical shape till the end of the period (Benedict et al., 2013).

Apart from physical inactivity, social isolation has also been seen to be associated with causing excessive health disorders as its been found to be a risk-factor for all-cause of mortality and morbidity with results comparable to obesity, smoking and high blood pressure. It has been also noted to be associated with declined immunity, cognitive decline and causing depressive disorders and dementia (Fairhall et al., 2012). It can also be linked to heightened chances of emergency hospitalization, delayed discharges and longer duration of stay. Various researches have shown that social interaction is strongly correlated with health and well-being of elderly patients. Societal associations are continually linked with the biomarker of good physical status. The social interaction may lead to enhanced motivational levels and people may sense some purpose in living and thus be happy to stay active (Fairhall et al., 2012).

Detection of depression as discussed afore was found to be rather complicated. Certain screening tests, however, can be used for the purpose (Dennis, Kadri and Coffey, 2012).The guidelines provided by NICE (National Institute for Clinical Excellence) for depression management amongst primary and secondary care have emphasized the significance to testing at risk populations such as physically ill old aged hospitalized individuals in general hospitals. In the general hospitals, already there are several screening instruments that are commonly used like GDS or Geriatric Depression Scale (Nice.org.uk, 2018). These measures are normally developed within the primary care settings or in community. However, they in it portray their own challenges such as whether the screening tests for depressive disorders function accurately in a particular setting; which instrument would be considered most appropriate and what could be the superlative cut-off score for a chosen scale in the hospitalized patients’ clinical setting (Mann, Adamson and Gilbody, 2012). Among various studies, thirteen different screening instruments for depression have been examined where many studies even implemented more than one tool. Though the most regularly examined instrument was the GDS (Dennis, Kadri and Coffey, 2012). It’s a complete thirty item instrument which is at times completely utilized while in some cases half and in other cases only a smaller fragment is being examined. In the United Kingdom, NICE advocated the screening of populations at extreme chances of depression and those individuals with chronic illness (Nice.org.uk, 2018). Originally NICE suggested the Whooley questions that included only two simple questions (Beauchamp, 2014) (Suija et al., 2012). These were “During ‘During the past month have you often been bothered by feeling down, depressed or hopeless?’ and during the last month have you been bothered by having little interest or pleasure in doing things? (Whooley, et al., 1997) (Beauchamp, 2014).

Conclusion

This review can be concluded saying that the Depression is most likely to occur amongst old aged hospitalized individuals but it’s difficult to diagnose due to similar kind of symptoms that can be associated to other chronic disorders. Depression can lead to adverse physical issues and may accelerate the impact of other chronic illness. Physical activity, cognitive behavioral therapies and social interaction are found to be associated with better health outcomes and treatment plans for old aged people in hospitalized setting. It has been suggested that proper screening for depression should be done in individuals with chronic health issues and those at high chance of depression (Biswas et al., 2009). The most usually used scale for the purpose was GDS and Whooley Questions (Nice.org.uk, 2018). This review thus systematically highlights the issue of depression in elderly people in hospital setting while assessing the treatment and screening procedures for the purpose.

References

Beauchamp, H. (2014). What factors influence the use of the Whooley questions by health visitors? Journal of Health Visiting, 2(7), pp.378-387.

Benedict, C., Brooks, S., Kullberg, J., Nordenskjöld, R., Burgos, J., Le Grevès, M., Kilander, L., Larsson, E., Johansson, L., Ahlström, H., Lind, L. and Schiöth, H. (2013). Association between physical activity and brain health in older adults. Neurobiology of Aging, 34(1), pp.83-90.

Biswas, S., Gupta, R., Vanjare, H., Bose, S., Patel, J., Selvarajan, S., Aaron, J., Nitya, E., Iyer, D., Jacob, N., John, K. and Jacob, K. (2009). Depression in the elderly in Vellore, South India: the use of a two-question screen. International Psychogeriatrics, 21(02), p.369.

Delbaere, K., Close, J., Brodaty, H., Sachdev, P. and Lord, S. (2010). Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ, 341(aug18 4), pp.c4165-c4165.

Dennis, M., Kadri, A. and Coffey, J. (2012). Depression in older people in the general hospital: a systematic review of screening instruments. Age and Ageing, 41(2), pp.148-154.

Fairhall, N., Sherrington, C., Kurrle, S., Lord, S., Lockwood, K. and Cameron, I. (2012). Effect of a multifactorial interdisciplinary intervention on mobility-related disability in frail older people: randomised controlled trial. BMC Medicine, 10(1).

Fiske, A., Wetherell, J. and Gatz, M. (2009). Depression in Older Adults. Annual Review of Clinical Psychology, 5(1), pp.363-389.

Mann, R., Adamson, J. and Gilbody, S. (2012). Diagnostic accuracy of case-finding questions to identify perinatal depression. Canadian Medical Association Journal, 184(8), pp.E424-E430.

Nice.org.uk. (2018). Developing NICE guidelines: the manual | Guidance and guidelines | NICE. [online] Available at: https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview [Accessed 2 Dec. 2018].

Suija, K., Rajala, U., Jokelainen, J., Liukkonen, T., Härkönen, P., Keinänen-Kiukaanniemi, S. and Timonen, M. (2012). Validation of the Whooley questions and the Beck Depression Inventory in older adults. Scandinavian Journal of Primary Health Care, 30(4), pp.259-264.

Whooley, M., Avins, A., Miranda, J. and Browner, W. (1997). Case-finding instruments for depression. Journal of General Internal Medicine, 12(7), pp.439-445.

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