Recognizing Depression in Special Patient Groups

Article Categories: Diseases & Caregiver Corner

As a hands-on caregiver, the CNA can often be the first professional team member to detect signs of depression in a patient. Elderly patients, as well as patients with chronic illnesses, are at risk for becoming depressed during treatment. Depression is more than a feeling of sadness. It’s a real medical condition that can be treated successfully. But first it has to be diagnosed.

Signs and Symptoms of Depression:

The CNA should report any of these signs last longer than a few weeks:

• Loss of appetite or eating too much
• Little or no interest in things that used to be pleasurable
• Fatigue and lack of energy
• Change in sleeping pattern: too little or too much
• Irritability or restlessness
• Feelings of guilt or being worthless
• Feelings of hopelessness or pessimism
• Ongoing complaints of pain, headaches, or digestive problems
• Suicidal thoughts or attempts

Depression in the Elderly

While only about 5% of elderly people in the general population do not experience major depression, the rate rises to 11.5% in those who are hospitalized and 13.5% of patients who require home health care. Depression also occurs more often in the 50% of older adults who have two or more chronic diseases and limited mobility.

It can be easy to miss the signs of depression in an older person. Many healthcare providers assume that the aging process or life changes are responsible for the person’s withdrawal or lack of interest. Even the family or patient may think the lack of energy, poor diet or insomnia are due to getting older. Most elderly patients respond well to antidepressant drugs.

Depression in the Chronically Ill

Patients with chronic diseases live with the reality that even though their conditions may be managed, they are not going to be cured. About a third of people with a serious chronic disease will develop depression; about 40% patients with Parkinson’s disease or Multiple Sclerosis report being depressed. The rate for people with chronic pain is 30-54%.

Depression can complicate and increase the disease symptoms that a patient already has, such as pain or isolation. Loss of their former independence can cause patients to feel hopeless about the future. Everyday functions can become a struggle, leading people to give up on favorite activities. Even the side effects of medications can contribute to depression. The CNA should report observations to appropriate care providers, so the source of the depression can be diagnosed. Treatment includes antidepressants and possible psychotherapy.

Role of the CNA

While the signs of depression are the same for the elderly and chronically ill as in the general population, they can be masked by other issues. Diagnosis may be delayed or entirely missed, because the signs and symptoms are attributed to other causes. As one of the professionals who spends time each day with each patient, the CNA can notice subtle changes and report new observations. CNAs also have more opportunity to talk with patients and families, discussing feelings and the signs of depression.

More than 80% of people with depression can be treated with a combination of antidepressants, psychotherapy, or counseling. When patients feel better, they are more likely to remain compliant with their care plans. They can also be more social and have a better quality of life.

Try reviewing the course material on elderly depression from our course library.


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