APNA 30th Annual Conference Session 2023: October 20, 2016 Chro nic So rro w in the E lde rly: Me tho do lo g ic a l Co nside ra tio ns a nd Clinic a l I mplic a tio ns André e de L isse r, DNP, APRN Ya le Unive rsity Sc ho o l o f Nursing (T he spe a ke r ha s no c o nflic ts o f inte re st to disc lo se ) Ag ing Me dic al Mo o d illne ss L e a rning Outc o me s Pa rtic ipa nts will b e a b le to : Ide ntify me tho do lo g ic a l a nd c linic a l c o nside ra tio ns whe n e valua ting de pre ssive sympto ms in o lde r a dults with c hro nic me dic al illne ss F o rmula te a n a sse ssme nt stra te g y to he lp ide ntify a nd po te ntia lly pre ve nt pro g re ssio n o f de pre ssive sympto ms fro m Chro nic So rro w to MDD Cre a te inte rve ntio ns re la te d to multiple fa c to rs, e spe c ially me dic al illne ss de Lisser 1
APNA 30th Annual Conference Session 2023: October 20, 2016 Me tho do lo g ic a l Co nside ra tio ns: my study F ro m study: Se lf-a dministe re d pa c ke ts inc lude d L OT S o f inc o mple te da ta Didn’ t c o nside r the mse lve s sic k b ut inte re ste d in study Stig ma a b o ut de pre ssio n/ me nta l illne ss Ove rla pping re sults Me tho do lo g ic a l Co nside ra tio ns: g e ria tric de pre ssio n Cha lle ng e s in e va lua ting de pre ssio n/ me dic al illne ss/ a dva nc e d a g e : Prima ry c a re to o ls vs po pula tio n-spe c ifc me a sure me nt to o ls Ne uro ve g e ta tive sig ns Ste re o type s a nd stig ma Psyc ho so c ia l c o nte xt Pa in Nutritio n Sle e p Po lypha rma c y de Lisser 2
APNA 30th Annual Conference Session 2023: October 20, 2016 Ca se Study 67 yo ma le with 8 ye a r histo ry o f e a rly PD, c hro nic L yme , ? he a d injury, so ma tiza tio n tra its Anxio us, de pre sse d prio r to dia g no sis, use s inte lle c tua liza tio n a s prima ry de fe nse , ha s use d a thle tic s, vo lunte e r a nd g e ne ra lly hig h a c tivity a s prima ry c o ping me c ha nism sinc e c ’ ho o d Ong o ing e valua tio n o f de pre ssio n r/ t a nd no t r/ t PD Clinic a l I mplic a tio ns Ste re o type s in c a re g ive rs: pro fe ssio na l a nd fa mily c a re g ive rs Stig ma- pe rc e ptio ns o f a g ing / me nta l illne ss b y g e nde r, ra c e , so c ia l g ro up, pro fe ssio na ls Psyc ho so c ia l c o nte xt: pe rc e ive d Qo L , disa bility, iso la tio n/ lo ne line ss, so c ia l suppo rt Una ddre sse d me dic a l sympto ms: pa in/ disc o mfo rt, mo b ility, IADL s, c o g nitive func tio n De pre ssive Sympto ms: sta te vs c o urse Chro nic So rro w de sc rib e s fluc tua ting c o urse vs o ne -po int e va lua tio n o r g e ne ra liza tio n Pe rva sive , c yc lic a l e mo tio na l re spo nse to ide ntifia b le trig g e rs: ho spita liza tio n, wo rse ning dise a se , de c re a sing func tio n, c o mplic a ting psyc ho so c ial stre sso rs, misse d de ve lo pme ntal mile sto ne s-WI T H PE RI ODS OF “NORMAL CY” in b e twe e n Co uld a lso te st a s MDD My hypo the sis: a lso b o th o r pro g re ssio n (L ung re n e t a l, 1996) de Lisser 3
APNA 30th Annual Conference Session 2023: October 20, 2016 Study Que stio ns Wha t is the le ve l o f c hro nic so rro w in e lde rly pa tie nts with c hro nic me dic a l illne ss? Wha t is the le ve l o f de pre ssio n in e lde rly pa tie nts with c hro nic me dic a l illne ss? Wha t is the re la tio nship b e twe e n c hro nic so rro w a nd de pre ssio n in e lde rly pa tie nts with c hro nic me dic a l illne ss a s me a sure d b y the K e nda ll Chro nic So rro w I nstrume nt (K CSI ) a nd the PHQ-9? Wha t is the re la tio nship b e twe e n c hro nic so rro w a nd de pre ssio n in e lde rly pa tie nts with c hro nic me dic a l illne ss a s me a sure d b y the Da mro sc h a nd Pe rry Chro nic So rro w Visua l Ana lo g a nd the PHQ-9? Sa mple Cha ra c te ristic s 11 me n, 18 wo me n Avg . a g e 83.14 ye a rs o ld Only 2 sub je c ts o f c o lo r We ll e duc a te d, 8 still ma rrie d 1.7 c hro nic illne sse s L ive d in se nio r ho using Study Re sults No sta tistic a l c o rre la tio ns b ut fre q ue nc ie s we re inte re sting : Hig h ra te s o f de pre ssio n re po rte d (34.47%, N=10)o n PHQ-9 Hig h ra te s o f CS (27.85%, N=8)o n K CSI 13 c ho se CS g ra ph 37.5% o f tho se with po sitive PHQ 9 ha d po sitive K CSI = o ve rla p o r pro g re ssio n? de Lisser 4
APNA 30th Annual Conference Session 2023: October 20, 2016 Wha t I mpa c ts De pre ssio n Pro g re ssio n? T he fo ur “P”s: Pre dispo sing Pre ve nta tive Pe rpe tua ting Pro te c tive Co nve rse with ne ig hb o r a nd c o me up with e xa mple s fo r e a c h Pe rpe tua ting F a c to rs with Chro nic Me dic a l I llne ss: pe rc e ptio n a nd re a lity L o ss o f he a lth, func tio n, ro le , inde pe nde nc e Pa in/ disc o mfo rt Cha ng e in re la tio nships Inte rac tio n with he a lthc a re syste m Illne ss tra je c to ry De ve lo pme nta l c o nside ra tio ns Co g nitive func tio n Mo o d I nte rve ntio ns MDD tre a te d with me ds a nd/ o r psyc ho the ra py (if CS o r b o th, tx ma y no t b e a ppro priate / suc c e ssful) No inte rve ntio ns te ste d spe c ific a lly fo r CS Inte re sting po ssibilitie s whe n a g ing , de pre ssio n a nd me dic a l illne ss a re ta rg e te d tre a tme nt- 2 nursing studie s Dya dic inte rve ntio ns mo re suc c e ssful in tre a ting o lde r a dults with la te life de pre ssio n (Sta hl e t a l, 2016) de Lisser 5
APNA 30th Annual Conference Session 2023: October 20, 2016 I nte rve ntio n Po ssib ilitie s Psyc ho e duc a tio n Pro b le m so lving skills Be ha vio ra l a c tiva tio n VNA/ o ffic e c lo se mo nito ring o f me dic a l c o nditio ns a nd a c c e ssibility fo r a djustme nt Mo re a c tivity/ stimula tio n/ sx c o ntro l o n inpt units Asse ssme nt o f suppo rtive c a re g ive r pa rtne rs (Sta hl e t a l, 2016, Ge llis e t a l, 2014, Go rma n, 2016) T HANK YOU!! “Whe n I c o nside r tha t the nurse s I tra in no w will b e the o ne s pro viding my c a re - I a m sudde nly ve ry inve ste d in wha t I c a n te a c h the m! “ de Lisser 6
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