Nursing Process in Geriatric Mental Problems

Nursing Process in Geriatric Mental Problems

Assessment Parameters

• Identify risks factors/ high-risk groups
• Current alcohol/ substance use disorder
• Specific comorbid conditions: dementia, stroke, cancer, arthritis, hip fracture, myocardial infarction, chronic obstructive pulmonary disease, and Parkinson's disease
• Functional disability
• Widow/widowers
• Caregivers
• Social isolation/ absence of social support
• Diminished perception of light in one's environment
• Utilizing a standardized depression screening instrument and documentation score, evaluate all at-risk groups. The GDS-SF (Geriatric Depression Scale- Short Form) is advised since it is quick to administer (about 5 minutes), validated, and widely used with other adults who are medically unwell, and it only has a small number of somatic items that could be confused with physical illness.
• Conduct a focused depression assessment of each at-risk category, then record the findings. Take note of the symptoms' frequency/patterns, length (particularly 2 weeks), changes from baseline mood, behavior, and functioning, and number of symptoms.
• Depressive symptoms:
  • Depressed or irritable mood, frequent crying
  • Loss of interest, pleasure
  • Weight loss or gain
  • Sleep disturbance
  • Fatigue/ loss of energy
  • Psychomotor slowing/agitation
  • Diminished concentration
  • Feelings of worthlessness/guilt
  • Suicidal thoughts or attempts, hopelessness
• Psychosis:
  • History of depression, current substance abuse, previous coping style
  • Recent losses or crises; changes in physical health status, relationship, roles
  • Obtain/review medical history and physical/ neurological examination.
  • Assess for depressogenic medications(e.g. steroids, narcotics,sedative/hypnotics, benzodiazepines, antihypertensive, H2 antagonists, beta blockers, antipsychotics, immunosuppressives, cytotoxic agents)
  • Assess the related systematic and metabolic processes.
  • Assess for cognitive dysfunction.
  • Assess level of functional ability.

Care parameters

• Severe depression should be evaluated by a psychiatrist. Medication, cognitive behavioral, interpersonal, or short psychodynamic psychotherapy or counseling (individual, group, or family), hospitalization, or electroconvulsive therapy are all possible forms of treatment.(GDS score 11 or greater, five to nine depressive symptoms [must include depressed mood or loss of pleasure] plus other positive responses individualized assessment [especially suicidal thoughts or psychosis and comorbid substance abuse])
• Refer to mental health services for psychotherapy or counseling for less severe depression, particularly for specific difficulties discovered in the individualized assessment and to decide whether possible drug therapy is justified. Psychiatric liaison nurses, geropsychiatric advanced practice nurses, social workers, psychologists, and other community- and institution-specific mental health services are a few resources to take into consideration. A referral or thorough psychiatric examination should always be sought if there are suicide ideation, psychosis, or co-occurring substance abuse issues. (GDS score 6 or greater, less than five depressive symptoms plus other positive responses on individualized assessment)
• For all levels of depression, develop an individualized plan integrating the following nursing interventions:
• Institute safety precautions for suicide risk as per institutional policy (in outpatient settings, ensure continuous surveillance of the patient while obtaining an emergency psychiatric evaluation and disposition)
• Remove or control etiologic agents:
  • Avoid/ remove/ change depressant medications
  • Correct/ treat medications / systematic disturbances
• Monitor and promote nutrition, elimination, sleep/ rest patterns, physical comfort
• Enhance physical function; develop a daily activity schedule.
• Enhance social support ;ascertain the need for spiritual support and contact appropriate clergy.
• Maximize autonomy/ personal control/ self-efficiency
• Determine and emphasize your strengths and abilities.
• Structure and promote daily engagement in music therapy, enjoyable activities, and relaxing techniques
• administer a depression screening test while keeping track of patient response to treatment and other therapy.
• Offer support in fixing problems and being practical
• Support adaptive coping, stimulate happy memories, and offer emotional support.
• Give details about the physical condition, its treatment, and depression.
• Inform them on the value of following a depression treatment plan that has been prescribed.
• Ensure community mental health collaboration; take into account psychiatric and nursing home care intervention.