In long-term care facilities, both medical problems and medications are frequently associated with depression. Medications that can sometimes contribute to depression include antihypertensives, beta-blockers, and benzodiazepines. Some of the medical problems associated with depression in long-term care facilities include:
•Endocrine disturbances: diabetes mellitus, hypothyroidism
•Viral infections: hepatitis, pneumonia, encephalitis, HIV
•Tumors: of the lung, pancreas, and central nervous system
•Neurological: Parkinson’s disease, stroke, epilepsy, cerebrovascular disease, Huntington’s disease
•Other: hypertension, electrolyte abnormalities, anemia, alcoholism
These disorders have been known to contribute to depressive symptoms in at least two ways, including the fact that depression may be a reaction to a medical problem. An example may be the losses associated with a head injury or stroke which has frequently been found to result in depression. Also, medical problems are sometimes believed to lead to or exacerbate depressive symptoms. Head injuries and strokes are known to cause structural changes in the brain, which are believed to trigger biochemical changes leading to depressive symptoms. It is sometimes difficult to figure out the specific causes of depression in a given long-term care resident. Some options include having nursing staff in long-term care facilities providing further assessment, changing medications or observing residents for longer period of time. In many cases, the depression may resolve if the underlying medical problem improves or the medications are changed for the resident.
When assessing a long-term care resident with these medical problems, it’s important to remember that these medical issues may also be the cause of some of the biological symptoms of depression including loss of energy, weight loss or appetite, and sleep disturbance. When medical problems are believed to be causing some of the depressive symptoms, you should probably focus next on some of the psychological symptoms of depression, such as guilt, helplessness, hopelessness lack of pleasure in normal activities and interests, feelings of worthlessness and suicidal ideation.
It’s very important to understand the reciprocal nature of physical problems and depression among long-term care residents. Physical problems are known to contribute to depression as well as depression having an adverse affect on an individual’s medical condition. It is a known fact for example that depressed long-term care residents complain of more intense pain at more pain locations then do residents who are not depressed with similar medical problems. Long-term residents who do feel like eating then become undernourished. Fatigue and lack of interest in activities make it less likely that residents will exercise, endangering their physical conditioning.
Some information from Psycholosocial Intervention in Long – Term Care by Gary W. Hartz Ph.D and D. Michael Splain LCSW
Additional information and webpage by Paul Susic Ph.D. Licensed Psychologist (Health and Geriatric Psychologist)