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The Nursing Identification, Assessment, and Management of Geriatric Depression

Master of Nursing Studies

Lisa van Seters

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Depression in the Geriatric Populations

The dramatic advance and increase in life expectancy in the aged population as result

of modern medicine impacts the burden of ill health such that chronic conditions are

increasingly common (Cheruvu & Chiyaka, 2019). The most common psychiatric illness in

the elderly is depression, with an estimated 10-15% of elderly Australian’s community in the

and over 50% of aged care residents experiencing symptoms (AIHW, 2013). Unfortunately,

no recent epidemiology studies have looked into more current rates of geriatric depression in

Australia. Depression in older adults is associated with poor health outcomes, morbidity,

suicide, cognitive and functional impairments, worsened adherence and self-care behaviour,

reduced social functioning, loss of disability-free life years, and an increased risk of falls

(Hummel et. al., 2017; Chang et. al., 2015).

Considering the high incidence of depression in the elderly and the subsequent burden

on quality of life, depression remains underdiagnosed, undertreated and regularly overlooked

by healthcare professionals (Knowles et. al., 2015). Commonly, this is due to stigmatisation

of mental illnesses in the community and the false belief that depression is a normal part of

the ageing process. However, depression is not a natural product of ageing, and treatment of

depression is valid and effective in older generations (Borglin et. al., 2019; Segel-Karpas et.

al., 2017). Despite this, studies suggest that elderly adults are less likely to receive treatment

for depression (Waterworth et. al., 2015). The purpose of this essay is to discuss and critically

analyse the current evidence base for geriatric depression including pharmacology,

psychosocial nursing assessment and management. The essay will identify current gaps in the

literature and conclude with future recommendations for research.

Pharmacological Treatment of Geriatric Depression

Pharmacological treatment of depression in elderly population using antidepressants

has been consistently shown to be effective in reducing depressive symptoms and is

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considered a first-line treatment (Kok & Reynolds, 2017). However, physiological changes to

systems in older patients such as decreased organ function, decreased fluid, and altered

muscle-fat ratios alter pharmacodynamics, pharmacokinetics and therapeutic efficacy of

antidepressants (Polatin, Bevers & Gatchel, 2017). Antidepressants also have anticholinergic

effects, can act as a sedative and are associated with cognitive and physical impairments, risk

of falls, fractures, dizziness and adverse drug related events (Polatin, Bevers & Gatchel,

2017). Therefore, treatment using antidepressants is risky due to the associated side effects,

and increased risk of drug interactions due to high incidence of polypharmacy in elderly

populations (Jonsson et. al., 2016).

Non-Pharmacological Treatment of Geriatric Depression

As not all older adults benefit from antidepressants, there is movement towards

psychosocial management of geriatric depression (Kovich & DeJong, 2015). The overall

effect size of non-pharmacological psychosocial treatment in older patients, is comparable to

antidepressants (Kirkham, Choi & Seitz, 2016; Kok and Reynolds, 2017). High quality

research is needed to find active components of psychosocial treatment modalities to support

older adults suffering from depression, however, there are limited studies on this issue. The

restricted available articles have disparities in definition of old age, depression, remission,

and follow-up duration reducing applicability of results (Jonsson, et. al., 2016). Furthermore,

it is important to note that common exclusionary criteria in research are patients who are frail,

have physical diseases, are cognitively impaired or are aged over 75 decreasing the

generalisability and feasibility of psychotherapy in these cohorts. These issues limit the

evidence for specific interventions; however, it does prove merit for several options for the

nursing management of geriatric depression (Holvast, et. al., 2017).

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Nursing Assessment of Geriatric Depression

As registered nurses (RN’s) are the frontier of healthcare, they have the ability to

identify and utilise evidence-based and person-centred interventions for elderly patients with

depression (Borglin et. al., 2019). Conversely, research shows that RN’s struggle to

accurately identify depression in older people and that they do not believe it falls within their

scope of practice (Waterworth et. al., 2015). Assessment of older adults for depression can be

challenging for healthcare providers due to hearing loss, cognitive impairment, presence of a

comorbid or health condition, adverse medication reactions and somatic conditions that can

overlap with depressive symptoms confounding accurate identification and assessment (Cosh

et. al., 2019). Furthermore, RNs face considerable time restrictions during shifts which can

further impede assessment.

Barker, Heaslio, and Chelvanagam (2015) propose that nurses lack confidence and

understanding of the presentation of depression in older adults so they evade these

discussions with patients as a result of lack of mental health training. It is important for

nurses to be educated on the presentation of psychiatric conditions and to understand that

depression can present differently within older generations (van Driel et. al., 2018). Older

adults will commonly complain of somatic problems rather than conventional presentations

of depression, and typically have loss of motivation, low energy, anxiety, somatisation,

confusion, increased desire for death and trouble sleeping (Kok and Reynolds, 2017). As

these symptoms overlap with other comorbid conditions and can be misinterpreted as

cognitive dysfunction, depression is commonly overlooked and underdiagnosed in older

populations (Polatin et. al., 2017). The importance of education and training in the

identification of mental health issues cannot be understated for RN’s as they have a unique

and significant impact on the identification, assessment and delivery of evidence-based

services and interventions.

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Nursing Management of Geriatric Depression

The psychosocial nursing management of geriatric depression should target the

fundamentals of care including nutrition, exercise, rest, and sleep which have been found to

be comparable to antidepressants in treating depressive symptoms (Kitson, Muntlin and

Conroy, 2014; Briguglio et. al., 2020). The establishment of a professional relationship with

patients is a prerequisite to the accurate identification of depressive symptoms and the

subsequent implementation of quality care in older adults (Borglin et. al., 2019). The RN

should foster a kind, caring and non-judgemental relationship that includes educating older

adults on the benefits of exercise, nutrition and sleep and supporting them to engage in social

activities. Current evidence-based treatment modalities that trained nurses can use include

cognitive behavioural therapy, bibliotherapy, life review therapy, behavioural therapy and

problem-solving therapy (Holvast et. al. 2017).

There is an explicit scarcity in the number of studies on the psychosocial treatment of

depression older adults. Although the results of these studies are promising, the available

trials have small samples sizes and the quality of the evidence across studies is low.

Furthermore, studies on geriatric depression treatment consistently fail to report the follow-up

effects of treatment (Jonsson, et. al., 2016). This is particularly important to research as it is

indicative of treatment effectiveness and there is currently no knowledge on the rate of

relapse of depression following psychosocial treatment in this population. Currently the

literature on treatment modalities lack validity, and there is a need for future research into

applied nursing practice that reflect day-to-day clinical practices. This research is imperative

for RNs ability to develop and implement evidence-based interventions to treat depressive

symptoms for older populations.

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