APNA 30th Annual Conference Session 2023: October 20, 2016 Chro nic - - PDF document

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 1

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 illne ss Mo o d

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

• 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

• 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

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 2

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

• 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

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 3

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)

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 4

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?

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 5

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

• 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)

APNA 30th Annual Conference Session 2023: October 20, 2016 de Lisser 6

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! “