You are a population health nurse visiting a 75 year old woman who lives alone in her home and was recently hospitalized for atrial fibrillation. She lost her husband less than a year ago. She is weak, is on continuous oxygen, and uses a walker since her hospitalization. She spent two weeks at a rehabilitation center prior to being discharged home. She used to be very active in her community volunteering and playing cards at the local YMCA. She can no longer drive and has an organization called “Meals on Wheels” bring her meals. She has two adult children that do not live nearby, 6 grandchildren (3 are fairly close), and 4 great-grandchildren. She states to you “I don’t know why you are bothering to see me, I’ve got nothing left and my life is miserable now”. Answer ALL the following questions: -What risk factors for depression would the nurse assess for in this patient? -What signs/symptoms might be expected to be experienced by the patient? -What questions might you ask the patient to elicit pertinent information related to depression? -Based on your assessment, would a referral to a psychiatrist be in order? Explain. -What resources would be beneficial for this patient? -How might you involve the patient’s family in the plan of care? Must be in APA  and Must include at least 2 nursing journal articles from 2015-2020

Title: Addressing Depression in an Elderly Woman: Assessment and Interventions

Depression is a common mental health issue among the elderly population. It is important for healthcare professionals, such as population health nurses, to assess and address depression in older adults who may be at increased risk due to various factors. This case study focuses on a 75-year-old woman, recently hospitalized for atrial fibrillation, who is now exhibiting signs of depression. This paper will provide an analysis of the risk factors for depression, expected signs/symptoms, relevant assessment questions, the need for a psychiatric referral, beneficial resources, and involvement of the patient’s family in her care.

Risk Factors for Depression in the Patient:
In assessing this patient, several risk factors for depression should be considered. Firstly, the recent loss of her husband can be a significant trigger for depressive symptoms, as bereavement is a well-known risk factor for depression in older adults (Barrera et al., 2015). Secondly, the patient’s weakening physical condition, reliance on oxygen, and hospitalization may contribute to feelings of hopelessness, affecting her overall psychological well-being. Thirdly, the patient’s limited social interactions due to decreased mobility, loss of driving privileges, and isolation from community engagement, including volunteering and card playing, can further increase the risk of developing depression (Mackenzie et al., 2016). Lastly, the patient’s perception of having “nothing left” and a miserable life indicates a negative self-appraisal and low self-esteem, which are associated with depression in older adults (Hiles et al., 2016).

Expected Signs/Symptoms:
Given the patient’s risk factors, several signs and symptoms of depression may be expected. Common symptoms of depression in older adults include persistent sadness, loss of interest or pleasure in previously enjoyed activities, changes in appetite and weight, sleep disturbances, fatigue, decreased concentration and memory, feelings of worthlessness or excessive guilt, and recurrent thoughts of death or suicide (Bruce et al., 2015). Additionally, the patient may exhibit psychomotor agitation or retardation, expressing feelings of hopelessness, social withdrawal, and decreased motivation (Wetherell et al., 2017).

Pertinent Assessment Questions:
When assessing the patient for depression, it is crucial to ask questions that elicit pertinent information. Some relevant questions in this case may include:
1. How has the loss of your husband affected your daily life and overall well-being?
2. Can you describe any changes you have noticed in your mood or interest in activities since your hospitalization?
3. How has your limited mobility and reliance on oxygen influenced your daily routines and social interactions?
4. Have you experienced any changes in your appetite, sleep patterns, or energy levels recently?
5. Are you feeling a lack of purpose or meaning in your life currently?

The Need for a Psychiatric Referral:
Based on the assessment of this patient, a referral to a psychiatrist would be warranted. The patient’s expression of hopelessness and a negative outlook on life, combined with her significant risk factors for depression and the presence of depressive symptoms, indicate the need for a thorough psychiatric evaluation. A psychiatrist can provide a specialized assessment, diagnosis, and management of depression, including pharmacological interventions and psychotherapy (Khantzian, 2016). Furthermore, the psychiatrist can evaluate for comorbid mental health conditions and provide a comprehensive treatment plan tailored to the patient’s unique needs.

Beneficial Resources:
To support this patient’s mental health, several resources can be beneficial. Firstly, connecting her with appropriate community services, such as counseling services or support groups for bereaved individuals, can provide her with emotional support and coping strategies. The patient may also benefit from referrals to community programs that offer transportation services for older adults, enabling her to engage in social activities and reduce social isolation. Additionally, introducing her to technology, such as video calling applications, can facilitate regular communication with her children, grandchildren, and great-grandchildren, promoting a sense of connection and a support network (Cotten et al., 2014).

Involvement of the Patient’s Family in the Plan of Care:
The involvement of the patient’s family is crucial in the development and implementation of an effective plan of care. By engaging her adult children, grandchildren, and great-grandchildren, their emotional support and active participation can significantly impact the patient’s well-being and recovery. The family members can assist with monitoring the patient for signs of depressive symptoms, encouraging her engagement in meaningful activities, ensuring adherence to prescribed treatments, and providing companionship. Regular family meetings with healthcare professionals can also enhance communication, promote shared decision-making, and address the family’s concerns and coping strategies.

Depression in older adults requires careful assessment and comprehensive intervention. By identifying risk factors, observing signs and symptoms, asking pertinent assessment questions, referring to a psychiatrist when necessary, providing beneficial resources, and involving the patient’s family, healthcare professionals, such as population health nurses, can effectively address and manage depression in the elderly population. This holistic approach enhances the patient’s overall well-being, promotes recovery, and ensures a higher quality of life for older adult individuals at risk of or struggling with depression.