Effective Interventions for Depression

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(No Transcript)
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Effective Interventions for Depression

• Mid-West QIOs Teleconference
• June 12, 2008
• 130-230 p.m. CST
• Presentation by
• Roberta Williams, CRC, LCPC

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Objectives

• Participants will identify depression
  epidemiology
• Participants will describe the methods used to
  detect depression
• Participants will be able to list three
  strategies to alleviate sign and symptoms of
  depression

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What is Depression

• Depression is a treatable illness involving
  imbalance of brain chemicals called
  neurotransmitters
• Neurotransmitters are chemicals that move
  messages in the brain and to all parts of the
  body
• Depression and Bipolar Support Alliance,
  ww.dbsalliance.org

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What is Depression (cont.)

• Alterations in body chemistry can bring on a
  depressive disorder
• These changes can be caused by
• Hormone changes
• Poor health habits
• Substance abuse
• Other illnesses
• Depression and Bipolar Support Alliance,
  ww.dbsalliance.org

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Depression

• A Mood Disorder That Affects a Persons
• Mood
• Thoughts
• Body
• Energy
• Emotions
• Depression and Bipolar Support Alliance,
  ww.dbsalliance.org

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Depression in Nursing Homes

• Between 24-50 of elders living in nursing homes
  experience clinically significant depression
• American Journal of Geriatric Psychiatry report
  on research at the University of Pennsylvania,
  Sept. 2005

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Admission to Nursing Homes

• Older adults with mental illness are three times
  more likely to be institutionalized than older
  adults without mental illness
• 89 are admitted to nursing homes
• Community Integration for Older Adults with
  Mental Illness, www.mentalhealth.samha.gov

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National Depression Rate

• National Average of Depressed Long-Term Care
  Residents 14
• NH Compare Website 4/07-6/07

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State Depression Rates

• Indiana 17
• Illinois 15
• Kentucky 19
• Michigan 13
• Iowa 17
• Wisconsin 17
• NH Compare Website 4/07-6/07

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Failure to Treat Depression

• The primary reason for failure to treat
  depression in the elderly is a failure to
  recognize it in the first place

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Failure to Treat Depression (cont.)

• Under diagnosis
• Confused with a diagnosis of dementia
• Lack of appropriate treatment
• Limited reimbursement for mental health services

Handout Depression Awareness
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Results of Failure to Treat Depression

• Resistance to care
• Substance abuse
• Poor nutritional intake
• Suicide
• Lack of quality of life
• Decline in physical condition
• Isolation and social withdrawal

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Risk Factors for Depression

• Recent loss of significant other
• Alcohol or substance abuse
• New admission to nursing home
• Recent loss in functional status
• Financial stress

Handouts Depression Awareness
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Consequences of Depression

• Nursing home residents with depressive disorder
  were 59 more likely to die than residents who
  were not depressed
• Recognizing and Treating Resident Depression
  http//nursinghome.org/fam/fam_005.html

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Consequences of Depression (cont.)

• Older adults with mental illness have
• Worse general health status
• Less social support
• Greater number of problem behaviors
• More deficits performing activities of daily
  living (ADLs)
• Community Integration for Older Adults with
  Mental Illness www.mentalhealth.samha.gov

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Signs Symptoms of Depression

• Emotional
• Cognitive
• Behavioral
• Physical

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Emotional

• Loss of interest
• Inability to experience pleasure
• Sense of uselessness
• Hopelessness/worthlessness
• Death wishes
• Agitation/grumpy

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Cognitive

• Slowing of memory
• Complaints of poor memory
• Paranoia
• Delusions
• Hallucinations

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Behavioral

• Poor grooming
• Isolative behaviors/withdrawal
• Slowed movement
• Change in sleeping
• Change in eating

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Physical

• Vague somatic complaints
• Changes in ADLs
• Onset of infections
• Certain Medical diagnosis

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Depression Screening

• Screen all residents for depression on a
  regularly scheduled basis.
• Use appropriate, valid assessment tools for
  residents who screen positive.

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Assessing Depression

• Geriatric Depression Scale
• MDS Triggers
• Nutritional decline
• Death wishes or suicidal thoughts

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What Can Your Facility Do?

• Services
• Autonomy and control
• Programming

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Treatment Modalities

• Physician/Psychiatrist Assessment
• Nursing/CAN
• Social Services
• Activities
• Outside treatment options

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Physician/Psychiatrist

• Assessment
• Consult
• Medications

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Nursing/CNA Role in Treatment

• Watch for symptoms while providing care
• Report your concerns/findings to the appropriate
  person

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Social Services

• Social Services Assessment
• Behavior Tracking
• Round Table discussion
• Chat groups
• One on One
• Subpart S programming
• Communication/Follow-up with other staff

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Activities Staff Role in Treatment

• Evaluating past interest/hobbies
• Programming
• Communication with other staff

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Outside Treatment Options

• Contracting for services
• Psychiatrist, NP, APN, or PA
• Outside counseling programs
• IOP
• Partial Hospital Programs
• Individual counseling

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Prevention Measures

• Formal support groups
• Productive social roles
• Enhance caregiver skills
• Support from informal relationships
• Depression and Bipolar Support Alliance,
  ww.dbsalliance.org

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Facility Approaches

• Consistent staffing
• Facilitate social interventions
• Minimize institutional aspects of environment

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Culture Change in Treating Depression

• Offer opportunities for productive roles
• Allow resident choices in room décor
• Provide more nutritional choices
• Staff recidivism
• Autonomy and control

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Depression Resources

• Substance Abuse and Mental Health Services
  Administration (SAMHSA) http//www.samhsa.gov
• National Foundation for Depressive Illness, Inc.
  http//www.depression.org
• Depression and Related Affected Disorders
  Association
• http//www.drada.org

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Additional Resources

• Pioneer Network http//www.pioneernetwork.net
• Culture change information
• Skilled Nursing Facility Center
• http//www.cms.hhs.gov/center/snf.asp
• Links to manuals, education materials,
  regulations, billing information
• QIES Technical Support https//www.qtso.com
• Links to online training, MDS information

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Questions?
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Contact Information

• Jenny Harrison
• Kristin Lueschow
• [phone] ext. 8222
• jharriso_at_metastar.com
• www.metastar.com
• This material was prepared by MetaStar, the
  Medicare Quality Improvement Organization for
  Wisconsin, under contract with the Centers for
  Medicare Medicaid Services (CMS), an agency of
  the U.S. Department of Health and Human Services.
  The contents presented do not necessarily reflect
  CMS policy. 8SOW-WI-NH-08-25.