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Let There Be Light

by Erika Hoffman, Staff Writer

 

“Just Do It!” admonishes the Nike ad.  “God helps those who help themselves” goes the old saw.  “Carpe diem” is a philosophy everyone needs to buy into, including the depressed elderly.

Of course, depression can strike any age group, any ethnic category, and any social–economic strata, but there is a multitude of reasons why the elderly are disproportionately afflicted nowadays.

No doubt exists that a family history of the disorder predisposes some elderly to the disease. Yet, without that genetic tie, the elderly can still be candidates for depression due to several other factors: widowhood, social seclusion, other diseases, interaction of medications, a negative perception of body image, fear of dying, chronic pain, and self-medication with alcohol or drugs.

Because of outdated stigmas, misguided notions of family members, or treatment expense, many seniors suffer their feelings of hopelessness and helplessness in silence. They resign themselves to being blue and don’t seek medical intervention.

The sad shame of this situation is that proven medical help is available for the elderly. Screening devices easily administered in a variety of medical offices, even optometrist offices, can identify quickly, painlessly, and effortlessly those in need of anti–depressants. Once the diagnosis is determined, a caregiver can ensure follow-up treatment.

There is “light” at the end of the tunnel in Baltimore! Project LIGHT was created at Levindale Hebrew Geriatric Center and Hospital in Baltimore, Maryland to screen the elderly for depression. LIGHT is an acronym for a four step process. First, the patient Learns about depression; the patient is Inspired to seek help; the patient is Given Hope; and the last step is Treatment.

In this program, a psychiatric registered nurse visits primary care physicians where she conducts tests for depression on site. Therefore, patients and their caregivers need not make separate trips to psychiatric offices. Their emotional status can be quickly assessed in the comfortable and familiar setting of their family doctor’s office.

Ms. Poklemba, a clinical nurse specialist at Levindale Hebrew Geriatric Center and Hospital in Baltimore, realizes that building relations with primary care physicians to help screen for depression in elderly patients can significantly reduce patients’ risk for suicide. She cited the alarming statistic that 20 percent of all suicide deaths are in people over 65. Unfortunately, those folks rarely exhibit any outward sign of their intentions.

The LIGHT Program uses the Geriatric Depression Scale to screen patients and start a dialogue with them about their feelings. Fifteen questions comprise the survey. They inquire about the person’s energy level, satisfaction with life, and coping mechanisms for disappointments. 

If a senior tests positive for depression, that patient can receive psychotherapy in the same physician’s office and also schedule follow-up screenings in the same office at three months, six months, and a year. Ms. Veronica Poklemba (APRN,CS-P) points out that elderly patients don’t react well to the idea of a psychiatrist’s office. Treating them for their depression where they receive their primary care is more likely to be successful. Anybody identified as depressed is offered treatment and if transportation to a clinic is an issue, a therapist can go into the home of the referred patient. Project LIGHT is funded by a grant, but Ms. Poklemba feels that a family doctor could rent office space to a mental health specialist just as some rent out office space to cardiologists, dermatologists or other specialists.

The toolkit supplied by Project LIGHT, containing stickers, posters, brochures, CD’s, and lists of mental health providers, benefits the physician as well as the patient. Many physicians ask their own questions regarding depression and don’t need to pull out the supplied list. They have appropriate questions. The goal is: screening of the elderly for depression. The primary care doctor is not expected to treat the patient for his/her depression, but the idea is that he can ID the person’s problem easily and then refer the patient for more in-depth screening. Because Ms. Poklemba is tied into the practice, her paperwork goes back to the primary care doctor, and he can read her conclusions which she leaves in the patient’s medical record. She, too, has an accurate record of the patient’s health problems and doesn’t need to rely solely on what the senior may or may not tell her about physical problems.“I make sure the doctor knows if I find something,” she states.

Ms. Poklemba screens the patient verbally. For example, a question reads: “Has there been any change in your usual activities?”She knows to add “in the last month.” If not, elderly patients might relate changes in the last ten years! Veronica phrases it in a way that makes sense to the elderly person. In addition, she studies their non-verbal clues, such as a confused expression. Folks in the beginning stages of dementia are with it enough to know if they are experiencing depression, and therapy will help them. They can sit and discuss their worries. However, if suffering from severe dementia, the senior cannot benefit from therapy, but sometimes taking anti-depressants is helpful.

Veronica has worked with caregivers who suffer stress from managing their elderly parents with “heavy duty” dementia. If the caregiver gets therapy, it can help her cope with the senior afflicted with dementia and depression. By helping the caregiver control her stress levels, the elder is also helped. Even an aged person with deep confusion and rampant memory loss can pick up on the caregiver’s stress. In a situation Veronica relates, she asserts that when the caregiver became calmer due to therapy, so did her mother. Veronica emphasizes that caregivers must take care of themselves if they look after someone else. That 70-year-old didn’t understand all the ways dementia impacted her 91-year-old mother until Veronica gave her a book to read on the subject. Later she remarked to Veronica, “I felt very frustrated. Now, I understand how changeable her abilities can be.”Some family members can think the older person is just trying to seek attention when she repeats the same thing over and over or when she forgets something she seemed to know ten minutes earlier. Therapy for the caregiver can reduce the anxiety and worry that accompanies looking after the elderly.

The focus of Project Light is two pronged: Get Doctors inclined to screen for depression in their elderly clientele and then get identified people into treatment. Physicians have told Veronica that because of Project LIGHT, people have gotten into treatment that doctors could not persuade into treatment for years, especially men.

All the physicians involved in LIGHT say they screen more now, even if they use their own set of questions rather than the Geriatric Depression Scale supplied by LIGHT, which is used in the study so there is a standard approach to track data.

“Depression is something that, unfortunately, we don’t pick up on early,” states Steven Miller, MD at Woodholme Clinic.“In elderly patients, there are other health issues that come to the surface, like diabetes or heart disease,” says Dr. Miller.“While depression can be impairing, it tends to be more hidden. Having the mental health clinician in the office to screen patients has been a very positive experience.”

Studying the results of the screening of 2,563 seniors living in the Levindale service area, one finds 251 screened positive for depression. Of the 251, 119 agreed to a treatment program. One hundred and seven of the depressed were treated by LIGHT’s clinical nurse specialist, and 12 were treated elsewhere after being identified by Project LIGHT.

Of the 107 initially treated by LIGHT, 58 could be contacted at three months. Seventy-five percent of them showed improvement at the three-month follow-up using the short form of The Geriatric Depression Scale. This is a very impressive result given the fact that a myriad of challenges arise when trying to reach individuals for follow-up, such as hospitalization, relocation, tragic events, telephone disconnection, and increased dementia interfering with their ability to answer questions.

In meeting with each practice to discuss the LIGHT toolkit, Veronica Poklemba found high praise for the information the kit provided: an explanation of depression, the symptoms, the treatments, the mental health resources, and educational handouts for medical and lay communities.

Veronica Poklemba’s advice is: Don’t hesitate to bring up questions about mental health with your primary doctor. She urges, “If it’s in your head, you should ask it.” She emphasizes that a caregiver must take care of himself in order to care for another. She advises to search online to find mental health care providers in your area, ask your physician for a list, and if you need names of therapists and psychiatrists in the Baltimore environs who enjoy working with elderly patients, call her. [410-601-2875]

Look over the list of symptoms of depression. If you notice these present in your loved one, ask the doctor, “Can you determine if my loved one has depression?”Be proactive.

Today’s caregivers must be knowledgeable about the proven tie between a person’s emotional well-being and physical health. To treat only symptoms that have a readily identifiable physical cause is to deny a person help, hope, and the pursuit of happiness. So, all ostrich heads must yank themselves up into the 21st century and get their loved ones to a program like Project LIGHT where beauty, truth, and joy can be within the grasp of their beloved charge—the person they care for.


Geriatric Depression Scale

Answers indicating depression are highlighted. Each BOLD-FACED answer counts one (1) point. A score greater than 5 is indicative of probable depression.

Question
Response

1

Are you basically satisfied with your life?  Yes/NO

2

Have you dropped many of your activities and interests? YES/No

 3

Do you feel happy most of the time? Yes/NO

4

Do you prefer to stay in your room/facility, rather than going out and doing new things?
YES/No
If none of the above responses suggests depression, STOP HERE.  If any of the above responses suggests depression ask questions 5-14.

 5   

Do you feel that your life is empty?     YES/No

6

Do you often get bored?                YES/No
7

Are you in good spirits most of the time? 

Yes/NO
8

Are you afraid that something bad is going to happen to you?

YES/No
9

Do you often feel helpless?          

YES/No
10

Do you feel you have more problems with memory than most people do?

YES/No
11

Do you think it is wonderful to be alive?

Yes/NO
12

Do you feel full of energy?            

Yes/NO
13

Do you feel that your situation is hopeless?             

YES/No
14

Do you think that most people are better off than you?      

YES/No
 
SCORE
 

 

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