Geriatrics and Depression

When a person reaches the age of 65, their chances of getting dementia doubles every five years (Buettner, Fitzsimmons, & Dudley, 2010; Mansah et al., 2014). Once a person has an altered mental state, like dementia, they often exhibit agitation, passivity, and depression (Buettner, Fitzsimmons, & Dudley, 2010; Mansah et al., 2014). Since these interactions affect ones cognition, personality, and daily activities, the quality of life seen is often decreased, making engagement and perception of life also lessening (Buettner, Fitzsimmons, & Dudley, 2010; Mansah et al., 2014). As a person gets older, multiple factors can lead to a decline in the quality of life including loss of partners, siblings, or friends and even control of their everyday life events (Babatsikou et al., 2017; Kawamura, Niiyama, & Niiyama, 2009; Prosser, Townsend, & Staiger, 2008).

Age is an inevitable thing that brings health problems along with physical and emotional changes (Adam, Shahar, & Ramli, 2016; Gopi & Preetha, 2016; Kawamura, Niiyama, & Niiyama, 2009; Wang, Ying Chair, Mi Ling Wong, & Li, 2016). Depressive symptoms in the elderly population will continue to rise as the baby boomer population reaches the geriatric stage of their life (Adam, Shahar, & Ramli, 2016; Babatsikou et al., 2017; Wang et al., 2016). Unfortunately, most nurses admit to not knowing enough about geriatrics and that they would rather work with the patients who had easy and quick-to-apply interventions rather than the ones who had more time-consuming ones (Bleijenberg et al., 2016). A study done by Bleijenberg et al. (2016) shows that there is room for nurse to improve when it comes to how they divide their care and what quality they put into it.

Significance to Nursing

Depression is seen in 77% of older people with dementia, yet it often goes unrecognized even with its effects on the quality of life (Buettner, Fitzsimmons, & Dudley, 2010; Mellor et al., 2008). Since some nurses feel like depression symptoms take longer to treat, appropriate medical attention is not achieved for these residents (Buettner, Fitzsimmons, & Dudley, 2010; Mellor et al., 2008). However, caregivers often feel like they lack proper skills needed to recognize and help residents with depressive symptoms, so many feel like educational programs on the different types interventions would be beneficial, interesting, and used daily (Buettner, Fitzsimmons, & Dudley, 2010; Mansah et al., 2014; Mellor et al., 2008).

Education provided to nurses and care givers is one way to improve care to patients (Mansah et al., 2014). When nurses were provided with educational material and assessment tools, completed training programs, and implemented reflection techniques, they felt like the care they provided to each patient was improved (Bleijenberg et al., 2016; Mansah et al., 2014; Mellor et al., 2008). When a nurse implements their skills, they were able to increase the care and communication they provide to the nursing home residents, gain knowledge about care, and accomplish a sense of self-efficacy (Mansah et al., 2014; Mellor et al., 2008).

With the geriatric population rising and nurses being the advocates for residents, an open mind and new innovative types of care need to be looked at to create an individualized treatment plan for residents (Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Mansah et al., 2014). Oftentimes, pharmacologic interventions are the first, if not only, line of defense used in patients with an altered mental state (Buettner, Fitzsimmons, & Dudley, 2010), but they typically lead to medication intolerance, increased fall risk, and daytime confusion (Wang et al., 2016). There are multiple structures therapeutic interventions that nurses can lead and implement to impact the geriatric populations quality of life (Adam, Shahar, & Ramli, 2016; Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Sampoornam et al., 2016). Since every person is different though, it is important to remember to keep interventions individualized to the patient/resident. The purpose of this paper is to compare how structured versus nonstructural interventions affect the quality of life in geriatric nursing home residents.

Review of Literature

Structured therapeutic interventions that nurses can apply

Initiating a personalized exercise program for each resident based on needs and abilities. As time passes and a person ages, the perception of the quality of life tends to decrease (Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010) and the presence of insomnia increases (Sampoornam et al., 2016). Exercise has been shown to have positive effects on an older persons' perception on the quality of life, while also decreasing fall incidents that can lead to morbidity and mortality (Babatsikou et al., 2017; Buettner, Fitzsimmons, & Dudley, 2010; Sampoornam et al., 2016; Wang et al., 2016). Some studies done show a positive correlation between exercise and the perception of quality of life, sleeping patterns, and the meaning of life experiences (Adam, Shahar, & Ramli, 2016; Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Sampoornam et al., 2016).

Changes in the central nervous system from age can cause a person to lose balance, muscle strength, and mobility all together (Adam, Shahar, & Ramli, 2016). There are many types of exercise training techniques that can be implemented to improve the overall quality of life and slow the physical limitations down. Some of these implementations include, but are not limited to, walking (Sampoornam et al., 2016), cardiorespiratory endurance, strength and balance training, flexibility (Justine & Hamid, 2010), cross training (Buettner, Fitzsimmons, & Dudley, 2010), resistance training, Tai Chi, and dancing (Adam, Shahar, & Ramli, 2016). Dancing was implemented in a study done by Adam, Shahar, and Ramli (2016) that allowed the residents to be themselves, have fun, and enjoy the exercise while they were partaking in it.

Providing animal interaction opportunities or ability for residents to have pets. Companion animals can help minimize the feeling of loneliness and assist with transition of the normal aging processes by providing a companion, being someone the older person can to talk to and have physical contact with, and being a topic that can be brought up with a stranger (Kawamura, Niiyama, & Niiyama, 2009; Prosser, Townsend, & Staiger, 2008). By animals increasing social interactions, a positive effect occurs and decreases agitated and depressive behaviors (Kawamura, Niiyama, & Niiyama, 2009; Moretti et al., 2011; Prosser, Townsend, & Staiger, 2008; Thodberg et al., 2016). Pets also allow the older patient with something to touch and since older patients have a more positive response to touch rather than communication, animals can be a perfect addition to those who have lost loved ones (Prosser, Townsend, & Staiger, 2008).

In a study done by Moretti et al. (2011), pet therapy was able to decrease symptoms associated with depression by 50% and increased the quality of life measured in long-term care facility residents. During the post-intervention interview in the study done by Prosser, Townsend, and Staiger (2008), many residents wanted the companion program to continue because they enjoyed contact with the animals, they had more social interactions, and it brought variety to their lives. Participants often found pleasure knowing the animals were coming and felt like it provided them with a positive experience at the nursing home (Kawamura, Niiyama, & Niiyama, 2009; Moretti et al., 2011; Prosser, Townsend, & Staiger, 2008). Using pets as therapy for elder nursing home residents is often implemented when the animals are brought in by a volunteer, but nurses can help encourage protocols to be developed that motivate animal therapy as a common occurrence (Kawamura, Niiyama, & Niiyama, 2009; Prosser, Townsend, & Staiger, 2008; Thodberg et al., 2016).

Offering music and singing programs that residents can be involved in. Music and singing therapy can be used to manage the effects aging has on health maintenance, daily functioning, and the quality of life (Gopi & Preetha, 2016; Wang et al., 2016). Through the use of music and singing, depressive symptoms can be decreased and the meaning of quality of life can be more significant to residents (Gopi & Preetha, 2016; Wang et al., 2016). Since music interventions are safe, easy, and generally effective at decreasing depressive symptoms, along with increasing the quality of sleep, music could be a simple implementation to add to a nursing home resident's daily activities (Gopi & Preetha, 2016; Wang et al., 2016).

Music that has tranquilizing effects have been thought to calm the body and suppress the sympathetic nervous system and turn on the parasympathetic nervous system (Wang et al., 2016). In addition, music also lets the mind focus on something other than thoughts, which allows the mind to relax (Gopi & Preetha, 2016) and can even initiate sleep (Wang et al., 2016). When music is blended with different tones, restoration of emotions, physical relaxation, and spiritual wellbeing is met (Gopi & Preetha, 2016).

Implementing different massage and relaxation techniques that residents can partake in. There are many types of massage and relaxation techniques that can be used on nursing home residents daily (Adam, Shahar, & Ramli, 2016; Keerthi, Malathi, and Nidagundi, 2018). In a study done by Keerthi, Malathi, and Nidagundi (2018), the use of footbath on joint pain was tested. A foot bath was given to the residents in the experiment twice a week and the effects were tested based on the amount of joint pain the residents felt afterward (Keerthi, Malathi, and Nidagundi, 2018). The footbath is able to cause blood vessels to dilate, which then increases the blood flow to other parts of the body (Keerthi, Malathi, and Nidagundi, 2018). When the dilation occurs, the blood movement causes the muscles to relax and release tension which leads to pain being relieved (Keerthi, Malathi, and Nidagundi, 2018).

Relaxation therapy is another technique that has been used for a while to treat stress and anxiety (Adam, Shahar, & Ramli, 2016). This type of therapy has been used to restore harmony in the body, reduce physical and mental tension, decreasing depressive symptoms, and creating an overall positive outlook (Adam, Shahar, & Ramli, 2016). There are many different types of relaxation techniques that can be used, but some of the most common ones are breathing, meditation, and progressive muscular relaxation (Adam, Shahar, & Ramli, 2016).

Perception on the quality of life for nursing home residents

The depression rates decreased in geriatric residents. In a study done by Buettner, Fitzsimmons, and Dudley (2010), agitation, passivity, and depression were all measured at the start and after two weeks of exercise treatments for each patient. This measurement showed that agitation in patients with depression was lowered after the individualized treatments were performed and went hand in hand with changes in passivity (Buettner, Fitzsimmons, & Dudley, 2010). Contrary, Justine and Hamid (2010) found that participants had an improvement in their life satisfaction, but there was no change when it came to their levels of depression.

Dancing however was shown to have a positive outlook for resident's with depression and anxiety (Adam, Shahar, & Ramli, 2016). This exercise not only implements movement, it also incorporated music, which allows muscles to be worked, stress to be released, and fun to be had (Adam, Shahar, & Ramli, 2016). Since music is so easy to implement and use, it is a simple thing to add to an exercise routine (Adam, Shahar, & Ramli, 2016; Gopi & Preetha, 2016; Wang et al., 2016). Music therapy is able to allow relaxation of the mind and body to occur, which in turn has a positive effect on mood and feelings (Gopi & Preetha, 2016).

Ensure that residents obtain a more consistent sleeping pattern. When quality of sleep is measured after walking exercise is implemented, a decrease in chronic insomnia was seen and sleeping habits were improved (Sampoornam et al., 2016). Sleeping disorders are common as age increases as falling asleep becomes harder and waking up early happens more often (Sampoornam et al., 2016). Circadian rhythm problems have been thought to go hand in hand with cognitive issues (Sampoornam et al., 2016). If cognitive issues are able to be assessed and put in check, sleeping problems could be resolved also.

Slow the onset of dementia for nursing home or long-term care facility residents. Since dementia is a progressive brain disease, reversal of this disease is not likely, but some interventions were able to slow the onset down or minimize symptoms (Thodberg et al., 2016). When resident's affected with dementia are able to engage in animal interactions, improvement in cognitive functions, motivation, and emotions was seen (Moretti et al., 2011). Meaningful life experiences are important for residents with dementia and these events can change both passive and agitative behavior (Buettner, Fitzsimmons, & Dudley, 2010).

Conclusion

Summary

When a nurse is able to work with other healthcare professionals, the resident, and their families, stronger therapeutic communication skills are gained, interpersonal relationships are improved, knowledge about personal events are shared, and multiple assessment tools are looked at to create an improved and individualized treatment approach (Buettner, Fitzsimmons, & Dudley, 2010; Mansah et al., 2014; Mellor et al., 2008). When nurses have the proper knowledge and education needed to help care for residents (Mansah et al., 2014; Mellor et al., 2008), implementations like exercise programs (Adam, Shahar, & Ramli, 2016; Justine & Hamid, 2010; Sampoornam et al., 2016), animal therapy (Kawamura, Niiyama, & Niiyama, 2009; Moretti et al., 2011; Thodberg et al., 2016), music and singing (Gopi & Preetha, 2016; Wang et al., 2016), and relaxation techniques (Adam, Shahar, & Ramli, 2016; Keerthi, Malathi, and Nidagundi, 2018), can be implemented and individualized for each elder. All of the interventions talked about previously can be applied into a resident's activity schedule based on what their interests are and their physical ability. It would also be beneficial to educate nurses on how to properly implement structured therapeutic interventions and provide nursing homes with the ability to offer those interventions.

Areas for Future Research

Most study researchers felt like they needed a longer adaptation period during their study so they could have more observations (Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Mansah et al., 2014; Moretti et al., 2011; Sampoornam et al., 2016; Wang et al., 2016). This longer period might allow more time for the positive impact on the quality of life to occur and ensure that the participants are comfortable and familiar with their new interventions (Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Moretti et al., 2011; Sampoornam et al., 2016; Wang et al., 2016). It was also a common that authors thought there needed to be a larger test group with more diversity in a future study done (Buettner, Fitzsimmons, & Dudley, 2010; Justine & Hamid, 2010; Kawamura, Niiyama, & Niiyama, 2009; Keerthi, Malathi, and Nidagundi, 2018; Moretti et al., 2011; Sampoornam et al., 2016).

Research can also be done to test the effects on younger children visiting and interacting with nursing home residents. This would provide the resident with someone to talk to that they can teach and do activities with. Gardening and cooking might be other areas that can be looked at. It might be hard for aging residents to partake in activities like this that they once enjoyed, but if modifications could be made to help them adapt to physical changes, these activities might be achievable.

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