This document discusses depression and confusion in elderly residents. It defines depression and lists its signs and symptoms. Common causes of depression in the elderly include loss of loved ones, health, independence, and loneliness. The nurse aide's role is to recognize symptoms, encourage independence, monitor intake, and report changes. For confusion, possible medical and environmental causes are identified, along with symptoms like incoherence and hallucinations. Implications include fear, reduced contact and independence. Interventions include treating underlying causes, improving nutrition/hydration, and using reality orientation, validation therapy, and clear communication.

1. NATCEP Day Thirty Three

2. Objectives
 Define depression
 Identify signs and symptoms
 Describe possible causes
 Identifies the nurse aide’s role and
responsibility in caring for the resident
with depression
 Possible nurse aide interventions

3. Definition
 An emotional disorder that involves
the body, mood, and thoughts. The
person loses interest in daily
activities.
 Most commonly overlooked disorder in
the elderly
 Misdiagnosised as a cognitive disorder
 Can mimic physical illness

4. Signs & Symptoms
 Sadness
 Inactivity
 Difficulty thinking
 Problems concentrating
 Feelings of despair
 Problems sleeping
 Changes in appetite
 Fatigue
 Agitation
 Withdrawn
 Thoughts of death or suicide
 Pain
 Irritability

5. Causes
 Death of family or friends
 Loss of health
 Loss of body functions
 Loss of independence
 Loneliness/boredom
 Medications – side effect
 Loss of purpose

6. Nurse Aide
Roles/Responsibilities
 Recognize signs & symptoms
 Encourage independence with ADLs
 Maintain safety
 Monitor food and fluid intake (is it adequate)?
 Report observations to nurse
 Follow care plan

7. Nurse Aide
Roles/Responsibilities
 Don’t make light of or ignore resident
comments or behaviors
 Suicidal?
 Suicide Precautions according to policy
 Observant for clues of attempts
○ High risk categories include
 75 years of age and older
 Recent diagnosis of terminal illness
 Unrelieved chronic pain
 Sudden loss of spouse
 Elderly with recent multiple losses

8. Possible Interventions
 One on One interaction
 Activities
 Learn the resident’s preferences and habits

9. NATCEP Day Thirty Three

10. Objectives
 Identify possible causes of confusion
 Identify symptoms that indicate a resident
may be confused
 Discuss implications of confusion for the
resident
 Identify ways in which some of the causes
of confusion may be minimized
 Identify behaviors hat may be seen
 Describe appropriate therapeutic
interventions

11. Possible Causes of
Confusion Medical issues
 Chronic illnesses
 Surgery & injury
 Degenerative brain diseases – Alzheimers,
dementia, arteriosclerosis
 Poor nutrition
 Poor fluid intake
 Medication
 Reaction
 Combo of meds
 Social Isolation
 Hearing & Vision Loss
 Changes in the usual environment

12. Symptoms of Confusion
 Does not know self or others
 Talks incoherently
 Forgetful
 Does not pay attention
 Does not understand when someone else
is speaking
 Sleep disorders
 Hallucinates – visual or auditory
 Hostile/combative
 SUNDOWNING

13. Implications
 The resident may be
 Frightened, unhappy, bewildered or angry
 Unaware of environment – doesn’t
recognize danger
 Reduced contact with others
 Less self expression
 Less independence
 Insecure
 Verbal or physical aggression
 Socially inappropriate behavior

14. Ways to reduce confusion
 Treat medical condition
 Improve nutrition & hydration
 Change prescribed medications
 Encouraging socialization
 Avoid overstimulation
 Calm, relaxed and peaceful setting
 Hearing aids and glasses

15. Behaviors
 Combative
 Withdrawn
 Socially inappropriate
 Verbal or physical aggression
 Wandering
 Abnormal sexual behavior
 Repetitive behaviors
 Catastrophic reactions

16. Therapeutic Interventions
 Reality orientation to maintain reality contact
 Reminiscing = life review
 Validation therapy
 Focuses on responding to the affect or emotion
expressed by the patient rather than the actual
content, which may be distorted. Rather than correct
and attempt to reorient a disoriented person, positive
reinforcement is continually given.
 Helps them feel more secure and oriented within their
own reality

17. Therapeutic Interventions
 Begin conversation by identifying yourself
 Do not ask if they remember you
 Eye level with eye contact
 Pleasant facial expression
 Place hand on resident’s arm or hand unless it causes
agitation
 Control background noise – be sure they can hear you
 Lower tone of voice
 Short, common words; short, simple sentences
 Give resident time to respond
 One question at a time – if need to repeat, say same
way
 Ask resident to do only one task at a time

18. Therapeutic Interventions
 Dementia: eventually unable to understand verbal
communication
 Use pictures and point, touch, or hand the resident items
 Demonstrate an action when you want resident to complete
a task
 Resident may use word substitutes
 Consistent – find out what they mean & use yourself
 Avoid abstract, common expressions
 “You can hop into bed now”
 Repeat resident’s last words to help stay on track
during conversation
 Do not try to “make” resident understand = agitation
 Use nonverbal praise freely and always respect
resident’s feelings