Sample Nursing Paper on Increase in depression among adult age 65 and over in Florida (USA)

Problem or Health Issue Description and Overview

Depression can be best described as a mood disorder. It is one of the most common psychological problems in the world, and a growing concern for mental healthcare (Ritchie & Roser, 2018). There are several causes and triggers of depression, including pre-existing illness, life’s hardships, loss, physical or emotional trauma, amongst others. More people have had an experienced with depression in the past decade than at any other time in history. It is estimated that at least 10% of the world’s population has had a depressive event lasting two or more weeks in their lifetime (CDC, 2017). Depression is a mental health disorder that affects people from all ages and walks of life.

An estimated 8% of Americans are living with depression, with the statistic ranging from children to adults advanced in age. Research places Florida state at having almost 16% of its population living with depression (CDC, 2017). There are various factors that predispose people to depression (CDC, 2017). However, depression can be further aggravated by the presence of conditions such as diabetes, obesity, cardiovascular diseases, cancer, arthritis, among others. These pre-existing conditions are found to mainly affect elderly adults above 65 years. The accompanying mood shifts and lowered cognitive abilities makes depression in persons above 65 years a healthcare and global concern.

The Covid-19 pandemic, which saw the world hit by a global health concern, has also significantly contributed to the rise in depression of older adults. One of the requirements for handling the pandemic is social isolation and distancing. This requirement is especially vital for older adults, who both the WHO and the CDC recognize as some of the most at-risk (Wu, 2020). The concern is genuine as 78% of Covid-19-related deaths in the US were among older adults (Wu, 2020). The high-risk status is accorded this group dur to low immunity and existing underlying conditions. However, the social distancing and isolation keeps them further away from people and activities that they enjoy (Wu, 2020). The accompanying loneliness is a large contributor to the spike in depression among this age group.

Prevalence of Problem or Health Issue Globally and Regionally

The World Health Organization posits in a recent repost that depression is the leading cause of disability and poses a heavy overall burden of disease worldwide (WHO, 2020). More than 260 million people suffering from depression the world over, with a higher prevalence exhibited in women (CDC, 2017). Some of the most influential predisposing factors include poverty, incorrect diagnosis and limited access to information and service concerning mental health (McCall & Kintziger, 2013). The general global burden of depression is on the rise following harsh economic times, the global pandemic and ensuing lack of prioritization for the treatment of depression (WHO, 2020).

Some countries fair better than others in terms of catering for mental illnesses. America is one of the leading countries with the best treatment access. Health education regarding mental health, and depression in particular, is better accessed in the US than in most other countries (Ritchie & Roser, 2018). However, there still is evidence of increase in cases of depression over the past decade. The cases are spread across the various demographic factors, with people as young as 10 years, and those above 65 years reporting for treatment (Ritchie & Roser, 2018). America shares about 3% of the global disease burden for depression, according to a report released in 2016. This figure is projected to increase in the next report following the current trends in economic, health and socio-political stability.

Prevalence of Problem or Health Issue Regionally

Among the states, Florida is ranked 39 in accessibility of mental healthcare. More than 15% of its residence were living with depression as of 2018. Health reports indicate that 16% of adults aged 65 years and older in Florida are living with depression (MHA, 2020). This number is expected to rise due to the current events, especially aggravated by Covid-19 pandemic. The state is yet to achieve efficiency in handling depression. However, the national and state governments have made strides in collaboration with non-governmental agencies and organizations to increase access to mental healthcare. These include general psychiatric services, with specializes programs for specific mental disorders (CDC, 2017). Organizations such Advantage Mental Health Center (AMHC) specifically offer their services to residents of Florida.

Who Is Affected and Who Is at Risk

Although older adults are at much higher risk, depression is not a normal part of growing old. Research shows that older adults is more common in those who have other illnesses, including diabetes, heart conditions or cancer. Many older adults with depression go untreated due to misdiagnosis of the symptoms (Wu, 2020). One of the causes of misdiagnosis is the assumption by the patients that having unabating feelings of sadness and grief are part of being old. This belief leads them to not seeking help, as they are not aware that they could undergo treatment and feel better (MHA, 2020). In other cases, lack of health education on mental disorders, and especially depression, means that older adults are not aware that they could be having depression.

Research has shown that, of the 34 million older adults in America, 2 million suffer from depression (Ritchie & Roser, 2018). Co-occurring diseases and the medication used to treat them are a major contributor to depressive symptoms, especially due to their side effects. Other sources of grief like widowhood and loss of family also greatly contribute to the occurrence of depression. Older adults in nursing homes exhibit a higher prevalence of depression than those living at home with family and loved ones (McCall & Kintziger, 2013). It is essential to note that suicide in older adults has increased over the past decade due to the adverse effects of depression, and lack of timely treatment (Ritchie & Roser, 2018).

Causes and Key Factors Contributing to Problem / Issue

Co-occurring conditions are a significant contributor to the occurrence of depression in older adults. Most of these conditions require a regular intake of medication that alters the patient’s biochemistry, and thus altering the mood. In addition, the patient may feel unable to handle their affairs and become dependent on others as a result of the disorders. The loss of independence, ability to carry out their normal duties and increased dependency on other people increases the chances of depression (Ritchie & Roser, 2018). The pain and physical suffering associated with diseases such as cardiovascular conditions and cancer easily predisposes the older adults to depression.

Lack of social and emotional support in old age is a significant contributor to depression in older adults. As people get older, they require more support. However, the desired support is often unavailable due to economic, social and other prevailing factors, which include the drastically reduced levels of social contact due to Covid-19 (Wu, 2020). Preferably, as people get older, they should live with family or close relatives who have their wellbeing at heart and understand their needs on a deeper level. However, most older people lose their spouses, and have children living far away. Also, economic situations become a hindrance to living with family and relatives (Ritchie & Roser, 2018). Some prefer to have them in homes due to their schedules that do not allow them to give the older adults the care they require. However, when the homes do not offer the kind of emotional and social support they need, chances of suffering depression increase.

Life satisfaction is an essential aspect of the quality of life older adults enjoy. Living a satisfactory life involves many different factors as dictated by individual character. However, some older adults find satisfaction in travel, work, being with family, having valuable activities occupying one’s day, spirituality, among others. Florida is especially favored as a travel destination for older adults due to favorable weather, quiet escapes and enjoyable environment.  Older adults who report having satisfaction in life have a lower chance of developing depression than those who do not. Older adults who report being dissatisfied with life also experience feelings of worthlessness, hopelessness and sadness, which are also symptoms of depression (McCall & Kintziger, 2013).

Importance to Global Health / Healthcare Professional Role

A longer life expectancy has seen to an increase in the population of people 65 years and older. Although life expectancy has increased, the general health of older adults has decreased following changes in lifestyle, economic conditions and increased prevalence of non-communicable diseases. The cost of healthcare covering older adults has, therefore, increased, bringing up the disease burden associated with older adults (MHA, 2020). The demand for various healthcare needs for older adults has increased. The WHO estimates the available psychiatric specialists at less than one per 10,000 population. These statistics mean even less are available for older adults.

There is an understated demand for mental healthcare specialists specifically available for older adults. Knowledge regarding the statistics of depression and general mental health of older adults provides valuable data that can guide the allocation of resources to this area. There is dire need for the coordinated effort of general practitioners, registered nurses, geriatric psychiatrists and psychologists, and social workers to make mental healthcare more readily available for older adults in Florida (McCall & Kintziger, 2013). Better infrastructure in terms of mental healthcare facilities and public health education is essential to increasing the quality of mental healthcare accorded older adults.

Social and emotional support is vital for the increased quality of life for older adults. It is important for the primary caregivers to be aware of signs and symptoms of depression in older adults. Similarly, they should be knowledgeable on the various ways to prevent the advent of depression by providing specialized care according to the patient’s needs. Healthcare providers in nursing homes should have basic training on handling depression in older adults (Fiske, 2009). Most older adults may not be aware of the symptoms of depression, or assume them to be part of old age. However, early identification and treatment of depression in older adults plays a significant role in preventing further aggravation and improving the patients’ quality of life.

Conclusion

Depression is the most common mood disorder in the world. A general increase has been observed in the reported cases of depression in the past decade (WHO, 2020). Life expectancy has also seen to an increase in the population of older adults aged 65 years and over. However, the quality of life and health has significantly decreased due to economic hardships, non-communicable diseases and lifestyle. Depression in older adults is mostly associated with low quality of life, lack of social and emotional support and the biochemical imbalances caused by medication (CDC, 2017). Most older adults fail to report depression either due to lack of recognition of the condition, or the assumption that prolonged sadness and grief is part of growing old. It is essential for resources to be allocated towards the development of skill and infrastructure required to sufficiently address depression in older adults.

References

CDC. (2017). Depression is Not a Normal Part of Growing Older. Centers for Disease Control and Prevention. https://www.cdc.gov/aging/mentalhealth/depression.htm.

Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in Older Adults. Annual Review of Clinical Psychology, 5(1), 363–389. https://doi.org/10.1146/annurev.clinpsy.032408.153621

Mccall, W. V., & Kintziger, K. W. (2013). Late Life Depression. Psychiatric Clinics of North America, 36(4), 475–481. https://doi.org/10.1016/j.psc.2013.07.001

MHA. (2020). Depression In Older Adults: More Facts. Mental Health America. https://www.mhanational.org/depression-older-adults-more-facts.

Ritchie, H. & Roser, M. (2018) “Mental Health”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/mental-health’

WHO (2020). Depression. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression.

Wu, B. (2020). Social isolation and loneliness among older adults in the context of COVID-19: a global challenge. Global Health Research and Policy, 5(1). https://doi.org/10.1186/s41256-020-00154-3