Management Program for Elderly Clients With Relapsing
Falk, BNC, MS, FNP
Family Nurse Practitioner
MSHS Adult Day Health
A pilot project conducted at the Adult Day Health Center
Nurse case management data
at Adult Day Health Center identified an aggregate with
relapsing clinical depression and related co-morbid decompensation.
These individuals remained symptomatic of major affective
disorders, even though they had access to outpatient psychiatric
services and the social structured environment of the Center.
Data from nursing assessments revealed a high level of non-compliance
with antidepressant medication (58%), long-term dependency
of hypnotic pharmacology, and fragmented psychiatric treatment.
A Family Nurse Practitioner/Certified
Psychiatric Nurse administered the following diagnostic
scales: the Geriatric Depression Scale, Yesavage J., Psychopharmacology
Bulletin, 1998; 24: 709-710; and Zung Self Rating Depression
Scale, Copyright @ 1965, 1974, 1991, W. K. Zung, used with
permission of Eli Lilly and Company. All of the clients
in this subgroup (twelve participants) scored positively
for evidence of mild, moderate or marked depression. Data
from admission nursing care plans indicated there was 100%
knowledge deficit regarding antidepressant medication.
Development of the Depression
Management Program to promote continuity of psychiatric
care, reduce risk of acute relapsing depression, and fewer
co- morbid decompensations. The project was designed to
maximize opportunities for integration of brain functioning
(stimulate parts of the brain that are not related to depression),
therefore mediating symptoms of anxiety and depression.
Modalities to accomplish this were cognitive/behavioral
therapeutic techniques, group therapy support process, psycho-educational
sessions and, complementary venues of music therapy, oral
histories, culinary workshops, cultural events and the arts.
A nurse led group
format was utilized to target clients, who have been vulnerable
to relapsing depression. Nursing interventions were intensified
in regards to current psychiatric care, medication regimen,
responses to medications and the various modalities offered
in the group. Weekly sessions were run by a Family Nurse
Practitioner/ Certified Psychiatric Nurse for six months,
then on going every two weeks. Diagnostic scales are repeated
every six months.
At the six month mark,
all participants (100%) were free of acute relapsing depression,
there were no psychiatric re-hospitalizations or medical
hospitalizations for co-morbid diagnosis. Subjective client
satisfaction survey rating was high, 61% in the excellent
category and 35% in the good category. Compliance with
psychiatric care plan and psychotropic medications improved
to 92%. Scores for intensity of depressive responses decreased
on average 2 points on the Geriatric Depression, and 5
points on the Zung Rating SDS Index, six months after
the program started.
Adult Day Health
Centers are to incorporate the expertise of psychiatric and
advanced practice nursing to health programs for the elderly,
depressed populations. Provide training for nurses at
the Center in Depression Management, Pharmacology and
Therapeutic Group Process. Expand the program to include
a family systems approach to empower clients, reduce dependency
and promote improved family relationships.
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