Depression and Anxiety in Dementia Patients

Discuss About The Psychological Treatments Depression Anxiety.

Mr. X is an 82 years old retired high school teacher. He was living with his wife. 5 years ago he diagnosed with initial stage of dementia and depression. Doctors prescribed some basic level medications and some regular activities. His wife monitored and assessed his disabilities and treatment.  Few months ago his wife died leaving him with high depressed and traumatized state. After his wife’s death he is experiencing consistent agitation during day time with frequent breathlessness. They did not have any children. One of his relatives consulted with a home centre care association to provide regular assessment and support. However, the breathing problem of Mr. X was deteriorating with frequent agitation and panic attack. After admitting him to a Aged care home. He refused to talk or move. When any caregiver or nurse is trying to help him, he is shouting with fury.  He has Blood pressure of 130/85, which is quite higher than normal and BMI of 29 that indicates the Obesity. Mr. X also has mild bronco infection and dust allergies that trigger his Asthma and breathlessness. He is also suffering from memory loss while having problem to find direction.

It has been estimated that almost 50% of individuals suffering from dementia are subjected to increased risk of depression. In patients suffering from dementia, depression is a prime cause of poor quality of life that profusely worsens the symptoms of dementia. The ultimate result of such decline in the patient’s condition leads to increased burden on the care giver. Anxiety has been denoted to be the most common symptom of depression among dementia patients, which has varied negative symptoms. In relation to the influence of the depressive conditions, there is a large pool of literature that point out that severity of depression is directly linked with dementia progress (Yoon et al. 2018). The primary outcomes of depression and anxiety in dementia are decreased dependence, increased risk of hospital readmissions, and comorbid physical conditions. Studies have indicated that the frequency of depressive symptoms might vary from one person to another as a function of the severity of dementia. For instance, experiences of depression are more common in those dementia patients who are at the later stages of life (Stewart et al. 2018). In the present case the patient is 82 years old and thus is at increased risk of suffering depressive symptoms. It was therefore perceived significant to consider focus on intervention for addressing depression in the patient and enabling improved quality of life.

Limitations of Anti-Depressant Drugs and Anti-Anxiety Drugs

Results of clinical trials that have been so far been conducted to assess the efficacy of anti-anxiety drugs and anti-depressant drugs indicate that the same do not hold much potential to relieve the individual of depressive symptoms. This background information puts forward the pressing need of implementing alternative effective treatments for addressing depression and improving quality of life in dementia patients (Payne 2017). As opined by Stokes (2017) the primary psychotherapeutic approaches to address depression in older adults are interpersonal therapy, psychodynamic therapy, supportive counselling and cognitive behavioral therapy (CBT). Previous research brings to the conclusion that psychotherapy delivered to older adult is noteworthy since there is promotion of general psychological well being along with improvement in depression.  Most of the psychotherapies have the focus on dysfunctional beliefs and incorporation of behavioral therapy components so that negative cognitions in patients can be challenged.  Cognitive behavioral therapy (CBT) has been the most widely discussed therapeutic approach in theory and practice. What lies at the core of CBT is monitoring and identification of thoughts and behaviors that are the contributory factors to anxiety and depression. Modifications of CBT can be brought about for targeting patients suffering from mild to severe dementia in later stages of life. The aim of such an approach is to bring reduction in the cognitive load on the patient by an increase in the repetition of information along with the use of concrete real life scenarios. For addressing needs of dementia patients, certain modifications might be brought about in the therapeutic process such as slowing of therapy pace and simplification of therapeutic communication. On the whole, CBT acts as a supreme care approach for dementia patient presenting with depression (Orrell et al. 2017).

The Cochrane review of Orgeta et al. (2014) pinpoint that CBT intervention when delivered in small groups are highly effective in reducing symptoms of depression and improving patient quality of life. Such sessions might be of 90 minutes duration to achieve optimal effectiveness. Cognitive strategies are to encompass difficult and stressful dysfunctional cognitions, development of positive coping skills and approaches for enhanced personal control. Behavioral strategies on the other hand are to include participation in pleasant and enjoyable activities thereby augmenting the therapeutic approach. Spector (2012) had carried out a randomized controlled study for understanding the importance of CBT in caring for dementia patients suffering from anxiety. The intervention included was considerate of practicing strategies that ensured increased feelings of safety, changes in negative behavior and incorporation of calming thoughts. Telephone support was provided in addition to the CBT sessions. A collaborative relationship was also built with the patients. The study outcome was statistically significant reduction in expressions of anxiety among the dementia patients.

Psychotherapeutic Approaches to Address Depression in Older Adults

In another study of Forstmeier et al. (215) the researchers assessed a CBT based approach treatment for mild Alzheimer’s patients with a randomized controlled trial research design. The background to the study was that about 90% of Alzheimer’s patients are subjected to neuropsychiatric symptoms which commonly include irritability, anxiety, depression and apathy. Psychosocial interventions which have the basis on principles of behaviour therapy have the potential to be the most effectual treatment of dementia’s neuropsychiatric symptoms. At the end of the trial it was inferred that CBT not only has the focus on dementia patients, but the care providers are also under care continuum. It was further noted that CBT can act as a multi-component treatment approach that is one of the state-of-the-art treatment strategies.

Drawing in the key insights from the discussion put forward, it is to be highlighted that CBT can act as an useful tool for addressing patient concerns in older dementia patients. The reviews of different strategic policy focusing on psychotherapy services have put forward the recommendation that psychological therapies are to be perceived as a crucial element of nursing care in diverse settings (Scott et al. 2016). Since CBT is increasingly becoming a part of nursing care process, professionals are to consider adding the capabilities of delivering CBT to their skill base. The demand for nurses who act as therapists is found to be growing with momentum. Uplifting education on CBT would expand the provision of expertise nurses in healthcare domains. As a result of this, it would be easier to address specific needs of diverse population (Kazmer et al. 2018).

A vast pool of literature has indicated the importance of CBT in improving mental health status among dementia patients. Since nurses are to provide holistic care to patients for having a comprehensive care approach, it is advisable that nurses equip themselves with the resources necessary for implementing CBT. In this regard it is to be remembered that nurses must deliver culturally sensitive care to the patients to achieve best patient outcomes as per the best interest of the patients.

References

Forstmeier, S., Maercker, A., Savaskan, E. and Roth, T., 2015. Cognitive behavioural treatment for mild Alzheimer’s patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. Trials, 16(1), p.526.

Kazmer, M.M., Glueckauf, R.L., Schettini, G., Ma, J. and Silva, M., 2018. Qualitative Analysis of Faith Community Nurse–Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers. Qualitative health research, 28(4), pp.633-647.

Orgeta, V., Spector, A. and Orrell, M., 2011. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews, (5).

Orrell, M., Yates, L., Leung, P., Kang, S., Hoare, Z., Whitaker, C., Burns, A., Knapp, M., Leroi, I., Moniz-Cook, E. and Pearson, S., 2017. The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: A randomised controlled trial. PLoS medicine, 14(3), p.e1002269.

Payne, J., 2017. Mindfulness Based Cognitive Therapy for People with Mild Dementia and Depression: A Feasibility Pilot Randomised Controlled Trial examining changes in Quality of Life and Cognition (Doctoral dissertation, UCL (University College London)).

Scott, J.L., Dawkins, S., Quinn, M.G., Sanderson, K., Elliott, K.E.J., Stirling, C., Schüz, B. and Robinson, A., 2016. Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers. Aging & mental health, 20(8), pp.793-803.

Spector, A., Orrell, M., Lattimer, M., Hoe, J., King, M., Harwood, K., Qazi, A. and Charlesworth, G., 2012. Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial. Trials, 13(1), p.197.

Stewart, R., Hotopf, M., Dewey, M., Ballard, C., Bisla, J., Calem, M., Fahmy, V., Hockley, J., Kinley, J., Pearce, H. and Saraf, A., 2014. Current prevalence of dementia, depression and behavioural problems in the older adult care home sector: the South East London Care Home Survey. Age and ageing, 43(4), pp.562-567.

Stokes, G., 2017. Challenging behaviour in dementia: a person-centred approach. Routledge.