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 interventions
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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
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 Misdiagnosised as a cognitive disorder
 Can mimic physical illness

4. Signs & Symptoms
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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Withdrawn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
 Lose of purpose
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6. Nurse Aide
Roles/Responsibilities
Recognize signs & symptoms
 Report observations to nurse
 Maintain safety
 Follow care plan
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7. Nurse Aide
Roles/Responsibilities
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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
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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
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11. Possible Causes of
Confusion
 Medical issues
 Chronic illnesses
 Surgery & injury
 Degenerative brain diseases – Alzheimers,
dementia, arteriosclerosis
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Poor nutrition
Poor fluid intake
Medication
 Reaction
 Combo of meds
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Social Isolation
Hearing & Vision Loss
Changes in the usual environment

12. Symptoms of Confusion
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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
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The resident may be
 Frightened, unhappy, bewildered or angry
 Unaware of environment – doesn’t
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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
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15. Behaviors
Combative
 Withdrawn
 Socially inappropriate
 Verbal or physical aggression
 Wandering
 Abnormal sexual behavior
 Repetitive behaviors
 Catastrophic reactions
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16. Therapeutic Interventions
Reality orientation to maintain reality contact
 Reminiscing = life review
 Validation therapy
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 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
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Begin conversation by identifying yourself
 Do not ask if they remember you
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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
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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
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Resident may use word substitutes
 Consistent – find out what they mean & use yourself
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Avoid abstract, common expressions
 “You can hop into bed now”
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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