Upper Jindalee Aged Care Residence, ACT
Depression and dementia - promoting the diagnosis and the care process
The need to develop a protocol for the detection and treatment of depression in the cognitively impaired was recognised after a senior member of staff completed a post graduate course in dementia. It was identified that Jindalee Aged Care Facility had a very basic knowledge of depression in the aged and an inadequate assessment process to address this problem. There was also no assessment being used at the facility to identify symptomology in those residents who have a diagnosis of dementia.
Depression often goes undiagnosed and at times is misdiagnosed. It is a potentially treatable condition. According to the Alzheimer's Association of Australia, up to 50% of people who suffer from Alzheimer's disease suffer from depressive symptomology. People in long term residential care accommodation appear to be at a higher risk. Given that people have usually lived productive lives with careers, homes, relationships and lifestyles that they independently managed, forced placement must have a terrible impact on those in care and their support people. There are often existing problems with health and issues of the loss of a spouse, or belongings or a home.
It is no longer acceptable to say that a person who is diagnosed with a dementing illness can not suffer from depression. Dementia and depression are not inevitable diagnoses as people get older.
There are residents who reside at Jindalee where an assessment program has identified areas of concern. The effectiveness of medications and adjunctive therapies are measured and monitored in various ways and at regular time frames. There have been definite imporvements in their quality of life with further interventions (which often includes a combined therapies program).
A mini mental state examination is undertaken to establish if there is a cognition problem. This is recorded and determines which of the depression scales are to be used. The two assessments that are used to flag depressive signs and symptoms are the Geriatric Depression Scale and the Cornell Scale. A Cornell Scale relies on the observations and signs of a resident by a staff member. Residents with a mini mental state examination of 24 or more, have a Geriatric Depression Scale attended. A mini mental state examination score of 23 or below requires a Cornell Scale.
Jindalee also completes an 'Emotional Response in Care' assessment tool, as a quality of care indicator. It is another tool that is attended to further support that the care being delivered to the person with dementia, is satisfactory or not. It requires an observation and recording process. When negative responses are identified, staff initiate an investigative process to exclude or identify possible causes like pain, sleep and/or behavioural problems or depression.
At Jindalee Aged Care Residence, the recognition and treatment of depression is paramount to optimise resident outcomes. There is an assessment process that staff follow in order to minimise the risk of depression going on unrecognised or undertreated. The ongoing monitoring of interventions is an integral part of resident care.
