Essay on Challenges in Assessment of Older People’s Depression Risks and Perceived Barriers in Emergency Rooms’ Interventions

Depression and suicidal ideation remains as a comorbidity among older people globally. Due to the complexity in their consequences, symptoms, and features’ overlaps, effective diagnosis and treatment remains a big challenge for the medical practicing staff. This study aims to identify some of the challenges experienced by clinicians while assessing the depression risks and explore the perceived barriers towards emergency room’s interventions regarding suicide and depression.

Some of the most common symptoms of depression include impaired memory, unexplained chronic pains, thoughts of death, poor sleep patterns, loss of interest in life, and poor concentration according to Black Dog Institute (2018). These same symptoms are also prevalent due to poor health, old age, and in individuals experiencing dementia. Depending on severity of the depression level and the type (melancholia, psychotic, and manic depression), fluctuation of both proximal and distal factors which are considered as the precursors of suicide ideation compounds suicidal identification difficulties among the health professionals (Hawton & van Heeringen, 2009). Depression compounded by predictors such as functional impairment, stressful life events, and physical illness form the first step towards suicide according to Lapierre et al. (2018). Although a wide range of treatments for depression are readily availed to the older people such as Antidepressant medication, Electroconvulsive therapy, and psychotherapy, clinicians face patients’ limitation challenges arising from imposed physical discomfort, poor eyesight, and poor hearing according to Jorm et al., (2018).

In determination and assessment of depression/suicide risks, the health professionals must be able to evaluate the patient’s psychosocial situation, history, individual’s weaknesses and strengths, and the general presentation. This information is meant to guide the health provider with insights on the patient’s suicidal ideation, intentions, and plans. While this information could be sourced from the said patient, friends, or family members, falsified and incomplete/non-accurate information is always encountered. Clinicians also face unprecedented challenge of focusing on judged elements and sharing information without consent of the patient (Morgan et al. 2019). Although instruments and conventional techniques may be available for assessing depression individuals with advanced dementia pose a challenge to the health providers by hampering assessment of intrapsychic symptoms as claimed by Rozzini et al., (2011). Some depression patients have been shown not to exhibit signs of depression such as psychomotor agitation or retardation, mnemonic, anhedonia, guilt, and energy deficit that would otherwise alert clinicians of mental disorders.

Several interventions strategies have been identified in regard to depression and suicide treatment. These interventions focuses on improving the skills of medical professionals on recognizing those individuals at higher risk of depression, improves psychiatric treatment, and addresses depression risk factors. They include psychological interventions and medical interventions such as use of anti-anxiety, anti-convulsant, and antipsychotic drugs. Lifestyle and complementary interventions are also used to treat depression (Morgan et al. 2019, pp. 9-10). Some of the identified perceived barriers to suicide and depression interventions include contextual and structural issues. Contextual issues relate to stigmatization, family breakdown, and inequality arising from depressive/ suicidal ideations. Structural issues relate to barriers arising from insufficiency of medical professionals’ training and insufficient resource allocation for intervention programs. In the emergency departments, barriers to intervention include overclouding, absence of patient-centered care, and delayed psychiatric evaluation. Counter-measurements to these barriers should include synchronized therapeutic alliance, patient’s safety attendance, developed treatment plan, and determined treatment settings (Bolton, Gunnell and Turecki, G 2015).

Complexity in suicidal and depression’s consequences, symptoms, and features’ overlaps, effective diagnosis and treatment has remained big challenge for the medical practicing staff. Health professionals have the prerogative of evaluating the patient’s psychosocial situation, history, individual’s weaknesses and strengths, and the general presentation. Perceived barriers to depression interventions must be countered for efficient treatment programs in health facilities.

References

Black Dog Institute Depression in older people, viewed 24 August 2021, <www.blackdoginstitute.org.au>.

Bolton, JM., Gunnell, D &Turecki, G 2015, ‘Suicide risk assessment and intervention in people with mental Illness’, BMJ. 2015; 351:h4978.

Hawton K, van Heeringen K. Suicide. Lancet. 2009; 373:1372–1381. [PubMed: 19376453

Jorm AF, Allen NB, Morgan AJ, Ryan S, Purcell R, 2013, A guide to what works for depression; 2nd Edition. Beyondblue: Melbourne, 2013.

Lapierre, S., Erlangsen, A., Waern, M., De Leo, D., Oyama, H., Scocco, P., Gallo, J., Szanto, K., Conwell, Y., Draper, B & Quinnett, P 2018, ‘A systematic review of elderly suicide prevention programs’ Crisis. 2011; 32(2): 88–98. doi:10.1027/0227-5910/a000076.

Morgan, A.J., Reavley, N.J., Jorm, A.F., Bassilios, B., Hopwood, M., Allen, N & Purcell, R 2019 ‘A guide to what works for depression’, 3rd Edition, Beyond Blue: Melbourne, 2019.

Rozzini L, Chilovi BV, Riva M, et al. 2011, ‘Depressive disorders in dementia’. Int J Geriatr Psychiatry 2011; 26: 657-658.