Recently, researchers at The University of Iowa College of Nursing, the Iowa Geriatric Education Center, and the UI Foundation received an $87,000 grant from the Wellmark Foundation to develop a CD-ROM that will help nurses recognize symptoms of depression later in the life of their patients. Kathleen Buckwalter, PhD, RN, FAAN, the principal investigator of the research and UI Sally Mathis Hartwig Professor in Gerontological Nursing and director of the Hartford Center of Geriatric Nursing Excellence, talks more about the research:
Is depression in the elderly a large concern for Iowans?
It most certainly is. It’s a nationwide concern, but because we have a proportionately high numbers of older adults in Iowa, it’s a real concern here in our state. We know that about five percent of all people over the age of 65—and that’s community dwelling, not institutionalized—have some sort of depression and that number increases dramatically when we analyze folks who are in institutional settings like nursing homes.
The Iowa Foundation for Medical Care indicates that 17 percent of older Iowans living in nursing homes have a major depression; another 17 percent a minor depression; and about 44 percent suffer from depressive symptoms that continue to contribute to their disability and distress and deserve interventions. Tim Culp and his colleagues did a study in 12 rural nursing homes where they screened and inventoried more than 320 nursing home residents. They found 39.1 percent of nursing home residents were identified by their primary care providers or the Geriatric Depression Scale as suffering depression. We really don’t have a good handle on the actual prevalence rate because this is a disease that is undetected or under-detected, and certainly under-treated, in Iowa.
Do depression symptoms in the elderly appear different than they would at another stage in life?
There are many symptom clusters that the elderly share with depressed persons throughout their life, but there are some unique features among older adults. For example, older Iowans tend to semanticize or contribute their mood changes to physical or bodily functions. So if you inquire if they’re feeling sad or blue or down in the dumps, they may say, “Well, I’m not depressed. It’s just this pain in my hip ever since I got arthritis that’s the cause of my change in mood.” There’s also a lot of stigma associated with any sort of mental illness, including depression. Many elderly attribute it to physical complaints; they also tend to be more irritable. This is a symptom that’s not commonly recognized as being part of the symptom picture for depression, but irritability, especially in older men, can be a hallmark of the disease.
Is the production of a CD-ROM a response to the statewide lack of mental health professionals?
Not really. There certainly is a huge problem with the lack of mental health professionals statewide, and our College of Nursing is trying to address that with support from the Iowa Department of Public Health to train more psychiatric nurse practitioners. But the CD-ROM is really a means to an end.
It’s the content that is important here, and not so much the method of delivery. What we wanted was something that would be accessible to health care professionals across the state. We’re not really targeting mental health professionals with this, rather, nurses who work in a variety of settings, including nursing homes, hospice, home health care agencies, rural health clinics, and assisted living facilities. So we’re using the CD-ROM as a preferred method to achieve our distance learning goals.
What’s the title of the CR-ROM program?
The title of it is “Depression Training to Promote Nurses as Advocates for Older Adults.”
How will the CD-ROM help nurses recognize symptoms of late-life depression and promote evidence-based treatment?
We intend to improve nurses’ knowledge of late-life depression itself; help them to be able to better screen, refer, and implement, as well as evaluate and monitor, non-pharmacological nursing interventions. We are using a fairly unique method developed at the Iowa Geriatric Education Center here at The University of Iowa. It includes an interactive, virtual patient module, digitalized video presentations with digitalized slides, printable job aides, workplace exercises to simulate application to real clinical practice settings, and a guide for the staff development coordinator to facilitate training at the various sites that I mentioned earlier. So we are using a lot of unique technology methods, but what we really want is for the nurses to own the content, and that’s why we have so many application and workplace exercises.
Is the program going to be Iowa-based?
It is. We have funding just for distribution in the state of Iowa at this time, but there’s been a lot of interest from surrounding states who have become aware of our work in this area. For example, just yesterday we had a teleconference with the Iowa Foundation for Medical Care, one of our key partners in this effort, and they told us that they had been approached by a quality improvement organization in North Dakota who very much wanted us to be able to replicate the training in a rural state like North Dakota. And we’ve also heard from Care Management Systems in Sioux Falls, South Dakota, who work with and manage nursing homes in northwestern Iowa and are very, very interested in our model. So our funding limits us right now to just an Iowa-based product and distribution, but we’ve already received a lot of interest from neighboring states. And we’ll probably pursue additional funding at the end of the year to be able to disseminate more widely, at least regionally.
How will the program be distributed?
We have a fairly elaborate marketing plan in place. We’ll be contacting facilities first via e-mail, and then sending letters to key membership, state organizations—for example, the Iowa Nurses’ Association. We’ll be working with other partners. I mentioned the Iowa Foundation for Medical Care, who’s our quality indicator organization here in the state. We’ll work with the Iowa Department of Elder Affairs, the Iowa Department of Public Health, the Department of Inspections and Appeals, at the state level, to get the word out in their newsletters and those sorts of things. We only have funding to distribute 800 CD-ROMs, so the first 800 people who respond to our invitation to participate and evaluate the product will get a copy of the CD-ROM. |
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