Final Project
Once you graduate and obtain your first job out of your Master of Social Work program, you may be asked to identify the gaps in services at your new agency. You may be asked to create a new group or help to identify a new evidence-based intervention that can be introduced to the clients. Understanding how to research the current literature, and then choose and evaluate an intervention, is an important component of being a successful social worker. For this course, you have researched new and interesting interventions that are currently being used with children, adolescents, adults, and the elderly. Further, you have explored the importance of connecting theory to practice.
For this Assignment, use will practice steps in Evidence-Based Practice. 1) You will think of a practice problem. 2) You then conduct a literature review on available research. 3) You will evaluate the evidence to determine which intervention to use. 4) You will consider client values and your clinical expertise. 5) You will think about what you hope the client gains from this intervention (i.e., decreased depression, increased quality of life, decreased PTSD symptoms) and consider how you might measure this change.
To prepare:
· Choose a population of interest to you.
· Children
· Adolescents
· Adults
· Elderly/Aging
· Choose a presenting problem (depression, family conflict, homelessness, etc.) related to the population of interest.
· Conduct a literature review focused on the presenting problem within the population of interest.
By Day 7
Submit an 8- to 10-page scholarly paper supported with a minimum of six peer-reviewed articles as references. In the paper, you should:
· Briefly describe the population and presenting problem you are focusing on for this assignment.
· Provide a review of the articles you reviewed from this project and explain what you learned from conducting this research.
· Briefly describe at least 2 evidence-based interventions currently used for your chosen population when addressing this particular problem. Provide supporting references when explaining the evidence behind the interventions.
· Explain which of these interventions you might choose to use and why.
· Consider client values and your clinical expertise and how those might affect your decision of which intervention to use.
· Describe how you might apply the specific skills and techniques of the chosen intervention.
· Briefly explain how you could measure the outcomes of this intervention.
· Explain any cultural considerations that you need to take into account when working with this population or the particular presenting problem.
· Discuss how the Code of Ethics applies when working with this particular presenting problem and population.
· Explain how you would apply a trauma-informed lens when working with this population.
Support your Final Project with specific references to the resources. Be sure to provide full APA citations for your references.
The Final Project will be evaluated according to the Final Project Rubric, located below and in the Course Information area.
10
Depression Among the Elderly/Aging
Tolulope I. Moses
Master of
S
ocial Work, Walden University
SOCW-6111: Clinical Social Work Practice
Dr Kristie Abbs
November 2021
Briefly describe the population and presenting problem you are focusing on
for this assignment.
Depression is a common clinical problem among the elderly. Depression refers to a mood disorder that affects the young and the old alike (Vu et al., 20219). However, that does not imply that it is normal. Late-life depression affects more than six million Americans aged 65 years and older (Casarella & Fulghum, 2020). Nonetheless, statistics show that only 10 percent receive treatment (Casarella & Fulghum, 2020). The reason attributed to the trend is that older adults exhibit symptoms of depression in different ways. Additionally, depression among the elderly might be confused with several illnesses that are common in the elderly population, making it challenging to seek necessary treatment on time. There are different types of depressions, as discussed below.
Major depressive disorder; is characterized by severe symptoms that affect the ability of an older person to work, concentrate, sleep or eat normally (Bot et al., 2019). In some instances, older adults may experience a single episode in their life, while major depressive disorder is often experienced on more than one occasion.
Persistent Depressive Disorder (Dysthymia) – exhibits slightly less severe symptoms than major depression (Bot et al., 2019). However, these symptoms persist for longer times. For instance, the symptoms might last for more than two years.
Minor depression; the symptoms are less persistent. Additionally, they are less severe than those of Dysthymia and major depression (Bot et al., 2019).
Difference between depression among the older and the younger adults
Depression symptoms are exhibited differently in younger adults compared to the elderly generation. For example, in older people, depression often goes along with other medical conditions and disabilities that last for longer (Guo et al., 2018). Additionally, depression among the elder can be associated with a higher risk for other chronic illnesses such as cardiac arrests. In some cases, depression among the elderly may lead to death from disease. Depression among the elderly reduces their ability to rehabilitate. Thus, it is more challenging to deal with elderly patients who have depression in nursing homes. This is entirely different the younger adults with depression as they can be managed more easily. Additional depression symptoms among the elderly may include feeling tired, confused, struggling to pay attention, inability to enjoy the activities they used to, suicidal thoughts, and hopelessness.
Health professionals should incorporate several standard measures to determine the extent of depression among the elderly to facilitate early interventions (Girgus et al., 2017). Early diagnostic approaches are more effective when integrated on time. Studies have also shown that depression is associated with an increased risk of suicide, especially among older white men. For example, the suicide rate in elderly adults aged between 80 and 84 is more than twice that of the general population.
Risks factors of depression among the elderly population
· Family history with depression; such members are at higher risks of depression
· Existence of certain medical conditions such as cancer and stroke
· Lack of exercise or physical activities.
· The presence of functional limitations makes it difficult for people to engage in physical activities.
· Addiction to substances of abuse, such as alcohol, increases the risk of substance-induced depressive disorder.
· Elderly females are at higher risk of depression compared to males (Girgus et al., 2017)
· Single, divorced, unmarried, or being widowed increases the risk of depression.
· Lack or absence of adequate social network support (Wang et al., 2017)
A review of the articles from this project and Lessons from conducting this research.
Identifying the risk and protective risks of depression among the elderly can be quintessential in understanding the elderly persons with the disorder. Maier et al. (2021) argue that this can be the breakdown in reducing the bias associated with the treatment of depression among the elderly and influencing treatment outcomes. According to the authors, female gender, cognitive impairment, and old age are some of the risks factors that persistently increase the risk of depression among the elderly. Additionally, the inability to move hinders the elderly from engaging in any form of physical activity, subsequently increasing the risk of depression.
There have been notable changes regarding the prevalence and treatment of depression among the elderly over the past two decades, according to the research by Arthur et al. (2020). The substantial improvement in depression treatment among adults is associated with the elderly taking antidepressant medication to arrest severe symptoms related to depression. Effectively, this has led to increased cases of depression being reported over the past two decades. However, the study shows that there is no evidence for change in the age-specific prevalence of depression among the elderly despite the improvement.
Risks factors associated with depression among the elderly do not necessarily differ from other groups. As Khaltar et al. (2017) observe, there are no significant interactions between sociodemographic factors among the elderly populations and the younger adults. Nonetheless, the study follows that low perceived social support and economic status could significantly influence depression among ethnic groups.
Two (2) evidence-based interventions currently used for Elderly Population and supporting references
Psychotherapy: in cases where no underlying medical causes are associated with symptoms of depression, talk therapy is one of the most effective evidence-based interventions used to treat depression (Van et al., 2019). The approach helps patients to learn essential skills and insights that they can use to prevent depression from manifesting in the future. Different types of therapy exist. Some of the common approaches include interpersonal therapy, behavioral therapy, and psychodynamic therapy.
Transcranial magnetic stimulation TMS; older adults suffering from depression resistant to medication, therapy, and self-help are offered TMS as the last treatment (Pitcher et al., 2021). TMS therapy is a typical treatment that directs recurring magnetic energy pules at brain regions involved in mood. The magnetic pulses are passed painlessly through the skull to stimulate the brain cells. This helps to improve communication between different brain parts and effectively reduce the symptoms of depression.
Chosen interventions and why.
Psychotherapy; is an engagement between the counselor, therapist, or psychologists and an individual seeking help. It is one of the preferred psychological treatments and is based on talking. It is sometimes referred to as talk therapy. Common illnesses and issues addressed successfully using the approach include anxiety, coping with stress, eating disorders, dealing with grief and depression (Van et al., 2019). I would choose psychotherapy intervention because there are different formats of treatment that can be used to treat depression disorder, as discussed below.
Individual therapy; in this case, the patient gets one-on-one counseling with the therapist, which helps establish a therapeutic relationship for effective treatment and outcomes. As such, it is ideal for aiding the elderly to deal with pertinent issues that could potentially cause depression—for example, coping with grief among the elderly, which can be a risk factor for depression.
Group therapy; another reason why I would prefer this approach is because it provides a platform through which, as the psychologist, I can deal with a group of older adults, usually three or four members. The advantage of group therapy is that it helps create a safe environment where no one feels judged individually. It also allows members to share their experiences without concealing details that may inhibit the effective treatment of the underlying conditions.
Couple therapy; is specifically designed to address issues associated with two people in a relationship or marriage (Van et al., 2019). It is effective in addressing issues related to sexuality among couples. Parents might as well bring children on board in cases where there is a need to address family issues that cause depression.
Consider client values and your clinical expertise and how those might affect your decision of which intervention to use.
Respecting human rights and dignity; is crucial in having practical therapy sessions by treating clients with utmost dignity (Ethics, n.d).
Fairness; ensuring that clients are provided with adequate provisions of counseling and other psychotherapy services.
Trust; honoring the trust placed on the psychotherapist by the client
Upholding a client’s values is critical in psychotherapy as it forms the basis for making rational decisions on the best ways to help the client (Ethics, n.d). For instance, being trustworthy helps the practitioner commit himself to understand ethical issues that might affect the effectiveness of the therapy sessions. Additionally, it is critical to ensure fairness and impartial treatment of all clients without prejudice. Clients should be provided with adequate counseling services that meet their needs.
Application of specific skills and techniques of the chosen intervention.
Some of the psychotherapy techniques and skills of psychotherapy are discussed as follows:
Behavioral experiments allow the client to test self-belief and achieve results (Moutoussis et al., 2018). Effectively, reflection is an essential aspect of the behavior experiments as it allows clients to reflect on the past experiences that could be triggering depression episodes. For instance, the therapist might ask the client to walk under the ladder as an experiment. This allows the client to see that their belief was without merit.
Thought records; the client is encouraged to write both negative and positive experiences they might have undergone. Consequently, it allows the client to analyze the thought results in a rationale without jumping to unfounded conclusions.
Happy activities; it is one of the most effective techniques in therapy. Clients are instructed to spare some time during the day to engage in something they like. Participating in these activities motivates the client to push through the day, eventually helping them to develop happier feelings (Moutoussis et al., 2018).
Measuring the outcomes of this intervention.
Symptom reduction; the strategy can be integrated to measure the outcome of the psychotherapy. Clients can be instructed to complete the Zung Anxiety Scale (Ewbank et al., 2020). In the initial stages, the clients might be asked to start with 20 items on a scale of 1-4. After one month, the same can be administered, and determine their overall score to determine if there are any changes.
Remission of disorder; it is an approach used to track outcomes that showcase whether the client has the depression disorder or not Scale (Ewbank et al., 2020).
Cultural considerations when working with eEderly population
Gender; as noted, females are at higher risk of depression disorder compared to male. As a therapist, it is critical to consider this during the session and not disclose sensitive content that might be offensive to the client. In other words, being gender-sensitive is crucial to effective therapy.
Race; racial discrimination is a pertinent cultural issue that needs attention from clients and psychologists. Essentially, the therapist has an obligation to respect the different racial inclinations of the clients.
Religious; some religions might not allow specific groups of people to attend therapy sessions. As a therapist, it is essential to consider this during sessions and not disclose sensitive content.
Application of Code of Ethics applies when working with Elderly population
Code of ethics in different ways when dealing with depression among the elderly. For instance, non-maleficence encourages therapists to uphold their commitment to avoid harming the patient (Ethics, n.d). For example, therapists should not exploit clients financially, emotionally, or sexually. Therapists should also be trustworthy. In essence, they should honor the trust placed on them by the clients. Therapists should also ensure the fair and impartial treatment to all clients and ensure the availability of all therapeutic services.
Applcation of trauma-informed lens when working with Elderly population
Demonstrating awareness of the effect of depression on the elderly population. This can be extended to the home, workplaces, and other places where the elderly usually meet. It would be essential to promote the thinking or approach when dealing with older people with depression and accord them special treatment. Being vigilant in anticipating their needs can go a long way in applying a trauma-informed lens and providing effective psychotherapeutic treatment to the clients.
References
Arthur, A., Savva, G.M., Barnes, L.E., Borjian-Boroojeny, A., Dening, T., Jagger, C., Matthews, F.E., Robinson, L., & Brayne, C. (2020). Changing prevalence and treatment of depression among older people over two decades. The British Journal of Psychiatry, 216, 49 – 54.
https://doi.org/10.1192/bjp.2019.193
Casarella, MD, J., & Fulghum Bruce, D. (2020). Depression in Older Adults. Retrieved 4 November 2021, from
https://www.webmd.com/depression/guide/depression-elderly
Bot, M., Brouwer, I.A., Roca, M., Kohls, E., Penninx, B.W., Watkins, E.R., van Grootheest, G., Cabout, M., Hegerl, U., Gili, M., Owens, M., & Visser, M. (2019). Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms: The MooDFOOD Randomized Clinical Trial. JAMA, 321, 858–868.
. https://doi.org/ 10.1001/jama.2019.0556
Ethical Framework for Good Practice in Counselling & Psychotherapy (2010) | Ethics Codes Collection. Retrieved 4 November 2021, from
http://ethics.iit.edu/ecodes/node/5132
Ewbank, M. P., Cummins, R., Tablan, V., Bateup, S., Catarino, A., Martin, A. J., & Blackwell, A. D. (2020). Quantifying the association between psychotherapy content and clinical outcomes using deep learning. JAMA Psychiatry, 77(1), 35-43 https:doi.org/10.1001/jamapsychiatry.2019.2664
Girgus, J. S., Yang, K., & Ferri, C. V. (2017). The gender difference in depression: are elderly women at greater risk for depression than elderly men?. Geriatrics, 2(4), 35.
https://doi.org/10.3390/geriatrics2040035
Guo, N., Robakis, T., Miller, C., & Butwick, A. (2018). Prevalence of depression among women of reproductive age in the United States. Obstetrics and Gynecology, 131(4), 671. https://doi.org/
0.1097/AOG.0000000000002535
Maier, A., Riedel-Heller, S. G., Pabst, A., & Luppa, M. (2021). Risk factors and protective factors of depression in older people 65+. A systematic review. PloS one, 16(5), e0251326.
https://doi.org/10.1371/journal.pone.0251326
Moutoussis, M., Shahar, N., Hauser, T. U., & Dolan, R. J. (2018). Computation in psychotherapy, or how computational psychiatry can aid learning-based psychological therapies. Computational Psychiatry, 50-73.
https://doi.org/10.1162/CPSY_a_00014
Khaltar, A., Priyadarshani, N. G., Delpitiya, N. Y., Jayasinghe, C., Jayasinghe, A., Arai, A., & Tamashiro, H. (2017). Depression among older people in Sri Lanka: With special reference to ethnicity. Geriatrics & Gerontology International, 17(12), 2414-2420.
https://doi.org/10.1111/ggi.13090
Pitcher, D., Parkin, B., & Walsh, V. (2021). Transcranial magnetic stimulation and the understanding of behavior. Annual Review of Psychology, 72, 97-121.
https://www-users.york.ac.uk/~dp859/Pitcher_Lab/Welcome_files/2021_Pitcher_AnnRev
van Bronswijk, S., Moopen, N., Beijers, L., Ruhe, H. G., & Peeters, F. (2019). Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression. Psychological Medicine, 49(3), 366-379.
https://doi.org/10.1017/S003329171800199X
Vu, H.T., Lin, V., Pham, T.V., Pham, T.L., Nguyen, A.T., Nguyen, H.T., Nguyen, T.X., Nguyen, T.N., Nguyen, H.L., Nguyen, T.T., Nguyen, L.H., Nguyen, Q.N., Nguyen, H.L., Tran, T.H., Tran, B.X., Latkin, C.A., Ho, C.S., & Ho, R.C. (2019). Determining Risk for Depression among Older People Residing in Vietnamese Rural Settings. International Journal of Environmental Research and Public Health, 16.
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Wang, G., Hu, M., Xiao, S. Y., & Zhou, L. (2017). Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study. BMJ Open, 7(10), e016091
http://dx.doi.org/10.1136/bmjopen-2017-016091
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