Depression in Older People in Australia

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Table of Contents

Ageing in Australia
Patient’s Perspectives
Students Perception on Depressed Elderly Adults
Family Attitude
Future Implications
References

Ageing in Australia

The number of old adults (85 years and above) in Australia with chronic ailments is rising. According to a report by the Australian Institute of Health and Wealth, 13% of the Australian populace is aged 65 years and above (Australian Institute of Health and Welfare, 2010). In 2007, the number of Australians aged between 65 and 84 years was 2.4 million (with 5.8% of this figure found in the residential aged care sector). In the next three decades, the number of Australians aged above 65 years will increase to 6.3 million, representing 24% of the entire population in Australia (Australian Institute of Health and Welfare, 2010). As a result, residential aged care facilities (RACFs) are currently the main areas of focus for evaluating ways to improve access to palliative care for elderly adults with chronic ailments (Australian Institute of Health and Welfare, 2010).

Patient’s Perspectives

Approximately 8% of elderly people in Australia’s primary care sector suffer from major depression (Raue & Schulberg, 2010, p. 1101). Nevertheless, a large number of these patients receive inadequate treatment for their condition due to an intricate combination of a clinician, patient as well as systems-driven obstacles (Bruce, 2004, p.1081). Despite the apparent benefits associated with primary care-based interventions, they have limitations in terms of patient remission rates, adherence as well as real-life application. In light of these limitations, clinicians must focus on a shared decision-making model (SDM) to enhance the treatment of depression among elderly adults in primary care settings.

SDM can be used to reduce depressive symptoms and augment clinical outcomes by improving patient adherence to treatment. Enhanced patient participation in the clinical decision-making process can also buttress patients’ self-efficacy, empowerment and autonomy (Loh, Simon & Wills, 2007, p.324; Raue & Schulberg, 2010, p. 1102).

Many patients prefer to be enlightened about their illness and available treatment options for their conditions. Although a good number of depressed elderly patients aspire to play an active role in the treatment decision-making process, some prefer to delegate this role to their doctors. Nevertheless, several studies on depressed elderly adults have found that many patients desire enhanced involvement in treatment decisions (Adams., Drake & Wolford, 2007, p.1219; O’Neal., Adams & McHugo, 2008, p.826) and are willing to take part in shared decision-making interventions when granted the chance (Deegan., Rapp & Holter, 2008, p.603).

Targeted SDM Intervention for Depressed Elderly Patients

Shared decision-making intervention may be suitable for elderly patients since it aims to improve their sense of empowerment and autonomy (critical aspects in alleviating hopelessness and helplessness). Nevertheless, full-scale SDM interventions are currently being developed for depressed elderly adults (Patel., Bakken., & Ruland, 2008, p.606). A Shared decision-making intervention can only be successful if it has decision-aid tools for informing elderly patients about available treatment options for their ailments (Raue & Schulberg, 2010, p. 1104; Wills & Rovner, 2007, p.149).

Considerations for SDM with Elderly Depressed Patients

Since there are no studies done to assess the benefits/limitations of involving depressed elderly patients in the SDM process, several aspects need to be considered:

The elderly depressed patients are more willing to play lesser roles concerning decisions concerning their medical treatment. These opinions/beliefs are partly attributed to elderly adults’ intricate medical experiences and extensive relationships with the healthcare system (Raue & Schulberg, 2010, p. 1105).
The cognitive injury and medical burden faced by the older adults may influence their participation in decision-making interventions. For example, a depressed elderly patient with cognitive impairment may lack the ability to make an autonomous decision in the decision-making process (Appelbaum & Redlich, 2006, p.122).
Elderly adults usually prefer family participation in their medical decisions. Sayers, White, Zubritsky and Oslin (2006) reported that about 50% of depressed elderly patients involved their family members in their medical decisions (p.318). Such family participation can therefore have a positive influence concerning patient’s treatment adherence.
Stigmatization and negative perceptions about depression can sway the elderly patient’s involvement in the shared decision-making process. Some depressed elderly adults opt to use natural treatment rather than evidence-based therapy for fear of victimization. What’s more, others assume that depression is a natural outcome of ageing and therefore, they do not seek treatment (Halter, 2004, p.180).

It appears that depressed elderly adults appreciate being involved in treatment decision-making. This implies that clinicians must evaluate the possibility of using SDM interventions and adjust accordingly (Raue & Schulberg, 2010, p. 1106).

Students Perception on Depressed Elderly Adults

When aged care nursing is mentioned around a cluster of nursing students, the common response is that it is depressing, exhausting and requires rudimentary educational preparation. However, nursing students do not detest the aged; they detest aged-care nursing. Accordingly, aged-care nursing is considered as least attractive career choice by many nursing students. The prevalence of negative perceptions on aged-care nursing is also rife within the residential aged care sector in Australia. The positive aspects of the aged care sector are incessantly ignored although nurses will continue to provide care to depressed elderly adults. Since the Australian population is ageing, the prospects for nurses in areas devoid of elderly patients will decline soon (Moyle, 2003, p.15). Thus, nursing students must be appropriately trained in aged care (Neville., Yuginovich., & Boyes, 2007, p.23).

University curricula have also contributed to the negative opinions about aged-care nursing. There is no doubt that the role of clinical educators is vital for the development of quality clinical placement (Abbey & Bridges, 2006, p.14). The quality of clinical placements is thus compromised by the enlistment of poorly qualified clinical instructors who cannot motivate nursing students since they lack an adequate knowledge base. Consequently, nursing students may encounter problems with the rigid routine care practices within primary aged-care settings (Abbey & Bridges, 2006, p.16).

Family Attitude

Previous studies on the Australian community’s knowledge of depression have revealed that most families have scant knowledge about the ailment or the pharmacological treatment available. A substantial number of Australian families prefer self-help interventions and have expressed negative opinions regarding pharmacological strategies to combat depression among old adults (Highet & Hickie, 2002, p.63). Consistent with this perception, most of the depressed adults in Australia desire to seek advice from family members, colleagues and community-based supports as opposed to healthcare experts (Highet & Hickie, 2002, p.63).

Several factors have influenced family’s knowledge and perceptions about depression among elderly adults. These include media coverage about topics on depression; improvements in the mental health interventions within the primary care environment; and extensive instructional programs on depression for patients and their primary caregivers (Highet & Hickie, 2002, p.63).

A study by Highet and Hickie (2002) revealed that a substantial number of Australian families are aware that depression is a major common health issue. Many participants (especially young adults and women) in the study noted that depression was a major issue. For instance, 57% of those polled reported that they had a family member suffering from depression. Younger people (below 55 years) with family experiences of depression perceived the ailment as more disabling compared to other chronic illnesses. For example, 50% of the participants distinguished depression from normal sadness.

However, most of them had limited knowledge about common risks and protective factors. What’s more, the participants preferred self-help interventions to treat depression over pharmacological interventions (Highet & Hickie, 2002, p.67; Highet & Hickie, 2002, p.63).

Future Implications

As the Australian population continues to grow older, the prevalence of depression and other age-related ailments will gradually increase. The discussions above can therefore enlighten healthcare experts about the current community/family attitudes/opinions to depression and its treatment. It also provides a foundation for assessing the outcomes of the present community-based mental health interventions in the future.

As noted above, many elderly depressed patients (and their families) have scant knowledge about depression as well as the available treatment. What’s more, these patients (and their families) have negative opinions toward antidepressant drugs. In light of the major issues raised above, future medical campaigns (especially via media outlets) on mental health must exhibit a substantial passion to change public opinions and knowledge about depression and its effective treatment. What’s more, the government and universities must promote aged-care nursing as an appropriate career path to attract more undergraduate nursing students.

References

Adams, J., Drake, R., & Wolford, G. (2007). Shared decision-making preferences of people with severe mental illness. Psychiatr Serv, 58(9), 1219–1221.

Abbey, J., & Bridges, P. (2006). Clinical placements in residential aged care facilities: the impact on nursing students’ perception of aged care and the effect on career plans. Australian Journal of Advanced Nursing, 23(4), 14‑19.

Appelbaum, P., & Redlich, A. (2006). Impact of decisional capacity on the use of leverage to encourage treatment adherence. Community Mental Health Journal, 42(2), 121–130.

Australian Institute of Health and Welfare (2010). Australia’s Health 2010. Canberra: AIHW.

Bruce, M. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA, 291(9), 1081 -1091.

Deegan, P., Rapp, C., & Holter, M. (2008). Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatr Serv, 59(6), 603–605.

Halter, J. (2004). The stigma of seeking care and depression. Arch Psychiatr Nurs, 18(5), 178–184.

Highet, N., & Hickie, I. (2002). Monitoring awareness of and attitudes to depression in Australia. MJA, 176, 63-68.

Loh, A., & Simon, D., & Wills, C. (2007). The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns, 67(3), 324–332.

Moyle, W. (2003). Nursing students’ perceptions of older people: continuing society’s myths. Australian Journal of Advanced Nursing, 20(4), 15‑21.

Neville, C., Yuginovich, T., & Boyes, J. (2007). A stocktake of existing aged care clinical placements for undergraduate nursing students in Australia. Australian Journal of Advanced Nursing, 26(2), 17-26.

O’Neal, E., Adams, J., & McHugo, G. (2008). Preferences of older and younger adults with serious mental illness for involvement in decision-making in medical and psychiatric settings. Am J Geriatr Psychiatry, 16(10), 826–833.

Patel, S., Bakken, S., & Ruland, C. (2008). Recent advances in shared decision making for mental health. Curr Opin Psychiatry, 21(6), 606–612.

Raue, P., & Schulberg, H. (2010). Shared Decision-Making in the Primary Care Treatment of Late-Life Major Depression: A Needed New Intervention. Int j Geriatr Psychiatry, 25(11), 1101-1111.

Sayers, S., White, T., Zubritsky, C., & Oslin, D. (2006). Family involvement in the care of healthy medical outpatients. Fam Pract, 23(3), 317–324.

Wills, C., & Rovner, M. (2003). Preliminary validation of the Satisfaction with Decision scale with depressed primary care patients. Health Expect, 6(2), 149–159.

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