Loneliness And Depression In Elderly People

Dimitri’s condition and symptoms

Discuss About The Loneliness And Depression In Elderly People.

Dimitri is a young man of Asian origin and presents himself as tidy, neat and well groomed. He has black hair of medium length and was dressed in casual attire. His physical built was lean with love skin tone. Dimitri wears glasses and his thin rim of moustache.

1. BEHAVIOUR

Throughout the interview process Dimitri is found to be cooperative however, he has extremely slow engagement in the entire conversation. This is evident from the his gestures like fiddling of fingers and excessive movements of hands. His sitting posture was little hunched and was aligned on the left side during the entire tenure of the interview. He exhibited extremely poor eye-contact during the entire interview process and frequently got distracted when he hear voices. For example, upon hearing certain voices, he turned his head towards the direction from which the voice was coming, interrupting the conversation. He looked restless and was less attentive as he was asking to repeat questions over and over again to the interviewer (nurse).

1. AFFECT

Dimitri noted to be restricted as he stated that he is scared and is not comfortable. However, his facial expression does not reveal any expression of fear or anxiety.

1. MOOD

Dimitri’s mood was not stable and this is evident when he stated that he is not comfortable during the process of interview conduction. He also reported that he is scared and fearful when he hears certain voices because he thinks that the voices are criticising him.

1. SPEECH

Dimitri did not initiate any conversation by his own during the entire interview process. When he spoke, his voice was slightly slurred, slow spaced and repetitive. The volume of his voice is normal but at times it became loud when he hearted voices. During the entire interview process, there was no spontaneous initiative to indulge or continue the conversation. He was only providing short or one word answers to the directed question framed by the nurse.

1. THOUGHT FORM

There are evidences of blocking of thoughts, looses association of logic with the questions along with incoherent mixture of phrases and words. He stars hearing certain voices even before he lines-up the ideas or these thoughts are finished and this interrupts his line of thought. Eventually after a brief pause or interruption, he fails to recall what he was saying.

1. THOUGHT CONTENT

Dimitri was found saying tht he was passing through auditory hallucinations and those voices were constantly criticising him. He also did not express any signs of obsessions or delusions at the moment. Moreover, he denied any intentions of harming others or causing harm to self or self-harm. Dimitri was also found saying the he will undertake certain protective actions for his self-defences. He also said that he has stated writing novel but he was unable to finish the same due to these auditory hallucinations.

1. PERCEPTION

1. COGNITION AND INTELLECTUAL FUNCTIONING

Dimitri is an oriented human being and was alert about the current place and time. However, when questioned, he replied back after a brief pause. He mentioned to the interviewing nurse that he was brought there b y one of his friend names Cheryl and at present he is at mental health clinic which generally followed an interview process. When the nurse conducted an intellectual functioning test, he gave correct answers to simple mathematics questions initially. However, later on, he corrected himself with wrong answers and informed the nurse that he weak in mathematics. Memory test was not performed but he displayed a good memory in the domain of the list of the medication that he is taking.

1. INSIGHT AND JUDGEMENT

Risk factors for Dimitri

Dimitri is aware of the mode of action of his prescribed medication. For example he said that Olanzapine will help him recover from hearing voices and this reveals that he has good insight and intact judgement. He also reported that when he did not take the medication (Olanzapine) for a month when he was in Japan, the situation became worsen as he started listening voices. He also has good level of judgement as he agrees to take new set of medications as prescribed by the doctor. However, he stated that he is not crazy.

1.  Social Isolation

The potential risk factor in case of Dimitri is the social isolation. Though Dimitri has been found reporting that he has friends but majority of them are virtual that is in the social media friends. This lack of real friends creates social isolation. According to Holt-Lunstad et al. (2015), social isolation increases the risk of early mortality. This is because, social isolation increases the sense of loneliness and this cast a negative impact on the mental and the physical health of the healthy adults (Coyle & Dugan, 2012). He said that he has got a good friend circle but he goes to move alone. According to Cacioppo and Cacioppo (2014), it is important to get a significant emotional support from family members and friends in order to maintain a stable and fit mental status. Support from the family members helps to reduce the sense of loneliness and this in turn reduces the sense of depression and thereby helping to increase the mental equilibrium and stability (Liu, Gou & Zuo, 2016).

1. Risk of adherence of medication

Though Dimitri is well aware about the role of the medications and the list of medication he takes, but there lies a risk of medication adherence. This is evident from the fact that when he was in Japan for a month, he skipped his medicines and this worsens his overall mental conditions. According to Thompson and McCabe (2012), it is challenging from the people suffering from the mental illness to undertake regular medications and hence can be considered as an important risk factor of Dimitri who is suffering from auditory hallucinations.

1. Risk of Financial vulnerability

Dimitri informed the nurse that at present he is unemployed and just came back from his one month holiday in Japan. This holiday outing in Japan has engulfed a significant amount of his savings. Thus in the present scenario, it can be ascertained that Dimitri might be suffering from financial instability as he is jobless and has spent a significant amount of money in travelling. According to Yoshikawa, Aber and Beardslee (2012), low economic status or lack of financial stability increases the susceptibility of stress or depression and thereby increasing the threats of mental health disorder.

1. Risk of impaired sleep patterns

Dimitri reported to the nurse that the voices he hears are very disturbing. According to him, those voices criticize him and thereby hampering a sound sleep at night. According to Short et al. (2013), lack of adequate sleep at night leads to the development of high level of mood disorder along with depression and anxiety and thus a potential risk factor of Dimitri who is suffering auditory hallucinations.

Clinical issue: auditory hallucination

CLINICALISSUE: auditory hallucination, as it is clearly seen that Dimitri is hearing voices. It is a form of hallucination that involves hearing of sounds without the presence of any auditory stimulus (Hepworth et al., 2012)

RATIONALE FOR CHOSEN ISSUE: Auditory hallucination is a clinical issue that is mainly faced by people with psychotic disorders. The sounds can be unnatural, familiar or even sounds of human voices (Hepworth et al., 2012). A proper care is required as auditory hallucination can make a patient aggressive, violent, and self-destructive or may lead someone in to clinical depression.

GOAL/S: The goal is to provide a healthy life style to the patient and the patient would stop hearing the voices and would be able to concentrate on his life.

A two-month follow up can be taken after the treatment in order to evaluate the cognitive condition of Dimitri. Cognitive screening test would help to understand the mental status of Dimitri, which can be helpful to known the effectiveness of the interventions. Dimitri would stop hearing the voices, would report of a better life style, and would be able to concentrate on his work.

A proper therapeutic relationship will ensure Dimitri that his problem will be addressed. Solitary activities and cognitive therapies would cease the thoughts of low esteem, self-criticism and would foster self-command in the patient.

In context of the recovery model of care, these interventions will help to promote, empowerment, hope, connection and healing. This recovery-based model would help Dimitri to establish the losses related to his mental health.

1. One of the examples of the positive interaction between the nurse and the patient is that it was good on the nurse’s part to initiate the interview, by introducing herself to the patient. It can also be seen that she had promised Dimitri that confidentiality should be maintained; hence, he can feel free to express his concerns. It can be seen that the nurse had accomplished the skills of communication, which is a prime quality of nursing (Kourkouta & Papathanasiou, 2014).   
2. It is evident from the video that the nurse has done a commendable job to initiate the discussion with open ended questions. According to Chaffin & Adams, (2013) closed ended questions can be uncomfortable for a patient for the first time and hence Dimitri might hesitate to disclose his emotions.
3. Another example of positive interaction is that the nurse was able to establish a calm and serene environment for Dimitri. She has been mindful while choosing her words to converse with Dimitri, such that she does not get perturbed. A nurse should be able to deal with their patients in a cam and compassionate way (Happell et al., 2012). Not paying heed to the patient’s concern or ignoring their perceptions can hamper the therapeutic relationship between the caregiver and the patient (Chaffin & Adams, 2013). It can be seen from the video that the nurse had been successful in active listening with disrupting the flow of emotions of Dimitri.
4. A nurse should be able to preserve the basic rights of a patient while delivering care to him. As per the nursing codes of ethics, nurse should respect the right of decision making and personal beliefs of patients (Gottlieb et al., 2013). The video reveals that the nurse has respected his decisions to not to call his mother as he never wanted to overburden his mother with the news of his illness.

1. The nurse was in close proximity of Dimitri, which can be dangerous to the nurse as people with auditory hallucination may show aggressive disorders and may show violence (Happell et al., 2012). Hence, the nurse should be careful about the behavioral pattern of the patient.
2. Close and confined area may be claustrophobic for psychotic patients (Cacioppo & Cacioppo, 2014). The interview took place in a confined area and the nurse attending Dimitri would not get any room for escape if the patient tries to hurt her.

References

Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and personality psychology compass, 8(2), 58-72.

Chaffin, A. J., & Adams, C. (2013). Creating empathy through use of a hearing voices simulation. Clinical Simulation in Nursing, 9(8), e293-e304.

Coyle, C. E., & Dugan, E. (2012). Social isolation, loneliness and health among older adults. Journal of aging and health, 24(8), 1346-1363.

Gottlieb, J. D., Romeo, K. H., Penn, D. L., Mueser, K. T., & Chiko, B. P. (2013). Web-based cognitive–behavioral therapy for auditory hallucinations in persons with psychosis: A pilot study. Schizophrenia research, 145(1), 82-87.

Happell, B., Davies, C., & Scott, D. (2012). Health behaviour interventions to improve physical health in individuals diagnosed with a mental illness: A systematic review. International journal of mental health nursing, 21(3), 236-247.

Hepworth, C. R., Ashcroft, K., & Kingdon, D. (2013). Auditory hallucinations: a comparison of beliefs about voices in individuals with schizophrenia and borderline personality disorder. Clinical psychology & psychotherapy, 20(3), 239-245.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237.

Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.

Liu, L., Gou, Z., & Zuo, J. (2016). Social support mediates loneliness and depression in elderly people. Journal of health psychology, 21(5), 750-758.

Short, M. A., Gradisar, M., Lack, L. C., & Wright, H. R. (2013). The impact of sleep on adolescent depressed mood, alertness and academic performance. Journal of Adolescence, 36(6), 1025-1033.

Thomas, N., Hayward, M., Peters, E., van der Gaag, M., Bentall, R. P., Jenner, J., … & García-Montes, J. M. (2014). Psychological therapies for auditory hallucinations (voices): current status and key directions for future research. Schizophrenia bulletin, 40(Suppl_4), S202-S212.

Thompson, L., & McCabe, R. (2012). The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC psychiatry, 12(1), 87.

van der Gaag, M., Valmaggia, L. R., & Smit, F. (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research, 156(1), 30-37.

Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: implications for prevention. American Psychologist, 67(4), 272.

Order an Essay Now & Get These Features For Free:

Turnitin Report

Formatting

Title Page

Citation

Outline

Place an Order