Question

You are working the day shift on a medical inpatient unit. You are discussing discharge instructions with J.B., an 86-year-old man who was admitted for mitral valve repair. His serum blood glucose is 250 mg/dL (13.9 mmol/L) and increasing for the past several months. During this admission, his dosage of insulin was adjusted, and he was given additional education in managing his diet. While you are giving these instructions, J.B. tells you his wife died 9 months ago. He becomes tearful when telling you about his loss and the loneliness he has been feeling. J.B. states he just doesn’t feel good lately, feels sad most of the time. J.B. also expresses his lack of involvement in his normal activities. He has few friends left in the community because most of them have passed away. He has a daughter in town, but she is busy with her work and grandchildren. He tells you he has been feeling “depressed” the last few months with thoughts of suicide.

1. What further assessment data is needed to determine the seriousness of J.B.’s thoughts of suicide?

2. What characteristics of J.B. put him at high risk for suicide?

3. Which psychiatric disorders can result in suicidal ideations or gestures? Name at least 3.

4. People with a physical illness, often have trouble sleeping, experience a change in appetite, reduce their level of activity, and have thoughts of death. How can you tell the difference between old age with illness and depression?

5. List 5 of the most common signs of depression in the older adult.

Answer 1

1. Further assessment data on J.B.'s thoughts of suicide include :

• Assess if there is sudden change in mood .
• Assess for his willingness to make new friends and you can refer self - help groups as his depression is related to loneliness.
• Involve the daughter too in this process so that she is aware of his loneliness and suicidal thoughts.
• Assess for any history of self harm.
• Assess for his willingness to change the diet pattern as his sugar levels are increasing.
• Assess his financial condition.
• Assess for his love for pets and advice on pet parenting as pets alleviate loneliness.

2.  J.B is a social being who wants to be involved with people. But he lost his wife 9 months ago, his most of the friends too have passed away as he is 86 years old and his daughter too is busy with her family. He feels lonely and is also experiencing altered glucose levels in his body. All these characteristics of J.B has put him at high risk of suicide.

3. Depression which is never ending, Bipolar Affective Disorder ( BPAD) , Schizophrenia , psychosis are the psychiatric disorders which results in suicidal ideations or gestures. Here, J. B suffered from depression.

4. Old age is associated with common physical changes associated with aging. They have reduced hours of sleep , with these physical illness and depression, their sleep pattern is highly distrupted. Also , it affects the blood glucose levels which takes longer time to normalise. It is also difficult to rehabilitate the older person with depression than younger. Their level of activity and diet pattern too is affected as the older person with depression tends to ignore about his diet choices.

5. Common signs of depression in older adults :

• Feeling of sadness.
• Crying spells.
• Fatigue
• Irritability
• Change in diet patterns.
• Sleep problems.
• Thoughts of suicide.

Thank you.