Mental Health Crisis: The Necessity of Improved Education on

Geriatric Depression for Nurses

Anna Yang

Mrs. Bagley

Lindsay Ellis

Centennial High School

16 January 2018
 In the United States alone, approximately 15%, and a greater percentage in hospitals and

nursing homes, of adults over 65 years of age are affected by depression. This serious disorder,

labeled as geriatric depression when it occurs in those over the age of 65, is characterized by the

symptoms of persistent sadness, excessive worries, feelings of worthlessness and helplessness,

and other physical and emotional changes (American Association for Geriatric Psychiatry). Risk

factors of geriatric depression include previous diagnostic of depression in earlier age,

bereavement, social isolation, and confounding illnesses, such as Alzheimer's Disease or

cognitive disorders. Although many believe that a deterioration in mental and physical health as

one ages is a normal process or a sign of weakness, consistent depressive symptoms cannot be

ignored because it can lead to further complications, such as cognitive decline, other illnesses,

and suicide. The stigma behind depression and other mental disorders causes a barrier between

the patient suffering from debilitating symptoms and the medical professionals that care and cure

these illnesses. From fear surrounding depression of appearing weak and the lack of awareness

about mental disorders, a large portion of the elderly community affected with depression are

reluctant to open to family members and medical professionals. Due to the underlying reasons

for this reluctance, it is even more pertinent for nurses and healthcare professionals who

frequently work and have contact with the elderly to have the ability to recognize and treat

geriatric depression. However, the lack of training provided and required for nursing home staff

is astonishing and appalling. Although nurses are trained to administer medicine for physical

disabilities or illness, many are not educated in treating geriatric depression and other mental

disorders. Even when geriatric depression is recognized and treated with antidepressants, the

benefits of nonpharmacological treatments are also essential to the process. Thus, to better the

treatment and care of geriatric patients in nursing homes and senior living communities, an
incentive to work in the geriatric field should be given, and a more comprehensive

curriculum provided to the staff should include the requirement of research on topics

related to disorders commonly affecting the geriatric community and a focus on

nonpharmacological methods of treating geriatric depression.

There is a shortage of staff and nurses interested in working in a geriatric setting.

According to Bosfield’s “Factors that Impact Registered Nurses’ Decisions to Continue

Providing Care to Older Adults,” “the American healthcare system is challenged with providing

nursing services for an increasing population of older adults. According to the Institute of

Medicine (IOM, 2008), trained healthcare professionals in geriatrics are needed to care for an

aging population, and even though opportunities exist to provide service, few providers choose

this career path.” The aging baby boomer generation creates an ever-growing elderly population

and increasing concern for the decline in geriatric healthcare professionals, not only in hospitals,

but in residential and home settings. A lack of interest in pursuing a career in the geriatric field

may be due to the absence of a geriatric rotation during clinical rotations in medical school or

nursing school. Without exposure to the field, young professionals have no interest in pursuing

the foreign field of geriatrics. Despite when programs do include the option of a geriatric

rotation, “less than 10% of medical schools require a geriatric course” (Bosfield). Moreover, the

job retention rate for geriatric staff is low, with up to a 100% turnover rate in extreme cases. One

reason for this low retention rate is the inadequacy of knowledge to sustain roles in geriatric

settings. Because many training programs do not require students and nurses to take a course on

medical illness relating to the elderly population, healthcare staff are unable to properly and

effectively care for geriatric patients. As a result, many professionals leave this field to pursue

different common fields that they have more knowledge about. Financial incentives are also in
need of reform to improve job retention. “In 2004, the average annual income for registered

nurses working full time in a hospital was $59,963; ‘this was the highest of any employment

setting,’ in contrast to the average annual income for registered nurses working in nursing

homes, which was $53,796” (Bosfield). Needing to support themselves and their families, nurses

considering geriatrics may be turned away by the lower salary. The higher demand for geriatric

nurses should entail an increased salary for the work and time required to serve the geriatric

community. Barriers obstructing the recruitment and retention in the geriatric field include the

absence of exposure and education in geriatrics and financial incentives.

Research is an integral component of improving care for the geriatric community.

Healthcare professionals who conduct research continually throughout the duration of their

career are able to provide optimal care because they are constantly adapting to new research in

the related field. The American Nurses Association (ANA) states that the baccalaureate level

nursing students should be able to: 1) evaluate research findings, 2) identify nursing problems

that need investigation, 3) use nursing practice to gather data, and 4) apply and share research

findings. However, in “Developing Leadership in Geriatric Education,” Gardner and Patzwald

describes these objectives as “ineffective in teaching the value of research” and are “better met

by way of direct involvement.” “In order to respond appropriately to the needs of an increasing

number of older adults,” Saundra Bosfield argues that “nurses need to use leadership skills to

evaluate their own progress and ‘identify gaps in data and analyses specific to age related

outcomes of care’ (AACN, 2010, p. 23).” In an extensive study conducted by the Geriatric

Nursing Education Consortium, nurses in Puerto Rico, Mexico, Canada were trained and

encouraged to take leadership positions. It was found that a high turnover rate in the position of

the director of nursing was caused by inadequacy to fulfill responsibilities, low retention rate,
and increased amounts of administrative work. A frequently changing leadership position is not

only frowned upon by the administration of nursing homes, but can also affect the residents’

care. To encourage and prepare nurses for the work required to sustain a leadership position,

“nurses should conduct research, identify questions relevant to the care of older adults, evaluate

the need for improvement, develop research tools, identify questions for clinical inquiry, conduct

literature reviews, study design and implementation, perform data collection, analyze data, and

disseminate findings” (Bosfield) prior to taking a position of leadership. Research is a critical

element in nurses’ training that can optimize care in nursing homes and senior living

communities.

It is not only necessary to include geriatric training and rotations in nursing and medical

schools, but educational reform also includes the content of geriatric courses. Throughout the

research of health, psychology and mental illnesses have been neglected in regard to physical

illnesses, however the integration of subjects such as depression and nonpharmacological

interventions is essential to the curriculum of geriatric nursing staff. In addition to

antidepressants and other medical drugs used to facilitate depressive symptoms,

nonpharmacological techniques can be employed to benefit adults suffering from geriatric

depression. Although antidepressants can significantly reduce depressive symptoms in geriatric

patients, they often cause unwanted side effects that lead to the discontinuation of the drug.

However, mild physical activity; various types of therapy, including behavioral, music, and

cognitive therapy; and nurse consultations have been proven to improve patients’ health. In a

review of cross-sectional and longitudinal studies on physical activity as a nonpharmacological

treatment for depression, an inverse association between exercise or physical activity and

depression was reported (Philips et al.). In a review of studies testing six different
nonpharmacological interventions, in which four were randomized controlled trials, all four

resulted in a statistically significant decrease on the 30-item Geriatric Depression Scale (GDS).

The implementation of recreational activities supported improvement in alleviating major and

minor depressive symptoms. In a 2-week trial where staff attached residents’ wheelchairs in

tandem to the front of a bicycle, there was a 45% decrease in GDS score in comparison to the 8%

increase in score from the control group. Furthermore, in a 6-month study including a variety of

recreational activities, there was a 36% response rate versus the 0% response rate in the control

group. In a 10-week trial of comparing the effects of group cognitive therapy, music therapy, and

usual care, there was a 30% statistically significant decrease in the GDS, a 3% decrease, and

worsening in depression, respectively. These results are comparable to the application of

antidepressants, such as nortriptyline, which demonstrated a 40% change in the Hamilton

Depression Rating Scale. (Snowden et al.) Together with the close monitoring of proper

antidepressants, nonpharmacological treatments can decrease depressive symptoms in geriatric

patients.

The geriatric field is lacking in healthcare professionals with the education and incentive

to provide optimal care for residents in nursing homes and senior living communities. There is a

necessity for reform in the financial and educational system to entice more young professionals

to pursue the geriatric field. Due to the growing population of adults over the age of 65, the

demand for nurses trained to care for geriatric patients is increasing rapidly. In addition, the

training for geriatric nurses often are incomprehensive regarding mental disorders, such as

geriatric depression. Although pharmacological treatments, such as antidepressants, are effective

and beneficial in alleviating symptoms of major and minor depression, they often cause harmful

side effects that lead to discontinuation. To aid the treatment of depression, nonpharmacological
methods, including therapy and recreational activities, are just as effective in decreasing

depressive symptoms and beneficial to improving mental health as antidepressants. The goal of

educational and financial reform in this field should be to improve the scope of nurses’ ability to

care for geriatric residents and to increase the number of healthcare professionals available to aid

and care for residents.

 Works Cited

Alexopoulos, George S. “Depression in the Elderly.” Lancet, 2005, pp. 1961-70,

www.thelancet.com.

Bosfield, Saundra. “Factors that Impact Registered Nurses' Decisions to Continue Providing Care
to Older Adults.” Argosy University, 2013.

“Depression in Late Life: Not A Natural Part of Aging.” American Association for Geriatric
Health, Geriatric Mental Health Foundation, www.aagponline.org.

Gardner, Davis L, and Patzwald Gari-Anne. “Developing Leadership in Geriatric

Education.”Proceedings of the Annual Summer Geriatric Institute, July 1990.

Murphy, Katharine M., et al. “Issues in Long Term Care: An Initiative to Improve Depression
Recognition and Management in Long-Stay Nursing Home Residents.” Clinical
Gerontologist, vol. 28, no. 3, 2005.

Philips, Wayne T, et al. “Physical Activity as a Nonpharmacological Treatment for Depression:

A Review.” Complementary Health Practice Review, vol. 8, no. 10, 2003.

Snowden, Mark, et al. “Assessment and Treatment of Nursing Home Residents with Depression
or Behavioral Symptoms Associated with Dementia: A Review of the Literature.”
American Geriatrics Society, 2003.