Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineDepressive symptomatology in the older adult is unique. Older adults report more somaticor physical symptoms rather than depressed mood, which is the most prominent feature ofdepression in younger persons. Other differences in the presenting symptoms for the olderadult experiencing depression are as follows: older adults are likely to accept their “unhappiness” and direct inquiry about their moodmay lead only to such replies as “No, I have nothing to be depressed about.” apathy and withdrawal are common feelings of guilt are less common loss of self-esteem is prominent inability to concentrate, with resulting memory impairment and other cognitivedysfunction is common (Kane, Ouslander & Abrass, 1994)31Recommendation • 5Nurses should objectively assess for cognitive changes by using one or more standardizedtools in order to substantiate clinical observations. (Strength of Evidence = A )Discussion of EvidenceStudies consistently suggest that clinical interview/observation is the most effective methodof detection, and should consist of multiple and varied sources of information (Costa et al., 1996).The Agency for Healthcare Policy and Research (1993) states that this interaction with theclient is the basis for including symptoms specific to depression, with the subsequent useof specific tools to augment the diagnosis, as a valuable addition. The use of consistent,standardized tools to enhance documentation of client behaviours, mood, cognition andchanges in functional ability, is strongly supported (AHCPR, 1993; Costa et al., 1996). It is stressedthat screening tools can augment, but not replace a comprehensive “head to toe” nursingassessment. Further, the Scottish Intercollegiate Guidelines Network (1998) reports thatthese standardized measures do provide valuable baseline data, and can assist in monitoringof response to intervention.