The case scenario, in this case, is the condition of Mr. Patel, an 81-year-old living alone, who was brought to the emergency department after having fallen at home. He has a carer who provides him with personal care once a day. The patient has a past medical history of Hypercholesterolemia, hypertension, and depression. He has the medication for the other conditions but not for depression. The medical team decides to admit him despite his vital signs being stable.
There are several issues that the patient, in this case, Mr., Patel is struggling with. The issues are connected to his past medical history, some of which he is still on medication. The major issue that I identified, in this case, is the fact that he has a past medical history of depression, yet he is not on any medication to manage that condition. The other medical issues that he has include hypertension, for which he is on a medication called ramipril, and Hypercholesterolemia, for which he is on a medication called atorvastatin. Hypertension is another name for high blood pressure in which the blood of the patient exerts against their blood vessel walls at a pressure that is higher than is expected (Burnier & Egan, 2019). Hypercholesterolemia is a condition in which the patient has a high level of cholesterol present in their blood. Another issue I noticed about the patient was the signs of depression illustrated by the fact that while his vital signs were normal, he was still showing signs of illness that caused the medical team to admit him. The signs of depression that he was showing include feeling tired, illustrated by the fact that he fell when he tried to walk; the other medical conditions that he has are also contributing to his depressive state. He is withdrawn and refuses to take food and medication. He also refuses help when it is offered.
Having analyzed the various issues that the patient has and the symptoms of depression that he is showing, the goal will be to identify the type of depression he has and the appropriate therapy and medication, since he is not on any, which would help in the treatment of the condition that Mr. Patel has. Other goals will include helping the patient find ways to cope and finding ways to reduce the risk of the patient getting depressed again in the future. I will also identify things that the patient likes to do to use them to prevent him from getting in a depressed mood. Finding ways for the patient to manage the other conditions that he has, which are significantly contributing to his depressive state, would be my goal in the management and treatment of depression in the case of Mr. Patel. Working on finding treatment solutions to the other medical problems that the patient has will be vital in solving his issue of depression because the other conditions’ medication may have side effects that lead to depression. However, depression may have been a factor that led to the development of the other conditions. The goal, therefore, entails working towards managing all the issues that the patient has.
There are several actions that I plan to take in the management and treatment of the conditions that the patient has, with the most crucial one being depression since it is the one that he is not on any medication for. There are several actions that I would take in helping my patient cope with the medical issues he has and manage and treat his state of depression. The first action would be to establish the cause of the depression that the patient has. This will entail establishing whether it is as a result of the medication that he is taking for hypertension and Hypercholesterolemia, or whether it arose from some other cause. If the conditions are the cause, I will consult a doctor who is experienced in treating those conditions to help me figure out the best strategy to go about managing Mr. Patel’s depression. I will also identify the factors that trigger the depression in Mr. Patel and find ways to help him avoid them.
Another action I would take would entail taking identifying the psychotherapy treatment and the medication that would work for Mr. Patel. According to the results of an analysis of the symptoms he is experiencing and the fact that he has a previous history of depression, it is clear that he needs treatment for depression. The type of psychotherapy that I would apply for the patient will be cognitive behavioral therapy because it will play a significant role in helping the patient change the depressive behaviors that he is showing (Avasthi & Grover, 2018). For instance, it will help him become less withdrawn and help change some aspects of his mood. I will also prescribe the patient some antidepressants, which will help the patient improve how his brain uses certain chemicals in the brain that control stress or his mood.
The next step I would take would be to take to the patient about the medication that I have prescribed in terms of the possible side effects and the possible adverse drug interactions that may occur when taking the antidepressants because he is on other medications. I will explain the whole process of treatment to the patient and when and for how long the various treatment options will last. I will also explain what the patient stands to benefit from accepting the treatment options. Before I commence the treatment, I will ensure that the patient is fully informed and consents to the treatment options that I would have discussed with them. Educating the patient about what the process of treatment will entail is vital to avoid and ethical issues that may arise in the course of treatment. Better treatment outcomes will be achieved when the patient is aware of the possible outcomes of the treatment that has been recommended. Knowing what to expect will enhance the chances of the patient’s recovery because he will not be surprised by anything concerning the treatment as he goes on with it. Helping a patient learn how to deal with disappointing situations is an important way of helping them avoid depression.
Another action step would be to monitor the patient to ensure that he adheres to the psychotherapy and treatment requirements. Once the best treatment option has been established and the patient consents to it, I will consistently follow up on the patient to ensure that he adheres to the requirements of the prescription. Getting in contact with any family and friends that the patient may have will be important because they will offer the best support system to enhance the recovery of the patient by being there for the patient through the treatment process. I will also take the measures that are necessary for assessing the effectiveness of the selected treatment and the side effects that may have arisen from it. Also, I will make the adjustments in the agent or dose, or in both, when I see necessary based on how the patient responds to the treatment (Avasthi & Grover, 2018). If I don’t notice any significant changes in the condition of the patient, I can introduce a collaborative care team including a depression care manager and a designated psychiatric consultant to help in the management of the condition in the patient.
ROLE (collaborative care team)
|PROCESS||Psychiatric Consultant||Depression Care Manager|
Consulting on the case of the patient when it becomes difficult to manage.
Consulting as expected when the patient is not improving and making recommendations for alternative treatment, or referring the patient to a specialist.
Engaging the patient through education and following up on medication intake.
Facilitating change of treatment, planning the prevention of relapse, brief counseling, and support the management of care for the patient to enhance their recovery.
Evaluation of Outcomes
There are several outcomes that I would evaluate to establish the effectiveness of the treatment intervention that I used for Mr. Patel. To establish whether CBT was effective for the patient in the management of depression, a randomized, single-blind controlled trial with follow-up visits for 4-and 10-months will be necessary (Holvast et al., 2017). Cognitive-behavioral therapy has been established by many studies to be effective in the treatment of depression in older adults and is associated with specific outcomes, like the improvement of the mood of the patient. I will evaluate the effectiveness of the antidepressants that were used for the patient by observing the changes in the depressive symptoms that he was portraying. For instance, I will observe whether the patient is less withdrawn, whether he is more accepting of help when offered to him, and whether there have been any improvements to his general well-being to make him feel less tired. A positive outcome would also be illustrated by the patient interacting more with other people. Positive outcomes of the antidepressants and the psychotherapy will be indicated by the patient feeling stronger and more accepting of his condition and having the will to get better. With this, he will be able to take medication without any resistance or constant supervision.
Reflection on the process and new learning
The process sets out the issues, causes, treatment, and possible interventions that the patient in the case study had. There are several lessons that I learned from an analysis of the case and the treatment options available for elderly patients with depression. For instance, if a patient has other conditions like hypertension for the patient in the case study, it is possible that the condition could have contributed to the patient having depression, or the depressive state of the patent could have contributed to him having hypertension. Also, there are some patients who may experience resistance to medication for depression and physiotherapy, calling for the involvement of other specialists to examine the patient and provide suggestions for alternative treatments that may help in treating the condition of the patient. An evidence-based collaborative approach in primary care settings can be used to effectively treat depression in patients showing resistance to medication. This is because the principles of care that are collaborative are consistent with the patient-centered and accountable care notion making it possible to enhance the care outcomes amid the reforms and changes in the delivery and financing of care. Creating effective collaborations is vital in the achievement of the desired clinical outcomes for the patients.
Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for the management of depression in the elderly. Indian journal of psychiatry, 60(Suppl 3), S341.
Burnier, M., & Egan, B. M. (2019). Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circulation Research, 124(7), 1124-1140.
Holvast, F., Massoudi, B., Oude Voshaar, R. C., & Verhaak, P. F. (2017). Non-pharmacological treatment for depressed older patients in primary care: A systematic review and meta-analysis. PloS one, 12(9), e0184666.