Needs of elderly people with late-life depression

In my work as a nurse and, later, as a clinical nurse specialist, I often encountered older people whose treatment for depression – performed according to the relevant guidelines – was inadequate, causing the depression to become chronic in nature. When the course of a depression becomes this adverse, with no improvement in sight, with the patient, his loved ones, and the treatment providers feeling helpless, and with the burden on the patient and his or her family being unrelenting, the clinical problem is enormous for all concerned. The helplessness that I experienced as a practitioner led me to think that when depression becomes chronic in nature, there may be a “missing link” in the known chain of cause and effect. That link might consist of a particular aspect of treatment that largely escapes the notice of practitioners, causing the patient’s feelings of depression to persist – in other words, dealing with the patient's unmet needs. My assumption was that the consequences of depression can be expressed in “unmet needs” but that there is a reciprocal relationship in this regard whereby the depression creates needs on the one hand, while unmet needs have an unfavourable effect on the course of the depression on the other. There has been very little research on the unmet needs of older people with depression and the reciprocal relationship referred to above, an observation that inspired me to undertake this study. To place the research in a more specific context, I formulated the general research problem as follows: There has been insufficient research exploring the consequences of a depressive disorder for the daily lives of older people. It is thus unclear to what extent the course of depression in later life is associated with unmet needs, particularly with regard to the individual’s ability to play a role in society. Read more: http://dare.ubvu.vu.nl/handle/1871/52759