Geriatric Depression Scale
Depression is a common condition among geriatric patients. According to Greenberg (2019), around 5 million older adults in the US experience significant morbidity from depression. Thus, it is imperative to screen geriatric patients for depression to avoid associated adverse events. Elizabeth M., a 77-year old female, was screened for depression using the geriatric depression scale (GDS) (see Appendix A). The patient scored 5 out of 15, which is not suggestive of depression. GDS recommends additional assessment if a patient scores higher than 5, while a score from 10 and above is almost always a sign of depression. Elizabeth does not seem to be depressed, as she as an active jolly person, who understands her limitations that come with age. However, she spends a lot of time with her family, which helps her cope with her bad mood. These observations are confirmed by the GDS.
The results of the assessment revealed no significant danger of depression in Elizabeth. This implies that she is not in increased danger of suicide and other associated consequences of the condition. The low score seems to be associated with support from relative and active engagement in activities of her interest. While she does not like to start any new activities and prefers to stay home, Elizabeth explains this by the limitation of her body. She seems to accept those limitations.
I learned that screening for depression is not a difficult task. It does not take much time; however, it can be very insightful. For instance, in the case with Elizabeth, I was sure that her score would be 1-2. However, the application of GDS revealed that she was close to the danger zone. Moreover, the screening test helped me realize that Elizabeth did not feel it was great to be alive and feared that something was going to happen to her. Since all this information was acquired in several minutes, I find GDS a very helpful tool.
Clock Drawing Test
The prevalence of dementia is increasing, which is associated with increased morbidity and mortality of geriatric patients (Livingston et al., 2017). Thus, prevention of the condition is extremely important to improve the physical and emotional well-being of older adults (Park et al., 2018). Clock-drawing test (CDT) is one of the most frequently used to understand if a patient has cognitive impairment or memory problems (Park et al., 2018). The same patient, Elizabeth M., was assessed for dementia during her visit to the hospital (see Appendix B). The results of the CDT do not suggest that the patient has any signs of dementia. Even though the circle was more like an ellipse, all the numbers were in the correct order and in the correct places. The hands indicate the correct time (ten past eleven), and the sizes of the hands can be distinguished.
There were two concerns about the results of CDT that bothered me. First, the circle was drawn in the top left corner of the paper and was relatively small for the sheet of paper provided. Second, the test took more than 10 minutes, which was unexpected. However, the patient explained that she was nervous, and her hands were shaking. At the same time, she was afraid she would need several attempts to draw a clock, so she wanted to leave some space for further attempts. Thus, even though the circle size suggested that Elizabeth may have had problems with planning, the explanation provided by the patient proved otherwise. In summary, CDT revealed that there were no evident cognitive or memory problems in Elizabeth. Thus, there is no reason she should be restrained from driving a car.
The activity helped me realize that the interpretation of the CDT is not always straightforward. In particular, the circle size is not always indicative of the planning ability of the patient. The problem with planning may be associated with insufficient instructions or other personal reasons that can be explained by the patient. Thus, before judging about the cognitive abilities of the patients, it is always beneficial to talk with them. Talking with patients also promotes the values of patient-centred care.
Mini-Mental Status Examination
Similar to CDT, mini-mental status examination (MMSE) is another method for assessing cognitive ability and memory. While CDT is considered more favorable due to its accessibility and decreased burden on the patient-provider relationship, MMSE is still preferred by many doctors and nurses (Palsetia et al., 2018). Elizabeth M. agreed to be screened for cognitive impairment using MMSE acquired from Heart and Stroke (n.d.). Elizabeth’s score was 27/30, which suggests that the patient had no sign of cognitive impairment, as the scores between 24 and 30 are not suggestive of the condition. Considering the results of MMSE, there is no reason for the patient not being allowed to drive. Elizabeth made one mistake trying to count backward from 100 by sevens, failed to remember one of the items, and took the paper with her left hand instead of taking with her right hand. According to the test scoring system, this is not considered significant (Heart and Stroke, n.d.).
After conducting MMSE, I realized that it is a very time-consuming procedure. Before administering both tests, I believed MMSE was preferable, as it has a clear scale. However, it puts much burden on the care providers and patients. I realized that I should choose screening tests based on their time-efficiency, together with validity and reliability. I also learned that I should not be afraid to try different screening tools to decide what best suits me.
References
Greenberg, A. (2019). The geriatric depression scale (GDS). Hartford Institute for Geriatric Nursing.
Heart and Stroke. (n.d.). Mini-mental state examination (MMSE). Web.
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D.,… & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.
Palsetia, D., Rao, G. P., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test versus mini-mental status examination as a screening tool for dementia: A clinical comparison. Indian Journal of psychological medicine, 40(1), 1-10.
Park, J., Jeong, E., & Seomun, G. (2018). The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy. Journal of Advanced Nursing, 74(12), 2742-2754. Web.