INFLUENCING FACTORS AND OTHER NEGATIVE EMOTIONS
When asked about possible mental illnesses, 19% of the participants mentioned depression and that they experienced being depressed. According to the Geriatric Depression Scale (GDS-15), 7% suffered from mild depression and 1% suffered from serious depression. No symptoms of depression were found in 92% of the subjects.
However, the participants did report some degree of melancholy or apathy (19%).
The GDS 15 scores usually reflect mild depression in those situations. Such feelings of apathy or melancholy can also be connected with loneliness. Unfortunately, loneliness is a common problem in Finland. The study by Savikko et al. (2005) found that 39 % of the respondents suffered from loneliness and that 5% did so often or always. Eloranta et al. (2015) found around one-fifth (18%) of the respondents born in the 1940 cohort suffered from loneliness at least sometimes, while the corresponding figure was around one-fourth (26%) in the 1920 cohort. Loneliness is found to be a major issue affecting older people’s quality of life (Ekwall et al., 2012).
Older people's loneliness is also associated with poor self-related health, impaired health and depression (e.g., Nummela et al., 2011; Peerenboom et al., 2015), increased use of health and social care services (Taube et al., 2015) and even increased mortality (Tilvis et al., 2011). Feelings of loss are a part of loneliness.The participants face many losses, such as the deaths of their spouse and friends. Losses were common in this study; only 18% of the participants reported no losses. In light of this, it seems justifiable to systematically ask every older person coming to the emergency department about feelings of loneliness. There are many kinds of improvements, for example, cooperation between health and social care professionals and societies and volunteers, etc., that could help to decrease older people’s loneliness. These connections and contact information could be useful in emergency departments, too.
For example, Pitkälä et al. (2009) found that socially simulating group interventions based on the effects of peer support improved lonely older people’s cognition. There were also positive relationships between reduced social activity and signs of depression, older adults with signs of depression had lower social activity.
The participants were also asked about their fears. Fear of falling was most common, 30% feared falling sometime, while 13% had a constant fear of falling. This is an important topic to recognize, because fear of falling can lead to older people’s solitude or social isolation, as older people may stay at home and not go out at all, which can increase factors leading to depression, such as loneliness.
Symptoms of depression can also be associated with medical problems, such as dementia, or as a side effect of prescription drugs. Left untreated, depression affects much more than just mood. It impacts physical health, impairs memory and concentration, and prevents affected individuals from enjoying life (Tsai-Yun & Ke-Hsin, 2011; Hölttä et al., 2012; Hammami et al., 2012; Taube et al., 2015).
Conversely, the symptoms of depression present in older people can be masked as, a somatic condition and are thus difficult to recognize (Almeida et al., 2012). In this study, according to the GDS-15, 12 of the participants (n=141) had mild (n=10) or serious (n=2) depression that was unrecognized by the healthcare professionals.
Those participants (12) also had normal results in MMSE ( 24 or higher).
Among the study participants, nearly half had weak (36), or fair or greatly weakened results (16) according to the MMSE scores. This finding strengthens knowledge that mental status impairment is highly prevalent in older people in acute care settings (Hustey & Smith., 2007; Faezah et al., 2008). Just as common is the lack of recognition of this important problem (Han et al., 2009; Rice et al., 2011). However, it is found that under diagnosing other diseases is more common among patients with memory disorders (Parke et al., 2013). Parke et al. (2013) suggest that system changes are needed to support the ability of nurses to carry out best practices because the triage system in EDs does not recognize atypical presentations of disease and illness. This
kind of perception is supported by some findings that suggest that delirium is common phenomenon of patients in intensive care units (e.g., Girard et al., 2008) and that the real frequency of missed and delayed diagnoses of memory disorders is unidentified (Bradfort et al., 2009).
However, the cause of an acute confusional state is usually multifactorial. Delirium and dementia are considerably interrelated, and dementia is the premier risk factor for delirium. The key steps to differentiate delirium and behavioural and psychological symptoms of dementia require addressing all the evident causes, such as dementia, dehydration, infection, polymedication, and to prevent complications and treat the behavioural symptoms. These study findings support the idea that there is a lack of reported mental status impairment in older people in acute care. There were no signs of systematic mental status assessment protocols in the participants´
medical records and nurse documentation on the issue was especially rare. Also, in the questionnaire made by e-mail in spring 2019, the nursing managers (5) of the emergency departments answered that they lack a systematic method, or process, for assessing older people´s mental status in emergency nursing.
The early recognition of memory disorders and signs of depression are important for older people’s quality of life and for the prediction of other diseases. Acute care nurses are on the front line for recognizing unidentified memory disorders and depression among older people. The ability to recognize these conditions requires specialized gerontological skills and the regular assessment of the cognitive status of older people in emergency departments.
In 2017 a cross-sectional, self-reported survey in Melbourne, Australia (Rawson et al., 2017) assessed emergency nurses´ knowledge and their self-rated practices for dealing with older patients. The findings showed inconsistent results. More than 80%
of the nurses rated themselves as "very good" or "good" in assessing pain (95%), identifying delirium (88%) and identifying dementia (83%). According to Rawson et al. (2017) areas with "poor" ratings were identifying depression (47%), assessing polypharmacy (47%) and assessing nutrition (38%). There was variation in the knowledge and self-rating of practice related to older patient care. Rawson et al.
(2017), suggest that the relationship between knowledge of nurses and the self-ratings warrants further exploration. This is an important aspect of emergency nursing and according to this study´s results “very good” knowledge related to the actual emergency department nursing of older people is lacking and therefore needs to be increased.
Similar results found by Kiljunen (2019) in her receatly published dissertation conserning a different nursing facility, a care home of older people. Kiljunen (2019) identified and described the competence requirements in older people in care homes and described and predicted care home nursing professionals´ self-assessed
competence. According to Kiljunen (2019), several aspects of competence were recognized: ethical, interactional, cooperation, clinical, guidance, leadership and development competence and competence in promoting the wellbeing of older people. Most participants described their competence as good or adequate, but the measurement of these aspects revealed several gaps in care home nursing professionals´ self-assessment competence (Kiljunen 2019).