“Just Do It!” admonishes the Nike ad.
“God helps those who help themselves”
goes the old saw.
“Carpe diem” is a philosophy everyone
needs to buy into, including the depressed
Of course, depression can strike any age
group, any ethnic category, and any
social–economic strata, but there is a multitude
of reasons why the elderly are
disproportionately afflicted nowadays.
No doubt exists that a family history of the
disorder predisposes some elderly to the
disease. Yet, without that genetic tie, the
elderly can still be candidates for depression
due to several other factors: widowhood, social
seclusion, other diseases, interaction of
medications, a negative perception of body
image, fear of dying, chronic pain, and
self-medication with alcohol or drugs.
Because of outdated stigmas, misguided notions
of family members, or treatment expense, many
seniors suffer their feelings of hopelessness
and helplessness in silence. They resign themselves to being blue and
don’t seek medical intervention.
The sad shame of this situation is that proven
medical help is available for the elderly. Screening devices easily administered in
a variety of medical offices, even optometrist
offices, can identify quickly, painlessly, and
effortlessly those in need of anti–depressants. Once the diagnosis is determined, a
caregiver can ensure follow-up treatment.
There is “light” at the end of the tunnel in
Baltimore! Project LIGHT was created at Levindale
Hebrew Geriatric Center and Hospital in
Baltimore, Maryland to screen the elderly for
depression. LIGHT is an acronym for a four step
process. First, the patient Learns about
depression; the patient is Inspired to seek
help; the patient is Given Hope; and the last
step is Treatment.
In this program, a psychiatric registered
nurse visits primary care physicians where she
conducts tests for depression on site. Therefore, patients and their caregivers
need not make separate trips to psychiatric
offices. Their emotional status can be quickly
assessed in the comfortable and familiar setting
of their family doctor’s office.
Ms. Poklemba, a clinical nurse specialist at
Levindale Hebrew Geriatric Center and Hospital
in Baltimore, realizes that building relations
with primary care physicians to help screen for
depression in elderly patients can significantly
reduce patients’ risk for suicide. She cited the alarming statistic that 20
percent of all suicide deaths are in people over
65. Unfortunately, those folks rarely exhibit
any outward sign of their intentions.
The LIGHT Program
uses the Geriatric Depression Scale to screen
patients and start a dialogue with them about
their feelings. Fifteen questions comprise the
survey. They inquire about the person’s energy
level, satisfaction with life, and coping
mechanisms for disappointments.
If a senior tests positive for depression,
that patient can receive psychotherapy in the
same physician’s office and also schedule
follow-up screenings in the same office at three
months, six months, and a year. Ms. Veronica
Poklemba (APRN,CS-P) points out that elderly
patients don’t react well to the idea of a
psychiatrist’s office. Treating them for their depression where
they receive their primary care is more likely
to be successful. Anybody identified as depressed is
offered treatment and if transportation to a
clinic is an issue, a therapist can go into the
home of the referred patient. Project LIGHT is funded by a grant, but
Ms. Poklemba feels that a family doctor could
rent office space to a mental health specialist
just as some rent out office space to
cardiologists, dermatologists or other
The toolkit supplied by Project LIGHT,
containing stickers, posters, brochures, CD’s,
and lists of mental health providers, benefits
the physician as well as the patient. Many physicians ask their own questions
regarding depression and don’t need to pull out
the supplied list. They have appropriate questions. The goal is: screening of the elderly for
depression. The primary care doctor is not
expected to treat the patient for his/her
depression, but the idea is that he can ID the
person’s problem easily and then refer the
patient for more in-depth screening. Because Ms. Poklemba is tied into the
practice, her paperwork goes back to the primary
care doctor, and he can read her conclusions
which she leaves in the patient’s medical
record. She, too, has an accurate record of the
patient’s health problems and doesn’t need to
rely solely on what the senior may or may not
tell her about physical problems.“I make sure the doctor knows if I find
something,” she states.
Ms. Poklemba screens the patient verbally. For example, a question reads: “Has there
been any change in your usual activities?”She knows to add “in the last month.” If not, elderly patients might relate
changes in the last ten years! Veronica phrases it in a way that makes
sense to the elderly person. In addition, she studies their non-verbal
clues, such as a confused expression. Folks in
the beginning stages of dementia are with it
enough to know if they are experiencing
depression, and therapy will help them. They can sit and discuss their worries. However, if suffering from severe
dementia, the senior cannot benefit from
therapy, but sometimes taking anti-depressants
Veronica has worked with caregivers who suffer
stress from managing their elderly parents with
“heavy duty” dementia. If the caregiver gets therapy, it can
help her cope with the senior afflicted with
dementia and depression. By helping the caregiver control her
stress levels, the elder is also helped. Even an aged person with deep confusion
and rampant memory loss can pick up on the
caregiver’s stress. In a situation Veronica relates, she
asserts that when the caregiver became calmer
due to therapy, so did her mother. Veronica emphasizes that caregivers must take care of themselves
if they look after someone else. That 70-year-old didn’t understand all
the ways dementia impacted her 91-year-old
mother until Veronica gave her a book to read on
the subject. Later she remarked to Veronica, “I felt
very frustrated. Now, I understand how
changeable her abilities can be.”Some family members can think the older
person is just trying to seek attention when she
repeats the same thing over and over or when she
forgets something she seemed to know ten minutes
earlier. Therapy for the caregiver can reduce the
anxiety and worry that accompanies looking after
The focus of Project Light is two pronged: Get
Doctors inclined to screen for depression in
their elderly clientele and then get identified
people into treatment. Physicians have told Veronica that
because of Project LIGHT, people have gotten
into treatment that doctors could not persuade
into treatment for years, especially men.
All the physicians involved in LIGHT say they
screen more now, even if they use their own set
of questions rather than the Geriatric
Depression Scale supplied by LIGHT, which is
used in the study so there is a standard
approach to track data.
“Depression is something that, unfortunately,
we don’t pick up on early,” states Steven
Miller, MD at Woodholme Clinic.“In elderly patients, there are other
health issues that come to the surface, like
diabetes or heart disease,” says Dr. Miller.“While depression can be impairing, it
tends to be more hidden. Having the mental health clinician in the
office to screen patients has been a very
Studying the results of the screening of 2,563
seniors living in the Levindale service area,
one finds 251 screened positive for depression. Of the 251, 119 agreed to a treatment
program. One hundred and seven of the depressed
were treated by LIGHT’s clinical nurse
specialist, and 12 were treated elsewhere after
being identified by Project LIGHT.
Of the 107 initially treated by LIGHT, 58
could be contacted at three months. Seventy-five
percent of them showed improvement at the
three-month follow-up using the short form of The
Geriatric Depression Scale. This is a very impressive result given the
fact that a myriad of challenges arise when trying
to reach individuals for follow-up, such as
hospitalization, relocation, tragic events,
telephone disconnection, and increased dementia
interfering with their ability to answer questions.
In meeting with each practice to discuss the
LIGHT toolkit, Veronica Poklemba found high praise
for the information the kit provided: an explanation
of depression, the symptoms, the treatments, the
mental health resources, and educational handouts
for medical and lay communities.
Veronica Poklemba’s advice is: Don’t hesitate
to bring up questions about mental health with your
primary doctor. She urges, “If it’s in your head, you should
She emphasizes that a caregiver must take care of
himself in order to care for another. She advises to search online to find mental
health care providers in your area, ask your
physician for a list, and if you need names of
therapists and psychiatrists in the Baltimore
environs who enjoy working with elderly patients,
call her. [410-601-2875]
Look over the list of symptoms of depression.
If you notice these present in your loved one, ask
the doctor, “Can you determine if my loved one has
Today’s caregivers must be knowledgeable about
the proven tie between a person’s emotional
well-being and physical health. To treat only
symptoms that have a readily identifiable
physical cause is to deny a person help, hope,
and the pursuit of happiness. So, all ostrich heads must yank
themselves up into the 21st century and get
their loved ones to a program like Project LIGHT
where beauty, truth, and joy can be within the
grasp of their beloved charge—the person they
Geriatric Depression Scale
Answers indicating depression are highlighted.
Each BOLD-FACED answer counts
one (1) point. A score greater than 5
is indicative of probable depression.
|Are you basically
satisfied with your life?
|Have you dropped many
of your activities and interests?
|Do you feel happy
most of the time?
Do you prefer to stay in your
room/facility, rather than going out and
doing new things?
If none of the above responses suggests
HERE. If any of the above
responses suggests depression ask
|Do you feel that your
life is empty?
|Do you often get
Are you in good spirits most of the
Are you afraid that something bad is
going to happen to you?
Do you often feel helpless?
Do you feel you have more problems
with memory than most people do?
Do you think it is wonderful to be
Do you feel full of energy?
Do you feel that your situation is
Do you think that most people are
better off than you?
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