Older Persons' Positive Nursing Care: A Case Study on Depression

This report delves into positive nursing care approaches for older persons, particularly focusing on the challenges of depression and the importance of long-term care policies in Singapore. It analyzes the case of Mrs. Jennifer, an 87-year-old woman experiencing depression, and explores how the Six Senses Framework and various aging theories can inform effective care strategies. The report emphasizes the need for holistic, patient-centered approaches that consider the biopsychosocial needs of older adults. It also examines the implications of Singapore's aging population, relevant legislation, and the role of nurses and caregivers in providing quality care. The paper highlights the importance of social engagement, strength-based approaches, and the integration of long-term care services to improve the well-being of older persons. Finally, the report underscores the need for continuous advancements in nursing practices to meet the evolving healthcare demands of the elderly.

Running Head: OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 1
Older Persons’ Positive Nursing Care Approaches: The Case of a Depressed Older Person
Name
Institution
Date

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 2
Older Persons’ Positive Nursing Care Approaches: The Case of a Depressed Older Person
Introduction
Empirical research has established that older persons are active and independent (Rebok,
et al., 2014). However, for some, aging brings with it old age health complications and chronic
illnesses. To this end, older people are active consumers of health services and as the Singapore
population balloons, older persons will demand more healthcare services in the long term
[Ageing Planning Office, 2014]. Old age and the demand for healthcare services are positively
correlated with research indicating that older persons above the age of 70 utilize 46% of
multiday patient stays in public hospitals which significantly pushes healthcare costs up.
Singapore is fast aging with only 340,000 people being aged 65 and above in 2010. It is focused
this number might reach 900,000 people by the year 2030 [Singapore Department of Statistics,
2012].
A majority of these older persons will demand assistance in almost all the activities of
daily living (ADL)( Millan-Calenti, et al., 2010) Moreover, shrinking family sizes and an
increasing trend of empty nester households and elderly single is bound to elevate the number of
elderly Singaporeans’ requiring both social support and healthcare services. These are grave
challenges if positive nursing care approaches that cater for the needs of older persons are not
instituted especially those that cater for psychiatric disorders like depression (Seitz, Purandare, &
Conn, 2010). This paper will focus on examining the theoretical and legislative perspectives of
positive approaches to nursing care that by and large support older persons. In doing so, the
paper will draw insights from the Six Senses Framework, aging theories, and Mrs. Jennifer’s
depression case. Mrs. Jennifer is 87 years of age.
Singapore’s Aged Resident Population

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 3
Singapore like a couple of other developed countries is seriously undergoing the
challenge of an increasingly aging population. This is caused partly by increasing life
expectancies and reducing fertility rates. The Singapore Department of Statistics (2012)
estimated that the aged population increased from 3.4% in 1970 to approximately 9.9% in 2012,
the aged population is residents who are 65 years and above. This is increment is projected to
reach 18.7% by 2030. Surprisingly, the old-age support ratio declined from 13.5 in 1970 to 6.7 in
2012. Moreover, life expectancy has dramatically increased from only 65.8 years in 1970 to 82.0
in 2011[Singapore Department of Statistics, 2012]. This withstanding, the aged are faced with
unique health requirements including depression.
Legislation and Policy Implications
Following these statistics, there is a need to institute positive nursing approaches and
policies that holistically address the nursing requirements of older persons. The specific
healthcare requirements of older persons demand a global paradigm shift from the usual
episodic, hospital-centric care nursing approaches towards long-term care policies effected at the
community level (Chin, & Phua, 2016). Over the last several decades, the Singaporean
government has strived to come up with effective strategies and policies to aid Singaporeans age
gracefully. This is realization follows the clinical fact that aging comes with it socioeconomic
challenges that not only adversely impact older persons themselves but also implicates families,
the society and the government. As early as 1999, the Singaporean government had instituted
efforts to coordinate the preparation for an aging population through an inter-ministerial
committee. Initiatives such as National Wellness Programme, Re-Employment Act and senior-
friendly home modification scheme were seen as effective to cater for the healthcare and
socioeconomic needs of older persons [Ageing Planning Office, 2014].

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 4
Long-Term Care Policies
The Singaporean health care system has long adopted the long-term care system in which
older persons with wanting long-term healthcare demands can be taken care of in residential and
non-residential care settings to improve their health conditions. The long term care initiative
majorly targets older persons who require further nursing care after being discharged from a
health facility (Chin & Phua, 2016). Moreover, it caters for older persons with various severe
healthcare conditions living in community residences and who may need constant supervision or
support in their daily undertakings. The Aging Planning Office, (2014) described long-term care
as:
"A range of social and health care services to support the needs of people who are
unable to care for themselves for an extended period of time due to their chronic health
conditions. Long-term care is mainly for persons who need further care and treatment
after being discharged from an acute hospital as well as community-dwelling seniors who
may be frail and need supervision or assistance with their daily activities”
To underpin the functionality and advancement of quality long-term care nursing
services, accessibility, and affordability are critical to the older persons, families and/or
caregivers (Francesca, Ana, Jérôme, & Frits, 2011). As such, the development of individualized
long-term care services and the integration of the same with systemic and social services is
critical at advancing more holistic patient-centric care services to older persons in care centers.
This calls for the need to increase the capacity of nurses and caregivers to respond to the
different health care needs of older persons. Increasing the number of nursing homes and senior
care centers can help bridge accessibility gaps beside elevating the quality of nursing services
especially for patients with mental illnesses.

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 5
Mrs. Jennifer’s Depression Condition and the Long-Term Care Policy Interventions
From the foregoing, Mrs. Jenifer falls under the dire statistics of the Department of
Statistics (2012) in Singapore. Mrs. Jennifer is fairly aged. At 87 years of age, she fairly
surpasses the Singaporean life expectancy mark and indeed has been diagnosed with old age
mental health complications. Though she is always in the company of Brian her nephew and
Bingo her pet dog, Mrs. Jennifer is by and large lonely prompting her constant negative thought
that eventually lead to her depressed condition. Moreover, the death of her husband and the
tragic death of her two daughters some 20 years ago explain her current condition.
Due to the wanting biopsychosocial situation of Mrs. Jennifer, long-term care policies are
a favorable nursing care option for her. Premised on the responsibility of taking care of older
persons that require constant supervision and who require support in activities of daily living, the
long-term care services are bound to assist Mrs. Jennifer to significantly recover from her
depressed condition. Kaye, Harrington, and LaPlante, (2010) assert that long-term care services
are not only patient-centered by also holistic with regard to the healthcare needs of the particular
older person. They are also integrated to include systemic interventions that can help depression
patients to easily recover from their conditions.
For instance, nurses at such facilities offer comprehensive depression treatment and
management approaches like cognitive-behavioral therapies (CBT) framed in sessions that cater
to the needs of older persons. Nurses also utilize person-centered services that allow the patient
to be part and parcel of their own care by contributing on how best they think care ought to be
advanced. Moreover, nurses encourage older persons to engage in social activities that allow
them to remain integrative and connected with the social scene (Wilson, Mottram & Vassilas,
2008). With strength-based approaches, nurses are able to help older persons to exploit their own

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 6
strengths and those of the environment around them to bring their depressed conditions at bay
(Hirst, Lane, & Stares, 2013). If subjected to these psychosocial therapies, Mrs. Jennifer is bound
to recover from her condition quite effectively.
The Six Senses Framework
The tenets informing the long-term care initiative in Singapore aligns with the Six Senses
Framework as developed by Sheffield University. The six senses framework advances a
methodology meant to assist healthcare institutions and elderly nursing homes provide high-
quality elderly care (Nolan, et al., 2009). The Six Senses Framework is devised to advance older
persons with the facets they need to age gracefully. Older persons ought to be provided with
residences from where they can feel they have a sense of security. A sense of security relates to
situations in which older persons feel they are free from both physical harm and psychosocial
threats. Having qualified nurses that understand how best to instill a sense of security can go a
long way in helping depressed older persons like Mrs. Jennifer regain confidence and shun past
life. As such, a sense of security then fosters a sense of belonging which help a depressed older
person feel they are part and parcel of the community despite their psychosocial concerns.
This virtue allows the sense of continuity to take place in which case patients are able to
exploit opportunities that allow them to connect with their past to inform their future. This then
nurtures a sense of purpose in which case depressed older persons are given an opportunity to
reinvent their purpose in life and to encourage to them live by it. Providing patient-centered
services that allow nurses to connect with their patients can go a long way to this end (Seymour,
Kumar, & Froggatt, 2011). A sense of purpose then allows depressed older persons to assume a
sense of achievement for milestones they have achieved in life as well as during their recovery
period. The six senses culminate to a sense of significance in which case patients are able to lead

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 7
high-quality lives since they are more self-aware and purposeful in life (Dewar & Nolan, 2013).
If subjected to such a framework, Mrs. Jennifer's road to recovery cannot only be short but also
fruitful since she will have come to the realization that she needs to live uninterrupted life from
past life experiences.
Aging Theories
As people age, complex and multifaceted economic, physiological, social, and
psychological challenges advance which by extension explain people’s declining health,
cognitive, and physical functionality (Moberg, 2012). Factors such as losing loved ones and
contemplating death like in the case of Mrs. Jennifer can go a long way in accelerating aging.
However, when nurses are able to understand aging theories, they can be in a position to assist
older persons to navigate the challenges at their disposal. Many aging theories have been
proposed by biologist, sociologists, nurses, and physiologist.
Sociological Ageing Theories
Sociological theories of aging focus in describing how changing roles, status, and
relationships, as well as generational cohorts, impact the aging process and how older persons
adapt to old age. For instance, the Activity Theory as advanced by Havighurst and Albrecht
(1953) is of the view that for people to minimize their aging process, they are supposed to remain
active. Staying active is by extension critical at having a satisfactory late-life since prolonging
the middle age is instrumental at delaying late-life adverse effects like the ones facing Mrs.
Jennifer. The Disengagement Theory on the other hand as advanced by Cumming and Henry
(1961) is of the view that aging is a function of gradual disengagement from relationships and
the society in which case older people pave way for the younger generation to take active roles in
the society. The disengaged older adults then take time to reflect on their inner selves. However,

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 8
critics of this theory argue that disengagement from the active social scene goes against what is
perceived to be the key elements of leading successful and satisfying lives. To this end, though
Mrs. Jennifer has been suggested to be disengaged from her familiar home setting, she should
still be engaged with the community to allow her to regain her sense of significance.
Psychosocial Theories
Psychosocial theories of ageing, on the other hand, constitute some of the oldest
formulated aging theories. The theories perceive aging as an alteration of personalities, attitudes,
and behaviors. As such, aging is seen as a lifelong process with numerous transitions. The
Human Needs Theory advanced by Marlow (1954) assert that five basic human needs motivate
the human behaviors and by extension their aging process. Self-actualization which sits at the top
of Marlow’s hierarchy of needs constitutes what all older person should possess after living
through their lives. Missing to self-actualize lead to despair later in life which by extension
explain the emergence of mental disorders like Mrs. Jennifer’s depression condition.
Biological Theories of Ageing
Biological theories of ageing, on the other hand, explain the physiologic changes and
processes that happen during the aging process (Kirkwood, 2008). As such, the theories attempt
to explain the aging process from a molecular perspective by describing how the aging is
manifested in the tissues, cells, and body systems and by extension how the body and the mind
interact to affect aging. Moreover, biological theories analyze how biochemical and
chromosomes impact the overall aging process. Furthermore, biological theories also attempt to
explain the impact of the disease, injury and environmental factors on the aging process
(Partridge, 2010). Due to the varied dimensions of explaining biological aging theories, some
biological aging theorists categorize biological aging theories into stochastic and nonstochastic

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 9
perspectives (Kirkwood, 2011). Stochastic theories assert that the aging of various body cells,
organs, and systems are by and large episodic and this occurs throughout a person’s life’s time.
Damaged cells from various episodes of damage accumulate over time causing aging. On the
other hand, nonstochastic theories assert that aging is more or less programmed and that aging is
by and large a series of predetermined events that occur to all living organisms (Kirkwood, &
Melov, 2011)
The significance of Aging Theories
Aging theories have had positive implications for the practice of nursing. Psychological
theories have been instrumental in explaining both developmental challenges of older persons
and why it is significant to find meaning in life. Nurses can draw insights from these theories to
inform their nursing practice such as striving to come up with an older person's support systems
like long-term care services (Bergland, & Kirkevold 2008). Nurses can learn from these theories
on the importance of mobilizing resources that target older persons to minimize their old age
challenges. For instance, an occupational therapist can assist older persons with mental illness
like Mrs. Jennifer to adapt to a nursing home environment besides being able to come up with
psychosocial therapy care plans.
Nursing Theories
Due to the shortness of significance of both biological and psychosocial theories to old
age nursing care, nurses theorist have endeavored to address this gap by advancing nurse-
authored aging theories that align with the roles and responsibilities they perform in the care
older persons. The Functional Consequences Theory pioneered by Miller (2004) was developed
to advance a framework for catering for the needs of older adults with physical impairment.

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 10
Older persons are bound to experience biopsychosocial and environmental consequences
impacting their functioning.
As such, the role of the nurse is to critically assess older persons age-related changes and
their risk factors consequences and by extension coming up with interventions that curb age-
associated healthcare complications (Miller, Chen, & Parker, 2011). The goal of this theory is to
maximize functioning through ways and means that elevate patient safety and life quality. To
this end, this theory exploits the tenets of patient-centeredness and interprofessional nursing
practice. Despite age-related complications such as Mrs. Jennifer’s’ depression condition, older
persons can achieve quality life and positive consequences if advanced opportunities on the
same.
On the other hand, the Theory of thriving was developed by Haight et al., (2002) to help
enhance the experience of nursing home residents. Haight et al., (2002) observed that many
psychosocial factors such as depression among others curtail the thriving of older persons when
in home residents. To this end, Haight et al., (2002) asserted that the environment is critical to
the process of aging since people thrive when they are in a harmonious relationship with the
environment they are in as well as personal relationships they have with others. Mrs. Jennifer’
depression condition can be curbed when such a nursing aging theory is adopted.
Lastly, the theory of Successful Aging advanced by Flood (2006) is concerned with what
exactly it means to age well. In his deduction, Flood (2006) observes that aging gracefully is
dependent on how well older adults are able to cope with functional and physical changes they
have experienced throughout their life. Moreover, older adults have to believe that their aging
has meaning and purpose making spirituality a critical ingredient to the theory. To this end,
according to Flood (2006) aging gracefully means maintaining the solid interconnection of

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 11
physical, psychological, and social aspects with meaningful ways that are personally defined.
Mrs. Jennifer can achieve this hallmark of aging gracefully if nurses can endeavor to orient her
to this thought process. The theory successfully connects with the Six Senses Framework.
Depression Care Plan Development
Condition Description
The World Health Organisation (2018) define as
“Depression is a common mental disorder, characterized by persistent sadness and a
loss of interest in activities that you normally enjoy, accompanied by an inability to carry
out daily activities, for at least two weeks”
First Visit to a Mental Health Care Practitioner
To diagnose depression, mental health care practitioners usually ask patients and their
families/carers what the patient's symptoms are, when they started to experience them and how
they are impacting on their life and abilities to function. Mental health practitioners also assess
medical and family history.
Tests
A number of tests are conducted to ascertain depression including thyroid function tests,
depression questionnaires, physical head to toe examination, and critical vital signs,
Treatment Goals
Treatment’s primary goal is to; improve depression symptoms; elevate functionality;
eliminate suicidal thoughts and preventing relapse of depression symptoms
Treatment
Depression’s primary treatment includes psychotherapy; pharmacotherapy; social
activities or the combination of all these. Having an active lifestyle with support from friends and

OLDER PERSONS’ POSITIVE NURSING CARE APPROACHES 12
family members is instrumental in coping with depression. Moreover, medication choice will
depend on the patients’ other medical conditions, tolerance for side effects, and medication
history (Beck & Alford, 2009).
Mrs. Jennifer’s Care Plan
Assessment Nursing
Diagnosis
Patient
Outcomes Interventions Rationale
Evaluation
of Outcomes
Objective data:
-Depressed
facial
expression
-Lack of
appetite
-Appearing
tired, and
laziness
-Sleeping
difficulty
-Crying
-Lack of
concentration
-Lack of
interest in
favorite
activities
-Distorted
thinking
process
-Guilt feelings
-Hallucinations
and
depersonalizatio
ns
-Loneliness
Depression Mrs. Jennifer will:
1. Identify feelings leading
to depression and impaired
social interaction
2. Build a trusting
relationship with family
members and friends
3. Use adaptive coping
mechanisms to recover such
as resilience
4. Improve self-esteem and
desist from suicidal
thoughts
5. Follow medication
prescription such as
serotonin correctly and
precisely;
6. Will actively participate
in their own care by
providing alternative
treatment interventions
7. Attend psychotherapy and
participate in social
activities; verbalize
enjoyment of interacting
with others in a month’s
time
8. Showcase progress in line
with the Six Senses
Framework
1. Encourage Mrs. Jennifer to
talk about her inner feelings in
an empathetic manner
2. Listen to Mrs. Jennifer's
commentary empathetically;
Cross-examine her in a low
tone but clearly, concisely and
easy to understand gesture;
Interact with her often; Use
non-verbal languages such as a
nod or touch
3. Advance feelings of
encouragement; Suggest and
give Mrs. Jennifer a chance to
choose amongst various coping
mechanisms;
4. Assist Mrs. Jennifer that she
can overcome despair; Help
identify internal and external
sources of hope such as peer
relationships and beliefs.
5. Discuss medication’s details
with Mrs. Jennifer and carer
including name, dosage, side
effects; Assist Mrs. Jennifer on
how to be taking medication.
6. Encourage Mrs. Jennifer to
suggest how best care ought to
be given
7. Institute Cognitive
Behavioral Therapy (CBT)
sessions to improve Mrs.
Jennifer’s self-esteem; Make
her participate in social
activities; Exploit strength-
based approaches to identify
Mrs. Jennifer’s’ internal and
external support systems.
8. Encourage Mrs. Jennifer to
develop a sense of security,
belonging, continuity, purpose,
achievement, and significance
through various psychosocial
1. Identifying factors
leading to depression
forms a basis of
determining optimal
treatment and
management
intervention
2. Reestablishing trust
in relationships makes
depressed people feel
more secure and
wanted
3. Adaptive coping
mechanisms help
depressed people to
develop resilience
courage to face life
challenges
4. Developing self-
esteem encourages the
adoption of the six
senses framework in
the recovery process.
5. Following
medication strictly
elevates the speed of
recovery from
depression
6. Patient-centered
care help precisely
identify how exactly to
advance nursing
interventions
7. Psychotherapy
including CBT and
social activities help
elevate the self-esteem
of patients
significantly leading to
recovery
8. The Six Senses
Framework presents a
good outline to
1. Mrs. Jennifer is
able to vividly talk
about past
experiences and
showcases intent of
moving on with her
life
2. Mrs. Jennifer is
able to freely engage
with family
members and
friends
3 Mrs. Jennifer
socializes more and
enjoys her favorite
TV program; She is
ready to focus with
her future despite
past life concerns
4. Mrs. Jennifer
present more self-
esteem and is more
self-aware; Suicidal
thoughts have been
erased
5. She follows
medication precisely
6. Mrs. Jennifer
suggest to be
subjected to CBT in
the evening session
rather than in the
morning since she
have a difficulty in
waking up early
7. Mrs. Jenifer
showcases proactive
participation during
CBT sessions and
social activities
8. Mrs. Jennifer
gradually develops a
sense of significance
Subjective data:
-Worthlessness
-Hopelessness
-Suicidal
thoughts
Medical
Diagnoses:
-Emaciation
and skinny
- Poor skin
turgor
-Dehydration
-Weight loss