Depression can appear anytime along the caregiving continuum and must be addressed by the team. Depression can be assessed easily by two simple questions:
(1) During the past month, have you often been bothered by feeling down, depressed, or hopeless?
(2) During the past month, have you often been bothered by little interest or pleasure in doing things? These questions have been studied and repeatedly demonstrate accurate identification of depression.
Nurses should ask these questions to the caregiver and the patient and document the findings. If the questions are answered in the affirmative, the caregiver should be referred to his/her primary healthcare practitioner for assistance with addressing the depression symptoms. The patient's primary physician should also be consulted and alerted to the patient's symptoms of depression if this is a new or unaddressed problem.
What is the solution? Here is a good one, especially with the Canadian dearth of geriatricians, many of whom are not particularly adept at handling palliative care.
Hospice and palliative care: The time to get involved is now
Physician Assistants, as well as Nurse Practitioners.
These people can act as midwives or doulas, and support the family in ways that never have been done before. There is no reason that family members should suffer as much as the palliative patients, with all the information and the supports that are out there. There is no reason for palliative patients to be in pain.
We should demand Pain Management Kits, moral, spiritual and emotional support.
Unfortunately, by the time a patient is dying, much of the damage has been done. Caregiver stress is a huge burden on society. Until we are granted more support, and we regulate the home care, health care industry, adult children and caregivers will continue to suffer and burn out.