Cardiologists, other doctors and long term care
staff might be missing the big picture as one survey suggests
that only a third of heart disease patients with serious
symptoms of depression or anxiety get any treatment.
The findings are significant because psychological problems have
been linked to poorer health and higher death rates in heart
disease patients. Unfortunately, long term care residents and
other heart patients just aren't being screened because
physicians are just focused on the heart disease and don’t think
about other factors that could contribute to the condition.
We know that heart attack survivors suffer from psychological
distress twice as much as the general population and, with
congestive heart failure patients, who are often residing in
nursing homes, the figure is twice that…Staggering!
However, only about one third of heart disease patients who report the
symptoms are ever treated by a mental-health provider. This is
appalling because research suggests that psychological problems
often contribute to the onset of heart disease and worsen its
It's not entirely clear how psychological distress
and heart disease are connected. However, there is some
speculation that psychological symptoms may contribute to blood
clots or make the heart beat less efficiently.
Since the overwhelming amount of long term care residents are women, it’s
important for staff to note that women with mild and moderate
depression are 50 percent more likely to have heart attacks than
are other women.
It’s also crucial to note that depression and
anxiety are frequent responses to traumatic events, such as the
life-threatening and chronically debilitating illnesses, which
are often seen in long term care settings. The seriousness of
these symptoms is usually proportional to their duration and
depth and the degree to which they compromise the resident’s
life quality and/or participation in the treatment process.
Triggers for referral for a psychological evaluation include
symptoms that have continued for more than two weeks or
significantly impair functioning, life quality or participation
in prescribed treatment programs.
The role of heart doctors in
detecting psychological problems in their patients who are long
term care residents is a big problem. They often don't have
time because of the new emphasis on quick turnaround and high
productivity. That places the onus squarely on the long term
care staff who see the resident every day.
One remedial protocol to identify the residents who really need help might be
for nurses and other staff members to help screen residents
before they meet with their cardiologists. Neglecting
identification and treatment of psychological symptoms in
residents with heart disease is very unfortunate because doctors
now have effective tools to treat psychological problems, which
might lead to a lessening of both the psychological distress and
Copyright 2005, M. Shery http://www.nursinghomes.md/
Dr. Michael Shery is the founder of Long Term Care Specialists in Psychology, a mental health firm specializing in consulting to the long term care industry. Its
website, http://www.NursingHomes.MD provides state-of-the-art mental health treatment, facility staffing and career information to long term care professionals. To get a copy of the special report, “How to Reduce Resident Agitation Using Strength-Embedded Counseling,” email: firstname.lastname@example.org and put “Special Report” in the subject field.
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