Problem-Intervention-Comparison-Outcome-Time (PICOT) Approach to Nursing Research

Problem-Intervention-Comparison-Outcome-Time (PICOT) Approach to Nursing Research

Introduction

Problem-Intervention-Comparison-Outcome-Time (PICOT) is a strategy that aids in formulating clinical questions and provide guidelines in the search for evidence. PICOT approach helps find detailed evidence in a quicker, effective, and more efficient way. PICOT act as an evidence-based model in the framing of questions, carrying out assessment and evaluation in an orderly manner (Kang, Zou, & Weng, 2019). The paper attempts to develop a PICOT plan focusing on depression in the geriatric mental health population and carry out research on non-pharmacological mechanisms such as exercise food and social support that can help mitigate the condition. Geriatric health care is concerned about promoting health and providing treatment to ailments and disabilities that occur with old age. Depression is a dominant neuropsychiatric syndrome in neurodegenerative disorder (ND) familiar with the ageing population. One individual turns into 60 years in an estimate of eight seconds, with nearly 15% of the world’s population above 65 years as of 2015 (Manning, Gunning,  Aizenstein, & Steffens, 2019).  Statistics show that depression as a physiatric disorder affects approximately 18.8 older adults each year (Conner et al., 2015). In 2012 around 15% of adults aged above 65 years had developed the depressive disorder, a number that may double by 2030 due to higher life expectancy (Federal Interagency Forum on Aging-Related Statistics (the US, 2019. Pharmacological measures had been adopted for treatment purposes with very little outcome in the outcome in depression relief among the geriatric population; hence the emphasis on non-pharmaceutical initiatives is highly encouraged(Zubala et al. 2017). Physiotherapy is among the preventive measures that can bare promising results. Non-pharmacological initiatives such as behavioural therapy (CBT) and solving therapy (PST) should, therefore, be implemented to provide preventive measures against geriatric depression, which is a common medical condition among the ageing population.

Problem Statement

Need Statement.

Older adults are in danger of experiencing depression compared to the young generation. One individual turns into 60 years in an estimate of eight seconds, with nearly 15% of the world’s population above 65 years as of 2015 (Manning, Gunning,  Aizenstein, & Steffens, 2019). Research shows that Americans are living longer with a life expectancy of more than 75 years (Rao, Praveena, & Rao, 2010). Geriatric mental health disorder is a reasonable condition in unhealthy ageing. Bipolar disorder (BD), which is the most common geriatric mental health problem, affects more than 1% of the population, translating to adverse neuropsychological impairments (Rao, Praveena, & Rao, 2010). Depression is a dominant neuropsychiatric syndrome in neurodegenerative disorder (ND) familiar with the ageing population. Nutrition and exercise play a fundamental role in successful ageing. Carrying out education and preventive measures to the neuropsychiatric syndrome in Neurodegenerative Disorder (ND), which results from ageing, is therefore recommended approach. The anticipated growth in the older population with mental disorder triggers the need for strategies to guarantee systematic and effective implementation of evidence-based practices.            Reaching all the elderly people and educating them will, however, pose some challenges (Warmerdam et al., 2010). Most elderly people have restricted movements and maybe conservative when it comes to adopting new lifestyle practices. However, the program will adopt a flexible routine and make use of technology such as online therapeutic lessons to educate and sensitize a large number of individuals.

Population and Setting

Neuropsychiatric syndrome in Neurodegenerative Disorder (ND) is familiar with the older people. The problem is common among individuals over 60 years. According to WHO, 20% of adults above 60 years experience cerebral and neurological disorders with dementia and depression, affecting 5% to 7% of the group (WHO, 2020). Anxiety disorder affects an estimate of 3.8% of the older population resulting in about 26% of deaths by self-harm for people above 60 years (WHO, 2020). The program will, therefore, be implemented for individuals above 60 years of age. Several studies have shown that most individuals in this age bracket are conservative and not open to new ideas (Warmerdam et al., 2010). The task team will, therefore, be trained in the best way to handle geriatrics, especially those who are suffering from depression and dementia.

Intervention Overview

Depression in the geriatric mental health population can be reduced through non-pharmacological initiatives such as psychotherapy and psychosocial efforts. Psychotherapy and psychosocial programs will be launched, applying innovative internet-based multicomponent psychotherapy approaches. Several studies have shown a promising outcome of psychotherapy as a preventive model compared to treatment (Lee et al., 2012). Some of the predominant psychotherapy initiatives include Cognitive Behavior Therapy (CBT) and Problem Solving Therapy (PST). CBT is concerned with dysfunctional perceptions and levels of activity, which aid in restructuring the mind and, eventually, behavioural change (Leggett & Zarit, 2014). PST is a behavioural initiative that reduces depression through problem appraisal and educating on adaptive skills. Other intervention approaches involve psychosocial or exercise, which is less regulated compared to pharmacotherapy and psychotherapy initiatives. The approaches pose a promising result in the prevention of depression in the geriatric mental health population.

Comparison of Approaches 

The alternative approach to addressing the health condition is pharmacological prevention. The pharmacological intervention involves the use of antidepressants (ADS). However, the use of ADS has been attributed to the re-occurrence of depression across several considerable portions of the older population (Denihan et al., 2015). It is also essential to note that the application of ADS as a treatment to stress an expensive undertaking that may not guarantee full recovery. Nonpharmacological preventive measures are therefore recommended in treated depression in the geriatric mental health population. PST and CBT approach suggested in this research are inexpensive undertakings which have a significant effect in reducing and preventing depression. Also, prevention is better than cure. While Pharmacological intervention is the primary treatment, PST, CBT, exercise, and nutritional improvement are preventive measures that are expensive and effective.

Initial Outcome Draft 

The PST, CBT initiatives will significantly reduce the cases of depression in the geriatric mental health population, acting as preventive and curative measures. CBT will significantly restructure dysfunctional thoughts and ultimately result in behavioural change towards reducing stress. PST will equip individuals with skills to deal with stress, which will, in the long run, minimize depression cases among older adults. Physical exercise will work in improving moods and therefore promote tolerance, which is essential in fighting depression. The ultimate goal of the program will, therefore, be decreased cases of depression in the geriatric mental health population.

Time Estimate

            Program development and implementation will take roughly 12 months. The program will involve training personnel and carrying out seminars across the country to teach the older population on how to carry out PST, CBT, exercise as well as appropriate nutrition. The trained personnel will provide guidance and advice to the target group. The timeline could be affected by technique issues such as financial constraints and will depend on the response accorded by the respondents. The 12 month period, however, provides enough time for program implementation factoring all other phenomenons that may derail us from the course.

Literature Review

Depression in the Geriatric Mental Health Population

Depression is a significant public health concern among the elderly resulting in increased mortality and morbidity. Statistics show that depression as a physiatric disorder affects approximately 18.8 older adults each year (Conner et al., 2015). In 2012 around 15% of adults aged above 65 years had developed the depressive disorder, a number that may double by 2030 due to higher life expectancy (Federal Interagency Forum on Aging-Related Statistics (the US, 2019: Jeste, 2019). The population aged between 60 years is growing up, and it is anticipated to be more than 2.1 billion, with about 10% of them suffering from a mental disorder (Voshaar et al., 2019). Despite the alarming number, very few older adults are willing to seek professional mental checkups for treatment, which raises concerns about the number that may be already suffering in silence. According to some studies done on 350 respondents between 60 and 90 years, 85% endorsed to have once experienced depressing moods for a day with 42% confessing to having been depressed down for almost a week while 56% of them had never seen a health professional (Conner et al., 2015). Besides, only 18% confessed to being amenable to explore mental treatment in the future, with 82% of the respondents not likely to seek mental health care.

Effects of Depression on Elderly People

Depression affects older people quite differently compared to young ones. Depression is associated with other illnesses in older people who cause disabilities and lasts quite long. Elderly people have declined physiological reserves, which make them susceptible to diseases ranging from mild fever, dehydration, gastroenteritis making them polypharmacy (Kaiser, 2015). Older people are likely to experience a complication with hearing and vision, vascular and respiratory system as well as gastrointestinal problems. Depression in elderly people tags along with complications such as cardiac diseases and may result in death more quickly compared to young people. According to research conducted among elderly patients with elevated depressive symptoms, 19.9% of them suffered some form of cardiac problem, which shows that individuals suffering from depression are susceptible to a heart attack or related complications (Hornung et al., 2019). The study concluded that elderly people suffering from depression are at more risk of death or associated complications compared to young people. It is, therefore, recommend ensuring that elderly people suffering from any form of depression receive appropriate medical care.

Depression is further associated with suicide. The suicidal rate of individuals between 80 and 84 years is more than 50% of the general population, making it a significant health concern(Franklin et al., 2017). Besides, advancing age is associate with limited social support due to retirement, loss of a spouse through death, which acts as triggers of depression. The elderly in the society are therefore in higher risks of developing the complication compared to the young generation.

Approaches to Reducing Depression in the Geriatric Mental Health Population

With an increasing number of elderly people globally, a lot of effort should be directed towards preventive measures of adult mental disorder than treatment. Prevention measures can reduce the cost of health care and significantly lower mental illness incidences through the enhancement of well-being and proper functionality. Physiotherapy is among the preventive measures that can bare promising results. Effective measures include behavioural therapy (CBT) and solving therapy (PST)  (Leggett & Zarit, 2014). According to studies conducted to investigate the effect of CBT on elderly patients, after the patients were allowed taken through therapy sections, Geriatric Depression Scale experienced a significant drop within six months, and none of the participants developed MDD (Leggett & Zarit, 2014). The results prove that CBT is an incredible preventive of geriatric depression.

PST approach is aimed at reducing depression through teaching solving and adaptive skills. According to studies carried out on 3530 patients in randomized trials comparing PST and pharmacotherapy, PST was found to be more effective than other therapies (Cuijpers, 2018). According to different studies conducted on 221 respondents aged above 65 years and above,  61% of participants had reported suicidal ideation (SI); however, after the PST program of 1 week, the number reduced significantly among the elderly population (Gustavson et al., 2016). .PST is, therefore, a promising approach to older adults with suicidal ideation. Other innovative multicomponent psychotherapy measures are also helpful in reducing depression in an ageing population. According to studies carried out among 119 participants who participated in the CWD course aged between 55-85 years, the benefits of the approach were noticeable after 14 months in which 83% of respondents with MDD and anxiety disorder recorded a remarkable improvement (Haringsma et al. 2006). The course is beneficial to individuals suffering from severe depression, and treatment acceptance is overwhelming. Physical exercise similar causes improvements in mood and has a preventive advantage on MDD. Studies show that high-density resistance training, wait-list control, and aerobic training pose relief to both mild and more expressed depression symptoms (Franklin et al. 2017). It is therefore recommended to employ preventive approaches in the prevention of depression in the elderly population.

Conclusion

In conclusion, preventive measures such as Cognitive Behavior Therapy (CBT) and Problem Solving Therapy (PST) exercise can help promote the mental health of elderly people and save on the cost of treatment. Old people are at risk of suffering from depression compared to the young generation. One individual turns into 60 years in an estimate of eight seconds, with nearly 15% of the world’s population above 65 years as of 2015. Some of the predominant psychotherapy initiatives include Cognitive Behavior Therapy (CBT) and Problem Solving Therapy (PST). CBT is involved with dysfunctional beliefs and levels of activity, which aid in restructuring the mind and, ultimately, behavioural change. PST is a behavioural initiative that reduces depression through problem appraisal and educating on adaptive skills. The interventions pose a promising result in the prevention of depression in the geriatric mental health population. Program development and implementation will take roughly 12 months. The program will involve training personnel and carrying out seminars across the country to teach the older population on how to carry out PST, CBT, exercise as well as appropriate nutrition.

References

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