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Depression
in Older Adults
PSYCHIATRIC
MENTAL HEALTH INTERVENTIONS
Lenore
Kurlowicz, PhD, CS, RN
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Part
of the unique cachet of the School of Nursing
stems from its key partnerships with the Hospital
of the University of Pennsylvania (HUP). Undergraduates,
graduate students, and clinician educators,
like Lenore
Kurlowicz, PhD, CS, RN (Assistant Professor
of Geropsychiatric Nursing), are involved
with direct patient care, yet also view these
hospitals as fertile ground for education
and research. For example, in a study of older
hospitalized patients with clinically significant
depressive symptoms or delirium, the use of
clinical consultation was examined for its
impact on outcomes of care (Kurlowicz, 2001).
Based
on 103 clinical consultation records of older
patients consecutively evaluated by a Psychiatric
Consultation Liaison |
|
Dr.
Lenore Kurlowicz |
Advanced
Practice Nurse (PCLN) over a 12 month period, Dr.
Kurlowicz found that 30 percent had clinically significant
depressive symptoms and 33% scored positive for delirium.
The question was, what is the utility of an APN intervention
with this population?
Tailor-made
interventions by the PCLN were carried out in collaboration
with the unit-based staff nurses, to help them identify
and care for depressed and delirious patients, as
well as understand the impact of age on overall
behavioral responses to illness and hospitalization.
Through the intervention of the PCLN, placement
following hospitalization resulted in more appropriate
rehabilitation and psychiatric home care. Dr. Kurlowicz
also reported that staff nurses benefited from intradisciplinary
collaboration with the PCLN, which, in turn, may
also influence positive outcomes for patients. Dr.
Lenore Kurlowicz and her colleagues Freida Hopkins
Outlaw, DNSc, CS, RN, and Lois Evans, DNSc, FAAN,
RN conducted another exploratory study (Cotroneo,
et al 2001) of depressive symptoms among older,
frail people of African descent analyzing clinical
data gathered from The Collaborative Assessment
and Rehabilitation for Elders (CARE) program.
Using a self-report tool for geriatric depression,
findings suggested that many older, frail African
Americans experience clinically significant depressive
symptoms. Of special value was the discovery that
all of the items on the self-report instrument discriminated
for depression in this elderly group, providing
preliminary support for use of the instrument when
screening for depression in a frail African American
population.
Lenore
H. Kurlowicz PhD, RN, C, is Assistant Professor
(CE) of Geropsychiatric Nursing, HCGNE faculty,
Course Director, Mental Health & Aging; Geropsychiatric
Consultation Liaison, Hospital of the University
of Pennsylvania. To
learn more about research on geropsychiatric
nursing interventions at Penn Nursing, please contact
Dr. Lenore
Kurlowicz.
| FUNDING |
Lenore
Kurlowicz and
Margaret Cotroneo |
NINR/Pilot |
Outcomes
of Nurse Managed Depression
in Primary Care
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| SELECTED
PUBLICATIONS |
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Kurlowicz,
L. H. (1991). Psychiatric consultation-liaison
nursing interventions with nurses of hospitalized
AIDS patients. Clinical Nurse Specialist,
5, 124-129.
Kurlowicz,
L. H. (1993). Social factors and depression
in late life. Archives of Psychiatric Nursing,
1, 30-36.
Kurlowicz,
L. H. (1994). Depression in hospitalized medically
ill elders: Evolution of the concept. Archives
of Psychiatric Nursing, 7, 124-126.
Kurlowicz,
L. H. (1997). Barriers to recognition of depression
in hospitalized older adults. IMAGE,
29, 96.
Kurlowicz,
L. H. (1998). Perceived self-efficacy, functional
ability, and depressive symptoms in older
elective hip surgery patients. Nursing
Research, 47, 219-226.
Kurlowicz,
L. H. & Streim, J. E. (1998). Measuring
depression in hospitalized, medically ill
older adults. Archives of Psychiatric Nursing,
8, 209-218.
Cotroneo,
M., Kurlowicz, L.H., Outlaw, F.H., Burgess,
A.W., & Evans, L.K. (2001) Psychiatric
mental health nursing at the interface: Revisioning
education for the specialty. Issues in
Psychiatric Mental Health Nursing, 22,
549-569.
Kurlowicz,
L.H. (2001). Benefits of psychiatric consultation
- liaison nurse interventions for older hospitalized
patients and their nurses. Archives of
Psychiatric Nursing, 15, 53-61.
Kurlowicz,
L.H., Evans, L.K., Strumpf, N.E., & Maislin,
G. (2002). A psychometric evaluation of the
Cornell Scale for depression in dementia in
a frail nursing home population. American
Journal of Geriatric Psychiatry, Sept./Oct.,
Vol 10 (5).
BOOK
CHAPTERS
Kurlowicz,
L. H. (1998). Psychiatric consultation-liaison
nursing. In A. W. Burgess (Ed.), Advanced
practice in psychiatric nursing. (pp.
239-255). Stamford, CT: Appleton & Lange.
Kurlowicz,
L. H. & NICHE Faculty. (1999). Depression
in elderly patients. In I. Abraham, M. M.,
Bottrell, T. Fulmer, & M. D. Mezey (Eds.),
Geriatric nursing protocols for best practice
(pp. 111-130). New York, NY: Springer Publishing
Co.
Kurlowicz,
L. H. (i2001). Depression measurement instruments.
In M. D. Mezey et al. (Eds). The Encyclopedia
of Elder Care: The Comprehensive Resource
on Geriatric and Social Care (pp. 210-212).
New York: Springer Publishing Co.
Kurlowicz,
L.H. 2001. Delirium and Depression. In N.E.
Strumpf & V. T. Cotter (Eds.). Clinical
Practice Guidelines for Advanced Practice
Nurses Wroking with Older Adults. New
York, NY: McGraw-Hill.
EDUCATIONAL
VIDEO
Roose,
S., Morrison, M.F., Kurlowicz, L.H., &
Pfeiffer, E. (2000). Management of geriatric
depression complicated by comorbid illness.
American Association of Geriatric Psychiatry
Press. Washington, DC.
The
Mini Mental State Examination (MMSE)
( http://www.hartfordign.org/publications/trythis/issue03.pdf)
The
Geriatric Depression Scale (GDS) (http://www.hartfordign.org/publications/trythis/issue04.pdf)
Psychiatric
Comorbidities: Diagnostic & Treatment
Challenges
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