Learned Helplessness in Geriatric Patients
As healthcare providers we care for individuals who are in the most vulnerable moments of their lives. In the acute care facility the large majority of these patients are of the elderly population who have suffered from a physical, mental, or emotional loss. These are patients who typically require high levels of care. Because of this it is necessary for the nurse to determine is this a true vulnerability or a learned helplessness? When a patient is suffering from a learned helplessness (LH), it is the responsibility of the healthcare team to work as one and assist the patient in returning the baseline functionality through interventions such as physical therapy, occupational therapy, and targeted education. Often times LH is passed off as a normalcy of aging or certain disease processes, when in actuality we, as healthcare providers, are contributing to this behavior. Nurses are in a position to assess the patient to determine whether a LH behavior has been developed and help with the return to baseline function levels if this is the case.
Rationale for Concept Selection
Those who do not have much experience working within this group often label the geriatric population as “dependent” or “helpless”. What many people do not realize is that we hinder the ability of these individuals by constantly assuming the lead role in tasks and not allowing the geriatric person to attempt to complete the task alone. Learned helplessness can lead to a person becoming completely dependent and lead to other deficits as well (Faulkner, 2001). Because of this we must strive to identify those who are learning helpless behavior and redirect the concentration to the ability to complete tasks and change outcomes.
Concept Definition
The definition of LH varies depending on the population in which it is referring. For the purposes of this analysis it was viewed from the perspective of the geriatric patient, or those who are sixty-five years of age or older. According to Seligman (1992), LH is a psychological condition where an individual, such as a geriatric patient, has learned and become accustom to acting in a helpless manner, even when they have the ability to change the outcome of the situation. As we provide care for these patients, we must learn to differentiate between appropriate moments to encourage independence and those where providing assistance is appropriate.
Analysis of the Concept
When analyzing this concept the amount of information retrieved related to LH in the geriatric population is extensive. With the increase in the population related to the “baby boom” generation, there is an even greater need to have a better understanding of LH, how it effects the overall health of these individuals, and how it can be prevented. By taking a more in depth look at what leads to this feeling of inability to change a situation, these questions can be accurately answered.
Aim of Analysis
As nurses we consider ourselves natural helpers. Often we find ourselves offering unrequested and unneeded help, especially to geriatric individuals. By doing so it seems that we are fostering frailty and encouraging helpless behavior. Research has shown that learned helplessness induces dependence in the older adult, this in turn leads to deficits cognitively, motivationally, and emotionally (Faulkner, 2001). Many times when patients reach these levels it requires an extended period of rehabilitation in order to restore baseline functionality, if this can be achieved again. Increased education of the nursing staff is beneficial in these situations. By identifying the early signs and antecedents of LH it may be possible to prolong or prevent this life-altering occurrence.
Antecedents to Learned Helplessness
Learned helplessness is not an expected part of aging, although society tends to portray it in that sense. Typically there is a single or string of events that lead to the patient becoming dependent, known as an antecedent to LH, on a caregiver for what is intended to be a short period of time (Faulkner, 2011). Instead of working toward a goal of returning to a previous baseline of functionality, the caregiver unknowingly encourages dependence. Faulkner (2011) mentions that patients are typically disempowered upon any admission to the hospital, but with the geriatric population this disempowerment can have greater consequences. There are numerous examples of these events, but one of the most common is a hip fracture in an elderly patient. Evidence shows that a hip fracture reduced life expectancy by an average of 1.8 years and approximately seventeen percent of the remainder of the patient’s life is spent in a skilled nursing facility (Braithwaite, Col, & Wong, 2003). During this hospitalization the patient’s level of control is decreased which makes them appear to need more assistance (Faulkner, 2011). Because of this patients become dependent on others for assistance with activities of daily living and this eventually develops into a learned helplessness. Other antecedents to LH include uncontrollable circumstances, such as decreased mobility and increased number of hospitalizations due to chronic disease processes (Faulkner, 2011). Both of these examples increase in occurrence as the population age increases and with the baby boom generation reaching the geriatric age group healthcare professionals will see an increase in the number illnesses that have the potential to precede LH.
Defining Attributes
The long-term effects, or attributes, of LH can be from mild to severe and decrease the ability to preform activities of daily living in a patient who was recently living independently. From the bedside nursing standpoint we see first hand how LH effects individuals. Patients who suffer from LH often fall into a cycle of procrastination, frustration, and develop low self-esteem (Faulkner, 2001). The patient procrastinates tasks that were previously simple to perform. Once the tasks are initiated the patient becomes frustrated by the difficulty in doing so, low self-esteem is developed, and the cycle continues. Once low self-esteem is developed, depression is often seen (Faulkner, 2011). Depression is most often seen in individuals who have been in a long-term care facility for seven weeks to six months (Barder, Slimmer, & LeSage, 1994). This is an expected length of stay time for individuals who have experienced certain disparities such as hip fracture (Braithwaite, Col, & Wong, 2003), which is unfortunately a common occurrence in the elderly. By identifying these signs early, it could be possible to halt the progression and reverse the LH that has already developed.
Education of family members is another important aspect of providing care and assisting these individuals in returning to a level of functionality in which they wish to obtain. Sherman (2009) encourages healthcare workers to discuss with family members that resuming activity is a collaborative effort and the family members must be wiling to work with healthcare staff in order to provide the best care possible. When individuals understand why they are being ask to behave in a certain way, it makes the transition to this change more acceptable. This is why we must educate every family member or caregiver that will be involved in patient care.
Summary and Analysis of Empirical Referents
Empirical referents are measurable ways of demonstrating the occurrence of the concept, or learned helplessness. With LH, empirical referents can best be seen when analyzing related depression. Depression is one of the main problems seen in those suffering from learned helplessness (Barder, Slimmer, & LeSage, 1994). This is often times overlooked as a normal part of aging, when in reality it is not. The reduction in functioning is the typical cause of depression in the elderly population (Hedberg, Gustafson, Alèx, & Brulin, 2010). Screening and questionnaires can be used to test levels of depression and compare responses over a six-month period to evaluate trends or changes that warrant medical attention. One of the most developed scales for this age group is the Geriatric Depression Scale-15 (GDS-15); this scale is found to have a very high sensitivity and is specific in diagnosing the degree of depression (Hedberg et al., 2010). Another method of determining depression in the elderly is the Depression Rating Scale. This scale is closely related to the GDS-15 in regards to reliability and validity (Huang & Carpenter, 2011). Depression effects nine percent of the elderly population (Areán, Mackin, Vargas-Dwyer, Raue, Sirey, Kanellopolos, & Alexopoulos, 2010); because of this it must be identified early and prevented from causing complications with everyday life.
Summary and Analysis of Consequences
The consequences of LH are numerous and of a wide variety. These range from motivational deficits, cognitive deficits, and emotional deficits (Faulkner, 2001). In patients with motivational deficits it is noted that these individuals have a low likelihood of initiating voluntary responses, such as preparing ones meals and caring for ones laundry. They learn to depend on others to perform these activities of daily living. Cognitively these individuals are effected because they forget the necessary steps to preform specific tasks. As they forget the skills necessary to do so, it becomes inevitable that they are dependent. As healthcare providers we must determine a baseline level of cognitive status, whether this be information from the patient or family, in order to ensure the patient achieves this baseline functionality once again (Cleaveland & Denier, 1998). Finally, an emotional deficit is reached because the forgetfulness and lack of independence that has been reached. There is a direct correlation between depression and physical illness (Huang & Carpenter, 2011). For example, falls rates of hospitalized patients range between 4-20% and patients who have previously fallen have a 32% chance of falling again (van Harten-Krouwel, SchuurmansEmmelot-Vonk, & Pel-Little, 2011). Geriatric individuals often become depressed and appear with a flat affect after a period of time with limited independence (Faulkner, 2001).
Case Illustration
When analyzing specific concepts, such as LH, it is important to review different scenarios, or cases, to have a better understanding of the case. When doing this, it is important to delineate antecedents, attributes, and consequences in regards to the individuality of each case. For this purpose three different cases will be reviewed.
Dr. Sherman, a professor of geriatrics and medicine, shares his mother’s medical experience in a letter to the editor section of the geriatrics journal. In 2009 he discussed her battle with LH and how he assisted her in this fight. He explained that over the past several years she has suffered from a broken hip due to a fall, paralysis of her left arm and hand due to a left brachial plexus injury, and a stage four-pressure ulcer in her axilla, which was related to the fall. The fall would be the antecedent for this case. In the initial stages of her rehabilitation attributes included inability to perform activities of daily living that were previously done with no difficulty. To ensure that his mother did not suffer from learned helplessness, he made three specific efforts to encourage dependence. The first was with feeding: though she was too weak to feed herself, he placed a spoon full of food in her hand and guided her in the process of feeding herself. Secondly, he would not allow her to move via wheelchair only. Though the wheelchair was available when needed, he encouraged her to walk with assistance to reach desired destinations within her rehabilitation facility. Finally, he encouraged her to make and provide input on financial decisions that were to be made on her behalf. Though he and his brother had Power of Attorney and overall financial control, she was still encouraged to provide her opinion on decisions. By doing this his mother’s recovery time was half of what was originally anticipated. If Dr. Sherman had not worked so aggressively with his mother the consequences of her falls had the potential to be numerous. Though this is not the case in all scenarios of LH, we must learn to help as needed, and not just assume that every elderly adult requires assistance with the simplest of tasks.
Borderline case. In a 2012 study by Ní Mhaoláin, Fan, Romero-Ortuno, Cogan, Cunningham, Lawlor, and Kenny, the fear of falling and the possible health problems related to in geriatric patients was studied. The fear of falling, which in this case is considered the antecedent to LH, was measured in 301 participants by having them to complete the Modified Falls Efficacy Scale it was possible to assess anxiety, depression, loneliness, personality factors and cognition. Though these patients had never actually suffered from a fall, the results showed that those who were considered frailer were more effected by the thought of falling. Different levels of depression had already been developed related to the possibility of the fall and some of the patients were undergoing pharmacological treatment for this depression. These patients were often suffering from LH before an event had ever occurred. The results from this study reiterated the fact that healthcare providers must screen and identify those who are considered frail and at risk for falls. It is then the responsibility of that provider to ensure that the patient feels safe and understands that multiple steps are taken to ensure that a fall does not occur.
There are multiple cases that analyze patients who have ha suffered a hip facture and the related disabilities related to the fracture. Beaupre, Jones, Wilson & Majumdar, (2012) studied patients who were one-year post hip facture to determine their quality of life and level of function. The individuals involved in the study were asked to complete a Functional Independence Measure Motor score to determine level of functionality. At the one-year mark only one third of the individuals who were still alive had returned to a functional level comparable to that of pre-hip fracture. Forty-eight percent of those who were ambulatory prior to the hip fracture were no longer ambulatory and the overall mortality rate was nearly fifty percent. Lack of ability to ambulate and mortality are both attributes of the hip fracture. The lack of mobility increases the risk of consequences, such as depression, which was previously discussed.
Implications for Advanced Practice
The geriatric population is one that is extremely vulnerable; therefore nurses must have heightened assessment skills when caring for these individuals. Prevention is the key when learned helplessness may be an obstacle for a patient (Faulkner, 2011). By identifying those who are high risk and the antecedents of learned helplessness this is a realistic goal. It is recommended for healthcare providers to provide preventative measure for those who have been identified as a high risk for falls (In Mhaoláin, Fan, Romero-Ortuno, Cogan, Cunningham, Lawlor, & Kenny, 2012). For those whom we do not achieve prevention, the healthcare team as a whole must strive to return the patient to a baseline functionality. The nurse practitioner is in the position to collaborate this care and involve the additional members of the healthcare team, such as physical or occupational therapy, to improve patient outcomes. By doing so the healthcare provider has an opportunity to reduce the numerous consequence possibilities that can lead to further healthcare deficits.
Summary of the Analysis
Geriatric patients suffer from life altering illnesses on a daily basis. Because of this healthcare providers must realize that they are in a position to influence the outcome of the patient’s care and overall well-being. By identifying those who are at risk for LH and the antecedents to LH, it is possible to prevent the occurrence. If an event, such as a fall or fracture occurs, the healthcare provider must then determine the attributes that heave developed and the possible consequences related to the attributes. Working as a team with all members of the healthcare team, family members, and caregivers is necessary in order to ensure that each patient has the greatest chance of returning to a predetermined level of functionality. In doing so it is possible to provide a greater quality of life to an ever-growing population of individuals.
References
Areán, P., Mackin, S., Vargas-Dwyer, E., Raue, P., Sirey, J., Kanellopolos, D., & Alexopoulos, G. (2010). Treating depression in disabled, low-income elderly: a conceptual model and recommendations for care. International Journal Of Geriatric Psychiatry, 25(8), 765-769. doi:10.1002/gps.2556
Barder, L., Slimmer, L., & LeSage, J. (1994). Depression and issues of control among elderly people in health care settings. Journal Of Advanced Nursing, 20(4), 597 604. doi:10.1046/j.1365-2648.1994.20040597.x
Beaupre, L. A., Jones, C., C., Wilson, D. M., & Majumdar, S. R. (2012). Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: Prospective cohort study. Journal Of The American Geriatrics Society, 60(7), 1268-1273. doi:10.1111/j.1532-5415.2012.04033.x
Braithwaite, R., Col, N., & Wong, J. (2003). Estimating hip fracture morbidity, mortality and costs. Journal Of The American Geriatrics Society, 51(3), 364-370. doi: 10.1046/j.1532-5415.2003.51110.x
Cleaveland, B., & Denier, C. (1998). Recommendations for health care professionals to improve compliance and treatment outcome among patients with cognitive deficits. Issues In Mental Health Nursing, 19(2), 113-124.
Faulkner, M. (2001). The onset and alleviation of learned helplessness in older hospitalized people. Aging & Mental Health, 5(4), 379-386. Doi: 10.1080/13607860120080341
Hedberg, P., Gustafson, Y., Alèx, L., & Brulin, C. (2010). Depression in relation to purpose in life among a very old population: A five-year follow-up study. Aging & Mental Health, 14(6), 757-763. doi:10.1080/13607861003713216
Huang, Y., & Carpenter, I. (2011). Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardized care assessment in nursing homes. Aging & Mental Health, 15(8), 1045-1051. doi:10.1080/13607863.2011.583626
Ní Mhaoláin, A., Fan, C., Romero-Ortuno, R., Cogan, L., Cunningham, C., Lawlor, B., & Kenny, R. (2012). Depression: A modifiable factor in fearful older fallers transitioning to frailty?. International Journal Of Geriatric Psychiatry, 27(7), 727-733. doi:10.1002/gps.2780
Seligman, M. E. P. (1992). Helplessness, on depression, development, and death. W H Freeman & Co.
Sherman, F. (2009). Learned helplessness in the elderly: Stop fostering frailty. Geriatrics, 64(2), 6-7
Van Harten-Krouwel, Schuurmans, M., Emmelot-Vonk, M., & Pel-Littel, R. (2011). Development and feasibility of falls prevention advice. Journal Of Clinical Nursing, 20(19/20), 2761-2776. doi:10.1111/j.1365-2702.2011.03801.x
As healthcare providers we care for individuals who are in the most vulnerable moments of their lives. In the acute care facility the large majority of these patients are of the elderly population who have suffered from a physical, mental, or emotional loss. These are patients who typically require high levels of care. Because of this it is necessary for the nurse to determine is this a true vulnerability or a learned helplessness? When a patient is suffering from a learned helplessness (LH), it is the responsibility of the healthcare team to work as one and assist the patient in returning the baseline functionality through interventions such as physical therapy, occupational therapy, and targeted education. Often times LH is passed off as a normalcy of aging or certain disease processes, when in actuality we, as healthcare providers, are contributing to this behavior. Nurses are in a position to assess the patient to determine whether a LH behavior has been developed and help with the return to baseline function levels if this is the case.
Rationale for Concept Selection
Those who do not have much experience working within this group often label the geriatric population as “dependent” or “helpless”. What many people do not realize is that we hinder the ability of these individuals by constantly assuming the lead role in tasks and not allowing the geriatric person to attempt to complete the task alone. Learned helplessness can lead to a person becoming completely dependent and lead to other deficits as well (Faulkner, 2001). Because of this we must strive to identify those who are learning helpless behavior and redirect the concentration to the ability to complete tasks and change outcomes.
Concept Definition
The definition of LH varies depending on the population in which it is referring. For the purposes of this analysis it was viewed from the perspective of the geriatric patient, or those who are sixty-five years of age or older. According to Seligman (1992), LH is a psychological condition where an individual, such as a geriatric patient, has learned and become accustom to acting in a helpless manner, even when they have the ability to change the outcome of the situation. As we provide care for these patients, we must learn to differentiate between appropriate moments to encourage independence and those where providing assistance is appropriate.
Analysis of the Concept
When analyzing this concept the amount of information retrieved related to LH in the geriatric population is extensive. With the increase in the population related to the “baby boom” generation, there is an even greater need to have a better understanding of LH, how it effects the overall health of these individuals, and how it can be prevented. By taking a more in depth look at what leads to this feeling of inability to change a situation, these questions can be accurately answered.
Aim of Analysis
As nurses we consider ourselves natural helpers. Often we find ourselves offering unrequested and unneeded help, especially to geriatric individuals. By doing so it seems that we are fostering frailty and encouraging helpless behavior. Research has shown that learned helplessness induces dependence in the older adult, this in turn leads to deficits cognitively, motivationally, and emotionally (Faulkner, 2001). Many times when patients reach these levels it requires an extended period of rehabilitation in order to restore baseline functionality, if this can be achieved again. Increased education of the nursing staff is beneficial in these situations. By identifying the early signs and antecedents of LH it may be possible to prolong or prevent this life-altering occurrence.
Antecedents to Learned Helplessness
Learned helplessness is not an expected part of aging, although society tends to portray it in that sense. Typically there is a single or string of events that lead to the patient becoming dependent, known as an antecedent to LH, on a caregiver for what is intended to be a short period of time (Faulkner, 2011). Instead of working toward a goal of returning to a previous baseline of functionality, the caregiver unknowingly encourages dependence. Faulkner (2011) mentions that patients are typically disempowered upon any admission to the hospital, but with the geriatric population this disempowerment can have greater consequences. There are numerous examples of these events, but one of the most common is a hip fracture in an elderly patient. Evidence shows that a hip fracture reduced life expectancy by an average of 1.8 years and approximately seventeen percent of the remainder of the patient’s life is spent in a skilled nursing facility (Braithwaite, Col, & Wong, 2003). During this hospitalization the patient’s level of control is decreased which makes them appear to need more assistance (Faulkner, 2011). Because of this patients become dependent on others for assistance with activities of daily living and this eventually develops into a learned helplessness. Other antecedents to LH include uncontrollable circumstances, such as decreased mobility and increased number of hospitalizations due to chronic disease processes (Faulkner, 2011). Both of these examples increase in occurrence as the population age increases and with the baby boom generation reaching the geriatric age group healthcare professionals will see an increase in the number illnesses that have the potential to precede LH.
Defining Attributes
The long-term effects, or attributes, of LH can be from mild to severe and decrease the ability to preform activities of daily living in a patient who was recently living independently. From the bedside nursing standpoint we see first hand how LH effects individuals. Patients who suffer from LH often fall into a cycle of procrastination, frustration, and develop low self-esteem (Faulkner, 2001). The patient procrastinates tasks that were previously simple to perform. Once the tasks are initiated the patient becomes frustrated by the difficulty in doing so, low self-esteem is developed, and the cycle continues. Once low self-esteem is developed, depression is often seen (Faulkner, 2011). Depression is most often seen in individuals who have been in a long-term care facility for seven weeks to six months (Barder, Slimmer, & LeSage, 1994). This is an expected length of stay time for individuals who have experienced certain disparities such as hip fracture (Braithwaite, Col, & Wong, 2003), which is unfortunately a common occurrence in the elderly. By identifying these signs early, it could be possible to halt the progression and reverse the LH that has already developed.
Education of family members is another important aspect of providing care and assisting these individuals in returning to a level of functionality in which they wish to obtain. Sherman (2009) encourages healthcare workers to discuss with family members that resuming activity is a collaborative effort and the family members must be wiling to work with healthcare staff in order to provide the best care possible. When individuals understand why they are being ask to behave in a certain way, it makes the transition to this change more acceptable. This is why we must educate every family member or caregiver that will be involved in patient care.
Summary and Analysis of Empirical Referents
Empirical referents are measurable ways of demonstrating the occurrence of the concept, or learned helplessness. With LH, empirical referents can best be seen when analyzing related depression. Depression is one of the main problems seen in those suffering from learned helplessness (Barder, Slimmer, & LeSage, 1994). This is often times overlooked as a normal part of aging, when in reality it is not. The reduction in functioning is the typical cause of depression in the elderly population (Hedberg, Gustafson, Alèx, & Brulin, 2010). Screening and questionnaires can be used to test levels of depression and compare responses over a six-month period to evaluate trends or changes that warrant medical attention. One of the most developed scales for this age group is the Geriatric Depression Scale-15 (GDS-15); this scale is found to have a very high sensitivity and is specific in diagnosing the degree of depression (Hedberg et al., 2010). Another method of determining depression in the elderly is the Depression Rating Scale. This scale is closely related to the GDS-15 in regards to reliability and validity (Huang & Carpenter, 2011). Depression effects nine percent of the elderly population (Areán, Mackin, Vargas-Dwyer, Raue, Sirey, Kanellopolos, & Alexopoulos, 2010); because of this it must be identified early and prevented from causing complications with everyday life.
Summary and Analysis of Consequences
The consequences of LH are numerous and of a wide variety. These range from motivational deficits, cognitive deficits, and emotional deficits (Faulkner, 2001). In patients with motivational deficits it is noted that these individuals have a low likelihood of initiating voluntary responses, such as preparing ones meals and caring for ones laundry. They learn to depend on others to perform these activities of daily living. Cognitively these individuals are effected because they forget the necessary steps to preform specific tasks. As they forget the skills necessary to do so, it becomes inevitable that they are dependent. As healthcare providers we must determine a baseline level of cognitive status, whether this be information from the patient or family, in order to ensure the patient achieves this baseline functionality once again (Cleaveland & Denier, 1998). Finally, an emotional deficit is reached because the forgetfulness and lack of independence that has been reached. There is a direct correlation between depression and physical illness (Huang & Carpenter, 2011). For example, falls rates of hospitalized patients range between 4-20% and patients who have previously fallen have a 32% chance of falling again (van Harten-Krouwel, SchuurmansEmmelot-Vonk, & Pel-Little, 2011). Geriatric individuals often become depressed and appear with a flat affect after a period of time with limited independence (Faulkner, 2001).
Case Illustration
When analyzing specific concepts, such as LH, it is important to review different scenarios, or cases, to have a better understanding of the case. When doing this, it is important to delineate antecedents, attributes, and consequences in regards to the individuality of each case. For this purpose three different cases will be reviewed.
Dr. Sherman, a professor of geriatrics and medicine, shares his mother’s medical experience in a letter to the editor section of the geriatrics journal. In 2009 he discussed her battle with LH and how he assisted her in this fight. He explained that over the past several years she has suffered from a broken hip due to a fall, paralysis of her left arm and hand due to a left brachial plexus injury, and a stage four-pressure ulcer in her axilla, which was related to the fall. The fall would be the antecedent for this case. In the initial stages of her rehabilitation attributes included inability to perform activities of daily living that were previously done with no difficulty. To ensure that his mother did not suffer from learned helplessness, he made three specific efforts to encourage dependence. The first was with feeding: though she was too weak to feed herself, he placed a spoon full of food in her hand and guided her in the process of feeding herself. Secondly, he would not allow her to move via wheelchair only. Though the wheelchair was available when needed, he encouraged her to walk with assistance to reach desired destinations within her rehabilitation facility. Finally, he encouraged her to make and provide input on financial decisions that were to be made on her behalf. Though he and his brother had Power of Attorney and overall financial control, she was still encouraged to provide her opinion on decisions. By doing this his mother’s recovery time was half of what was originally anticipated. If Dr. Sherman had not worked so aggressively with his mother the consequences of her falls had the potential to be numerous. Though this is not the case in all scenarios of LH, we must learn to help as needed, and not just assume that every elderly adult requires assistance with the simplest of tasks.
Borderline case. In a 2012 study by Ní Mhaoláin, Fan, Romero-Ortuno, Cogan, Cunningham, Lawlor, and Kenny, the fear of falling and the possible health problems related to in geriatric patients was studied. The fear of falling, which in this case is considered the antecedent to LH, was measured in 301 participants by having them to complete the Modified Falls Efficacy Scale it was possible to assess anxiety, depression, loneliness, personality factors and cognition. Though these patients had never actually suffered from a fall, the results showed that those who were considered frailer were more effected by the thought of falling. Different levels of depression had already been developed related to the possibility of the fall and some of the patients were undergoing pharmacological treatment for this depression. These patients were often suffering from LH before an event had ever occurred. The results from this study reiterated the fact that healthcare providers must screen and identify those who are considered frail and at risk for falls. It is then the responsibility of that provider to ensure that the patient feels safe and understands that multiple steps are taken to ensure that a fall does not occur.
There are multiple cases that analyze patients who have ha suffered a hip facture and the related disabilities related to the fracture. Beaupre, Jones, Wilson & Majumdar, (2012) studied patients who were one-year post hip facture to determine their quality of life and level of function. The individuals involved in the study were asked to complete a Functional Independence Measure Motor score to determine level of functionality. At the one-year mark only one third of the individuals who were still alive had returned to a functional level comparable to that of pre-hip fracture. Forty-eight percent of those who were ambulatory prior to the hip fracture were no longer ambulatory and the overall mortality rate was nearly fifty percent. Lack of ability to ambulate and mortality are both attributes of the hip fracture. The lack of mobility increases the risk of consequences, such as depression, which was previously discussed.
Implications for Advanced Practice
The geriatric population is one that is extremely vulnerable; therefore nurses must have heightened assessment skills when caring for these individuals. Prevention is the key when learned helplessness may be an obstacle for a patient (Faulkner, 2011). By identifying those who are high risk and the antecedents of learned helplessness this is a realistic goal. It is recommended for healthcare providers to provide preventative measure for those who have been identified as a high risk for falls (In Mhaoláin, Fan, Romero-Ortuno, Cogan, Cunningham, Lawlor, & Kenny, 2012). For those whom we do not achieve prevention, the healthcare team as a whole must strive to return the patient to a baseline functionality. The nurse practitioner is in the position to collaborate this care and involve the additional members of the healthcare team, such as physical or occupational therapy, to improve patient outcomes. By doing so the healthcare provider has an opportunity to reduce the numerous consequence possibilities that can lead to further healthcare deficits.
Summary of the Analysis
Geriatric patients suffer from life altering illnesses on a daily basis. Because of this healthcare providers must realize that they are in a position to influence the outcome of the patient’s care and overall well-being. By identifying those who are at risk for LH and the antecedents to LH, it is possible to prevent the occurrence. If an event, such as a fall or fracture occurs, the healthcare provider must then determine the attributes that heave developed and the possible consequences related to the attributes. Working as a team with all members of the healthcare team, family members, and caregivers is necessary in order to ensure that each patient has the greatest chance of returning to a predetermined level of functionality. In doing so it is possible to provide a greater quality of life to an ever-growing population of individuals.
References
Areán, P., Mackin, S., Vargas-Dwyer, E., Raue, P., Sirey, J., Kanellopolos, D., & Alexopoulos, G. (2010). Treating depression in disabled, low-income elderly: a conceptual model and recommendations for care. International Journal Of Geriatric Psychiatry, 25(8), 765-769. doi:10.1002/gps.2556
Barder, L., Slimmer, L., & LeSage, J. (1994). Depression and issues of control among elderly people in health care settings. Journal Of Advanced Nursing, 20(4), 597 604. doi:10.1046/j.1365-2648.1994.20040597.x
Beaupre, L. A., Jones, C., C., Wilson, D. M., & Majumdar, S. R. (2012). Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: Prospective cohort study. Journal Of The American Geriatrics Society, 60(7), 1268-1273. doi:10.1111/j.1532-5415.2012.04033.x
Braithwaite, R., Col, N., & Wong, J. (2003). Estimating hip fracture morbidity, mortality and costs. Journal Of The American Geriatrics Society, 51(3), 364-370. doi: 10.1046/j.1532-5415.2003.51110.x
Cleaveland, B., & Denier, C. (1998). Recommendations for health care professionals to improve compliance and treatment outcome among patients with cognitive deficits. Issues In Mental Health Nursing, 19(2), 113-124.
Faulkner, M. (2001). The onset and alleviation of learned helplessness in older hospitalized people. Aging & Mental Health, 5(4), 379-386. Doi: 10.1080/13607860120080341
Hedberg, P., Gustafson, Y., Alèx, L., & Brulin, C. (2010). Depression in relation to purpose in life among a very old population: A five-year follow-up study. Aging & Mental Health, 14(6), 757-763. doi:10.1080/13607861003713216
Huang, Y., & Carpenter, I. (2011). Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardized care assessment in nursing homes. Aging & Mental Health, 15(8), 1045-1051. doi:10.1080/13607863.2011.583626
Ní Mhaoláin, A., Fan, C., Romero-Ortuno, R., Cogan, L., Cunningham, C., Lawlor, B., & Kenny, R. (2012). Depression: A modifiable factor in fearful older fallers transitioning to frailty?. International Journal Of Geriatric Psychiatry, 27(7), 727-733. doi:10.1002/gps.2780
Seligman, M. E. P. (1992). Helplessness, on depression, development, and death. W H Freeman & Co.
Sherman, F. (2009). Learned helplessness in the elderly: Stop fostering frailty. Geriatrics, 64(2), 6-7
Van Harten-Krouwel, Schuurmans, M., Emmelot-Vonk, M., & Pel-Littel, R. (2011). Development and feasibility of falls prevention advice. Journal Of Clinical Nursing, 20(19/20), 2761-2776. doi:10.1111/j.1365-2702.2011.03801.x