What Factors Related to Nursing Homes Can Lead to Depression and What Are Some of the Best Prevention and Treatment Options

Nursing homes are residential settings that provide around the clock medical care for people who are recovering from acute health issues such as stroke or hip fracture, or for people who can no longer manage to live safely on their own because of physical or psychological debilitation (Ferrini, 2008). Long-term nursing home residents are generally elderly, frail, have multiple chronic illnesses, mobility issues, and are dependent on others for many of their daily needs. The professional care and supervision that nursing homes provide are meant to positively impact the health and well-being of the residents, but this is often overshadowed by negative factors that can compromise health and well-being. These factors detract from the quality of life of the residents and often contribute to depression, which is quite prevalent in nursing homes. Although percentages range among studies, research has shown that as much as 31% of nursing home residents have been found to have major depressive disorder and up to 75% experience significant depressive symptoms (Namkee Choi, 2008).

Depression is considered a life-long mental illness, but it is often experienced as alternating periods of wellness with reoccurring bouts of illness. The illness affects mood, thoughts, feelings, behavior, and physical health (National Alliance on Mental Illness, 2013). Sadness associated with normal grief is different from depression. A sad or grieving person can continue to carry on with regular activities. The depressed person suffers from symptoms that interfere with his or her ability to function normally for a prolonged period of time. There is no exact cause of depression, but the general professional consensus is that depression has a biological basis involving genetics and an imbalance of chemical neurotransmitters in the brain, often combined with environmental and psychological triggers (National Alliance on Mental Illness, 2013).

Any circumstance of trauma, loss, difficulty, hardship, or stress can be an environmental or psychological trigger (National Institute of Mental Health, 2013). It is highly plausible that 100% of people living in nursing homes experience one or more of these environmental or psychological circumstances not only regularly, but relentlessly. The factors specific to nursing home life that can lead to depression include, but are not limited to, 1) the preconception of the nursing home as a death sentence, 2) the profound losses experienced by residents, 3) healthcare-associated acquired infections, and 4) the organizational culture and climate within the nursing home. This paper will discuss the negative environmental and psychological factors that can lead to depression, and explore options for management of depression; particularly better assessment and detection, more proactive prevention rather than reactive treatment, and the encouragement of realistic coping options.

Negative Environmental and Psychological Factors of Nursing Homes

The Death Sentence:

Once people have lost the ability to care for themselves on their own, moving to a nursing home becomes more of a necessity than a choice because there quite often is no other available and affordable alternative (Ferrini, 2008). Although people may value and benefit from the full-time care and supervision the nursing home setting provides, the transition is wrought with ambivalence and apprehension. Many people hold the preconceived notion that the nursing home is where they will go to die. For long-term residents, the nursing home represents a one-way street with a dead end. Unlike acute-care residents who live in nursing homes to recover from surgery or illness, long-term residents are not there to recover or stabilize to the point where they can take care of themselves and go back home. These people either die in the nursing home or are transferred to acute care hospitals, where they either die, or return to the nursing home, or transfer to hospice care to die (About Nursing Homes, 2013).

Residents have described their feelings about living in a nursing home as “institutionalized”, “imprisoned”, and “trapped” (Namkee Choi, 2008). This can create feelings of hopelessness and helplessness for nursing home residents, which are both symptoms of depression (Thakur, 2008). This hopelessness is compounded by the frequent encounters with the death of others that nursing home residents must endure. The death of other residents is a regular occurrence at nursing homes that forces people to constantly face their own mortality. The grief and loss experienced on a daily basis affirms the notion that the nursing home is where people go to die. Some residents just give up and openly express that they want to die (Namkee Choi, 2008).

Profound Loss:

Besides facing their own impending demise and the death of other residents, people in nursing homes experience a plethora of other losses. These losses have been shown to significantly affect the mental health of nursing home residents (Namkee Choi, 2008). First, people move to nursing homes because they have lost the physical ability to care for themselves due to chronic illness or increasing immobility, or they have lost the psychological ability to function on their own due to dementia or mental illness. Economic and sentimental losses are incurred because people sell their homes to pay for nursing home care. With their homes go lifelong memories and personal belongings. Because of limited space, cherished keepsakes, a familiar bed, a favorite desk, artwork, pictures, and beloved pets are only some of the things a person may never see again after entering the nursing home. Social losses are experienced when people move out of their community and away from friends and family to live in a nursing home. The inabilities to live in their own homes and communities and continue with their past lifestyles are the most powerful losses for people who have had to move into nursing homes (Namkee Choi, 2008). They miss out on life-affirming activities like the church choir, social engagements, gardening, and volunteering. Even seemingly mundane activities like cooking, cleaning, and shopping are longed for but lost forever.

Rules, regulations, and strict routines disconnect residents even further from any semblance of their past lives. As residents, people experience a profound loss of privacy, autonomy, independence, and self-determination. At the very onset of nursing home life, a new resident may be forced to share a room and a restroom with a complete stranger (Namkee Choi, 2008). The most intimate daily activities like dressing, sleeping, and using the bathroom are done in the very close vicinity of strangers. When receiving invasive medical treatments, like catheterization, or receiving highly personal daily care, like bathing or even diaper-changing, usually just a curtain is pulled for privacy. This may protect the resident from others seeing what is going on, but not from hearing what is going on. The perception of privacy is not only about not being seen, but also about not being heard. Doors to the rooms are often kept open, so that the nursing staff can keep an eye on the residents. It is not possible for many residents to close doors when they choose because of immobility issues, and even when doors are closed, staff members may walk in without knocking.

Bed checks, meal times, bathing times, and wake times are held to tight schedules. Residents do not have the flexibility to sleep in if they want or the option of family members staying the night, as they would in their own homes (Namkee Choi, 2008). Residents usually do not have their choice of roommates and compatibility is not considered. Many times cognitively intact individuals must room with people with severe cognitive impairments, making communication and companionship impossible. These many losses experienced are not just inconvenient, but devastating to the mental health and quality of life for nursing home residents (Namkee Choi, 2008).

Healthcare Acquired Infections:

Healthcare-associated or healthcare-acquired infections (HAIs) are infections that patients acquire while in a healthcare facility receiving treatment for other conditions (Healthcare Associated Infections, 2010). The age and already-compromised health and immune systems of the nursing home population, the close proximity of residents and staff, and environmental contamination are all factors that foster the development and transmission of infection within the nursing home (L.E. Nicolle, 1996). HAI’s significantly impact the physical health and mortality of the residents, and multiple illnesses are associated with greater risk of depression (Thakur, 2008).

One of the most common infections among nursing home residents are lower respiratory infections. Pneumonia and bronchitis are lower respiratory infections. Among all infections, they have the highest frequency and the worst consequences. Pneumonia is a leading cause of death among infectious diseases (L.E. Nicolle, 1996). Gastrointestinal infections are also deadly for nursing home residents. A gastrointestinal infection from Clostridium difficile, which causes diarrhea, has been connected to 14,000 deaths each year in the United States with nursing home residents being the most at-risk (Healthcare Associated Infections, 2010). This adds to the number of deaths of others that nursing home residents are forced to endure.

If they do not cause death, these diseases can lead to functional impairments such as immobility and incontinence. Conditions such as these tend to increase the need for hygiene while at the same time limiting the ability to perform the necessary hygiene on one’s own (L.E. Nicolle, 1996). This means more loss, trauma, hardship, and stress for the residents. These are all psychological triggers for depression. HAI’s can also lead to malnourishment because people are too sick to want to eat, can’t keep the food down, cannot feed themselves, or have trouble swallowing. Malnourishment has been found to be prevalent in nursing home residents (L.E. Nicolle, 1996). Malnourishment leads to nutritional deficiencies. Vitamin D deficiencies have been specifically linked to depression (Cherniack, 2011).

Some medications may also increase the likelihood of infection, and unfortunately, the average nursing home resident takes 5 to 10 different medications at any given time (L.E. Nicolle, 1996). Fluoroquinolones are broad-spectrum antibiotics that have been used to treat hospital-acquired infections such as pneumonia and urinary tract infections caused by cathaterization, but these medications tend to encourage the development of Clostridium difficile infections. Fluoroquinolones may also lead to depression as a side effect (Goldberg, 2012). In fact, many medications used to treat the chronic conditions prevalent in nursing homes cause symptoms of depression. They include the following:

• Beta-blockers and calcium channel blockers for high blood pressure, heart failure and angina,
• Estrogens to prevent or treat osteoporosis,
• Statins to lower cholesterol, protect against damage from coronary artery disease, and prevent heart attacks,
• Opioids to relieve moderate to severe pain,
• Bromocriptin for Parkinson’s disease,
• Benzodiazepines for anxiety and insomnia,
• Interferons for cancer (Goldberg, 2012).

With every increase in medication usage, there is an increased possibility of depression symptoms (Vann, 2010). When depression-inducing medications are added to the onslaught of psychological and environmental triggers of depression that nursing home residents must endure, they become particularly vulnerable to depression.

Organizational Culture and Climate:

There has also been found to be a connection between depression in residents and the organizational culture and climate within nursing homes. Organizational culture is defined as “the expectations that govern the way things are done in an organization” (Cassie, 2012). The three aspects of organizational culture include:
1) Rigidity- characterized by requiring employees to follow strict policies and procedures and seeking permission from a supervisor before acting independently
2) Proficiency- characterized by employees who are responsive to client needs and competent in their actions
3) Resistance- characterized by employees who are resistant to change or efforts to improve the organization (Cassie, 2012)

Organizational climate is defined as “the shared perceptions of the psychological impact of the work environment on the employee’s own well-being” (Cassie, 2012). The three aspects of organizational climate include:
1) Engaged- characterized by employees who connect with residents and view them as individuals, making their job important and worthwhile
2) Functional- characterized by employee perceptions that the organizations offers growth and opportunities for advancement, role clarity, and cooperation
3) Stressful- characterized by employees who feel emotionally exhausted in an organization with role conflicts and role overload (Cassie, 2012)

Research results show that organizational cultures with lower levels of proficiency and higher levels of resistance were associated with more depressive symptoms. This is evidence that a more negative culture and/or climate within the nursing home is associated with depression. In highly proficient cultures, residents experienced a decrease in depressive symptoms over time. This may be due to the fact that proficient cultures respond to resident’s needs promptly and competently making residents feel valued and protected, which may minimize depressive symptoms.

Dealing with Depression in Nursing Homes

Depression has been found to be “the most common cause of morbidity and decreased quality of life” in older people (Thakur, 2008). Given the plethora of psychological and environmental triggers of depression found in nursing homes, it is not surprising that long-term nursing home residents have the highest rates of depression (Cassie, 2012). The disease has detrimental effects on the elderly as it is associated with cognitive and physical decline, malnutrition, falls, hospitalizations, and longer nursing home admissions. As the older population continues to expand significantly with the aging of the baby boomers, the prevalence of depression is expected to grow and contribute to increased health care costs. It has become a major health issue, which has sparked much research on the subject (Cassie, 2012).

Because there are so many environmental and psychological triggers of depression present in the nursing home setting, the high rate of depression within nursing homes is a multidimensional issue. A systemic change in current nursing home practices is warranted to make any substantial difference in the rates of depression. These changes involve better assessment and detection, more proactive prevention rather than reactive treatment, and the encouragement of realistic coping options.

Better Assessment:

The Minimum Data Set (MDS) is a federally mandated standardized assessment completed on all residents in nursing homes that receive Medicare or Medicaid funding, regardless of how the resident pays for services. It is completed upon admission, quarterly, annually, and at various other intervals as necessary (Cassie, 2012). Its primary purpose is to identify resident care problems that can be addressed in an individualized care plan (CMS 2012 Nursing Home Action Plan). There are many scales within the MDS such as the Depression Rating Scale (DRS), which is a seven-item scale that rates the presence of depressive symptoms in residents in the past 30 days. However, using the MDSDRS to screen for depression has been found in at least three separate major studies to have poor validity in comparison to other standard screening methods (Thakur, 2008). Despite its shortcomings, the MDSDRS is the most readily and widely available comprehensive data to researchers (Thakur, 2008).

Also, recognizing depression in the elderly is not always easy. Older Americans do not readily admit feelings of depression because of the stoicism characteristic of their generation or the perceived stigma of mental illness. They worry about being labeled as crazy or that complaining about their problems will be seen as a character weakness (Namkee Choi, 2008). Depression may also go unnoticed because many depression symptoms overlap with the symptoms of other illnesses, which may mask the depression (Thakur, 2008). Researchers have noted that when compared to the Geriatric Depression Scale, the MDSDRS underestimates depression, “particularly in facilities reporting no or very low levels of depressive symptoms among their residents” (Cassie, 2012). Since the MDSDRS is completed by nursing home staff, these reported zero levels or low levels may be more of a result of the staff’s inability to recognize depressive symptoms rather than the actual absence of depressive symptoms (Cassie, 2012).

In response to these concerns, the Center for Medicaid and Medicare Services (CMS) contracted with Harvard University and the RAND Corporation in 2006 to revise and nationally test the new version, which was implemented in October 2010. The goals were “to introduce advances in assessment measures, increase clinical relevance of items, improve the accuracy and validity of the tool, increase user satisfaction, and increase the resident’s voice by introducing more resident interview items” (CMS 2012 Nursing Home Action Plan). The goals represent a four-year-long collaborative effort to improve individualized care and the overall health of residents in the nursing home population through quality improvement across the board. These quality improvements could certainly bring about culture changes in many facilities.

Proactive Prevention of Depression

Meaningful Activities and Exercise:

Antidepressants are the most common treatment for depression, and data from the CMS shows that 43.3% of nursing home residents take these medications (Suzanne Meeks, 2008). Antidepressants are effective in the treatment of depression, but are often under-prescribed because of detection issues. When prescribed, antidepressants are more poorly tolerated in the elderly, especially in the very old and frail who have multiple chronic illnesses (Nalin A Singh, 2000). Also, elderly patients are more likely to be taking several medications simultaneously, increasing the potential for adverse drug interactions.

Electroconvulsive therapy (ECT) is a depression treatment reserved for people who have severe or psychotic depression that is not responding to antidepressant medication or for people who cannot tolerate the medication. It is highly effective and considered safe, even in the elderly population (Thakur, 2008). However, both ECT and antidepressants are therapies that are reactive rather than proactive. Their focus is on treating depression rather than preventing depression.

Many researchers, however, have researched methods to prevent depression by decreasing the negative factors associated with depression that are prevalent in nursing homes. Meeks et al recognized that the negative events surrounding nursing home placement are not generally counteracted by positive experiences which, thus, compounds the risk of depression in nursing home residents. The Meeks et al research team created a non-pharmocological approach for the prevention and treatment of depression called BE ACTIV. This program involved 1) individual sessions with residents to identify positive events, 2) a person-centered plan tailored toward increased involvement in such events, 3) a system-wide assessment to increase the availability and frequency of such events, and 4) the assessment and removal of both individual barriers and institutional barriers that prevent access to any such positive reinforcements. Positive events are pleasant activities as defined by each individual and could be anything from a cup of coffee in the morning to having books on tape delivered. They could be as simple as getting a compliment to as challenging as going on an outing (Suzanne Meeks, 2008).

Overall results showed clinically significant reductions in depressive symptoms in the treatment group and a 75% recovery rate by the time of follow-up. There was a 50% recovery rate from depressive symptoms in the control group which received treatment as usual. The treatment group gained in activity participation whereas the control group declined. A positive affect was self-reported in the treatment group, it increased over time, and the affect was related to amount of activity participation. Positive affect in the control group decreased over time. Feedback from staff was positive as well. They appreciated the additional training they received and found it to be helpful in their ongoing relationship with their clients and assessing their needs appropriately (Suzanne Meeks, 2008).

There is a monumental amount of research about the effects of exercise on overall psychological well-being., which overwhelmingly shows that consistent physical activity is associated with better psychological well-being. Well-being is characterized as the presence of positive traits such as life satisfaction and hardiness, and the absence of negative traits like anxiety, anger, fatigue, and depression. Further research regarding depression, specifically, in relation to exercise have shown that there is a strong, cross-sectional relationship between depressive symptoms and physical activity with less active individuals experiencing the highest levels of depression. Also, those who were not depressed initially, but were active, had lower rates of depression over time than those who were not depressed initially, but were sedentary. This suggests that increasing physical activity may prevent the onset of depression as well (Fiatarone, 2000).

In regards to the older population, resistance training, or weight-lifting, has more benefits than aerobic exercise because 1) it specifically addresses the loss of lean muscle mass and strength, 2) it has fewer contraindications than aerobic exercise, 3) it is proven safe and feasible with high compliance in the frailest of elderly, and 4) it may directly counteract falls and hip-fracture risks. Aside from these benefits, exercise also offers additional benefits in the treatment of depression in older people. First, it is better tolerated than pharmacological treatments. Second, pharmaceuticals meant for depression do not treat comorbid diseases and they do not offer the potential benefit of improved fitness. Exercise, however, is an effective treatment for many comorbid diseases such as obesity, hypertension, cardiovascular disease, diabetes, osteoporosis, and arthritis to name a few, and exercise has the likelihood to improve fitness. Third, because of the evidence in research that depression in older people is being seriously under-diagnosed and under-treated, the adoption of exercise programs within nursing homes could potentially serve to treat depression that has yet to be diagnosed and even prevent the onset of depression in the first place (Fiatarone, 2000).

Religious Coping:

Although more research is being devoted to system-wide prevention methods that counteract the negative factors within the nursing home; admittedly, not all negative factors can be removed from nursing home life. Despite our greatest efforts, nursing home residents will always feel the trauma and stress of the many losses and environmental limitations they experience as a result of the nursing home setting. Therefore, it is logical to research viable coping strategies for nursing home residents. Since long-term nursing home residents are often the frailest of the elderly population with the most chronic illnesses, they tend to recognize that their situation is not likely to change. Therefore, coping with their problems becomes more of the focus than solving their problems (Joseph Z.T. Pieper, 2012).

Religious coping is “the most widely used spiritual resource that older people utilize to deal with illness and stressful life events” (Reyes-Ortiz, 2006). It is especially important for people who are living in nursing homes. In one study of 65 nursing home residents, 59 described themselves as religious by reading the Bible and praying on a regular basis. Many also attended weekly religious services at the nursing home. (Namkee Choi, 2008). Another study found that 86% of people either hospitalized in the geriatric unit or institutionalized in a nursing home used religion to cope with their illnesses and disabilities (Reyes-Ortiz, 2006).

Religious behavior includes intrinsic religious activities such as having faith in God, reading the Bible, and praying, as well as organizational religious activities such as attending church and participating in other religious group activities (Reyes-Ortiz, 2006). Religious attitudes and beliefs offer hope that exceeds beyond the hope of getting better. Many nursing home residents are no longer active members of the community, feel they have outlived their productivity, and are dependent on others for survival. Since their exterior lives can no longer be cultivated, religion allows people to cultivate their “interior” lives. It gives them meaning and significance in a world that may view them as useless members of society (Fahey, 1997).

This meaning and significance derived from religious beliefs has positive effects on health and well-being, according to several research studies. One study showed that being involved in organizational religious activities is strongly associated with improvements in functional ability and depression (Pierre, 1994). Other studies have found that deriving strength from religion is the best predictor of longetivity (Pierre, 1994). Research in the Netherlands showed that 74% of the 106 residents of a nursing home reported that religion was a positive resource for coping with their problems, and this positive influence tended to manifest itself as decreased anxiety and increased well-being ( (Joseph Z.T. Pieper, 2012). Also, studies on religion and aging at Duke University noted that people with a history of religion were better at coping with the stresses of aging (Fahey, 1997).

Other types of coping strategies have not been as well-received among the nursing home elderly. There are several studies on the effectiveness of Cognitive Behavioral Therapy (CBT) for the treatment of depression. CBT, also known as psychotherapy, is based on the idea that “our thoughts cause our feelings and behaviors, not external things, like people, situations, and events”. The premise of this is that we can change the way we think in order to feel and act better even if the situation does not change (What is Cognitive Behavioral Therapy?, 2013). The problem is that this requires older people to talk about their feelings. The current population of older Americans was raised during a time when people did not talk openly about their feelings and not much was understood about mental illness. Talking about problems was regarded as feeling sorry for oneself. As older adults, many of these same people are still more comfortable with being stoic and not complaining about their situation (Namkee Choi, 2008). Even if older people of this generation were more accepting of CBT, three-quarters of nursing homes are unable to access the psychiatric, consultation, or educational services to implement such therapies (Namkee Choi, 2008).

Conclusion

Physical illness, pain, disability, immobility, cognitive impairment, nutritional deficits, comorbidity, heavy medication use, death, loss of privacy, autonomy, self-determination, and independence are all real-life situations associated with depression and experienced by most if not all nursing home residents. Depression is an appropriate reaction to this conglomeration of negative experiences. Therefore, any treatments for depression such as pharmacology, CBT, ECT, exercise therapy, or other treatments not discussed in this text such as light therapy or reminiscence therapy, should be accompanied by noticeable and thoughtful efforts within the organization to decrease the negative experiences within the setting that lead to depression in the first place. Since research has shown that depression can be triggered by negative situations and circumstances, it follows that decreasing these negatives should decrease depression in nursing homes. Treating depression without any meaningful effort to prevent depression is illogical from both a practical and ethical perspective.

Great efforts have been made over the years to manage and improve the care that people receive in nursing homes for their physical and medical needs. For example, organizational changes and new protocols have been put in place to better control healthcare acquired infections, to minimize elder abuse, and to decrease the risk of falls. However, equal importance should be placed on protecting the mental health of residents as is placed on protecting their physical health. The exponential growth of the senior population, the projected increase in nursing home residents over the next several years, the high rate of depression found in residents, and the increased costs of healthcare resulting from the detrimental effects of depression are fair warning that grand efforts must also be made to manage and improve the psychological and environmental negatives of the nursing home setting that lead to depression.

Hopefully this research paper has given you some insight into what to expect if you have a loved one preparing to move to a nursing facility or is already living in one. Educating yourself is the first step in helping your loved one have a positive experience within the nursing home setting and possibly preventing the onset of depression. Key things to remember are:

1) Follow the BE ACTIV model by identifying what your loved one considers to be positive events or activities. (These can be anything whatsoever; for example, watching the news each morning, tea in the afternoon, getting a compliment, getting hair brushed, holding a baby, eating dessert, wearing an eye mask at bedtime, etc.) 2) Help to devise a game plan with staff and other family members to allow for as much availability and frequency of these events as possible in your loved one’s daily life.
3) Help to make sure your loved one has a variety of religious outlets such as a bible in the room, assistance or reminders in attending church services within the facility, and arranging for a pastor to visit with your loved one regularly.
4) Help to assure that your loved one engages in regular physical activity, especially resistance training as appropriate.


Works Cited

About Nursing Homes. (2013, April 22). Retrieved from National Care Planning Council Long-Term Care Link: http://www.longtermcarelink.net/eldercare/nursing_home.htm

Cassie, K. M. (2012). Organizational and Individual Conditions Associated With Depressive Symptoms Among Nursing Home Residents Over Time. The Gerontologist Vol 52, No 6, 812-821.

Cherniack, E. P. (2011). At a Loss for Words and For a Single Letter: “D” Vitamin D, Dementia, and Depression in the Elderly. Mind and Brain, The Journal of Psychiatry, 16-21.

CMS 2012 Nursing Home Action Plan. (n.d.). Retrieved from Center for Medicare and Medicaid Services: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/2012-Nursing-Home-Action-Plan.pdf

Fahey, C. (1997). Elderly Residents as Spiritual Beings. Nursing Homes: Long-Term Care Management, 39-40.

Ferrini, A. F. (2008). Health in the Later Years. New York City: McGraw Hill.

Fiatarone, N. A. (2000). Exercise and Depression in the Older Adult. Nutrition in Clinical Care, Vol 3., No. 4, 197-208.

Goldberg, J. (2012, July 24). Drugs That Cause Depression. Retrieved from MedicineNet.com: http://www.medicinenet.com/medicines_that_cause_depression/article.htm

Healthcare Associated Infections. (2010, December 13). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/hai/burden.html

Joseph Z.T. Pieper, M. H. (2012). Whenever God Sheds His Light on Me: Religious Coping in Clinical Healthcare Institutions. Mental Health, Religion, and Culture, 403-416.

L.E. Nicolle, L. S. (1996). Infections and Antibiotic Resistance in Nursing Homes. Clinical Microbiology Reviews, Vol. 9, No. 1, 1-17.

Namkee Choi, S. R. (2008). Depression in older nursing home residents: The influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy. Aging and Mental Health, Vol. 12, No. 5, September, 536-547.

National Alliance on Mental Illness. (2013, April 22). Retrieved from What is Depression?: http://www.nami.org/template.cfm?section=Depression

National Institute of Mental Health. (2013, April 22). Retrieved from Depression: http://www.nimh.nih.gov/health/publications/depression

Pierre, R. S. (1994). Religiosity Reduces Behavior Problems in Nursing Homes. Brown University Long-Term Care Quality Letter, 4.

Reyes-Ortiz, C. A. (2006). Sprituality, Disability, and Chronic Illness. Southern Medical Journal, 1172-1173.

Suzanne Meeks, S. L. (2008). BE ACTIV: A Staff-Assisted Behavioral Intervention for Depression in Nursing Homes. The Gerontologist Vol. 48, No. 1, 105-114.

Thakur, M. a. (2008). Depression in Long-Term Care. Journal of the American Medical Directors Association Vol 9, 82-87.

Vann, M. (2010, July 28). Prescription Drugs That Cause Depression. Retrieved from Everyday Health: http://www.everydayhealth.com/depression/prescription-drugs-that-cause-depression.aspx

What is Cognitive Behavioral Therapy? (2013, March 3). Retrieved from National Association of Cognitive Behavioral Therapists: http://www.nacbt.org/whatiscbt.htm

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My 15 Minutes of Fame as an “M.D.”

This is the tale of over 20 years of endless and inconclusive testing to pinpoint the reason for my mom’s chronic cough.  Not any of the medical specialists she saw throughout the years could ever figure out the cause.   When I discovered the answer, her doctors were skeptical at first, and then amazed by her complete transformation with the proper treatment. For that reason I thought the story was worth telling.  Maybe it will help someone else.

Mom’s coughing began in 1987.  For the first few months, she thought since it was “just a cough” it would eventually go away. After about six months of the cough not only lingering, but getting progressively worse, she saw her doctor.  The length of time she had been coughing, the frequency of her coughs, and the fact that there was no perceivable reason for the cough, concerned her primary care doctor enough to send her to a gastrointestinal specialist.

The first procedure was an upper endoscopy. This is a rather simple, yet invasive test to get a closer look at the inside of the throat using a scope to search for inflammation and other abnormalities that may be cancerous. Although it is basically painless, the procedure is rather unnerving when you have an uncontrollable cough, but are directed not to cough at all while the scope is down the throat.  The test showed that her voice box was damaged, but the doctor concluded it was probably because of all her coughing, not the cause of her coughing.

And so it began- this was the first of a multitude of specialists and tests to come.  Over the years mom was tested for allergies, acid and non-acid reflux, asthma, infections, and viruses. Besides the endoscopy, her numerous exams included pulmonary function tests, chest x-rays, reflux studies, barium swallows, and CT scans.  As time passed, some of these tests were conducted more than once, and they mainly came back negative or inconclusive.

During all this time, mom was constantly being experimentally treated with some medication or another in the hopes that something would work for her.  The medications included various steroid inhalers, antibiotics, allergy medications, proton pump inhibitors, and cough suppressants.  She was on each medication for several weeks to months, depending on the medication, to give each one a long enough chance to have an effect. This process continued intermittently for two decades.

All the while, mom’s cough was bad. It was relentless and sporadic. She never knew exactly when she would cough, but she knew she would cough throughout the day, every day.  She was flustered about going anywhere you are expected to be quiet…church, her grandchildren’s plays, awards days, recitals, my wedding. Cough drops helped somewhat, so she popped 15 to 20 a day.  All day long at work, she had cough drops in her mouth. Whenever she went anywhere, she took cough drops along.

I’m ashamed to say, I got irritated when I would talk to mom on the phone because she was always coughing.  She would answer the phone coughing and she would try to talk through the coughing.  As I rolled my eyes on the other end of the line, I would tell her to put a cough drop in her mouth. What a horrible daughter!  I had to find the reason for this cough to rid my mom of her exhausting burden and to redeem myself from my self-centered irritation at her.

Periodically over the years, I would get on the internet and use the keywords “chronic cough” to search for answers.  I visited the reputable websites like mayo clinic, webmd, and medicinenet. They all listed plenty of possible reasons for a chronic cough.  The usual suspects included asthma, allergies, postnasal drip, gastroesophageal reflux disease, respiratory tract infection, air pollution, bronchitis, ace inhibitors, and pertussis.  I read pages and pages about these possible causes.

However, mom had already been tested repeatedly for the usual suspects with negative results. Sure, she had a few allergies, but they were not the root cause of her cough. There were also less common causes listed on the websites like chronic obstructive pulmonary disease, laryngopharyngeal reflux, sarcoidosis, and cystic fibrosis.  I researched each of these conditions individually to determine if they could possibly be the culprit, but they were not.

Then, on March 11, 2010 I watched The Today Show. One segment was about a young girl who sneezed repeatedly up to 12,000 times a day.  She had a rare and newly-discovered condition called PANDAS, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. It’s what can happen when the body’s immune system goes crazy when fighting strep throat. The antibodies produced migrate to the brain and cause tics or obsessive-compulsive behavior.  Here is a link to The Today Show segment that I watched:

http://www.today.com/id/35814608/ns/today-today_health/t/bless-you-girl-who-kept-sneezing-has-stopped/#.Vp2k7JorKt8

A light bulb flashed on in my brain.  Mom may have a coughing tic!  I decided to research this possibility on the internet.  Maybe all this time I had been using the wrong keywords to search for the answer.  This time, instead of searching for “chronic cough”, I searched for “coughing tic”, and pressed enter. After all these years, there it was…the answer!  Wow, just typing these words in this blog brought tears to my eyes because I know how monumental this discovery was to my mom’s well-being and quality of life.

It turns out that the issue the little girl from The Today Show had was not the exact cause of my mom’s suffering, but it was what led me to the correct answer.  My mom’s chronic cough was caused by laryngeal sensory neuropathy. This is when the nerve that provides sensation to the voice box, which is the same nerve that initiates the cough reflex, becomes damaged.  The damage is usually caused by a virus and the nerve becomes hypersensitive as a result.  Here is the link that I found:

http://www.fauquierent.net/cough.htm

Why in the world this information is completely omitted as a possible cause of chronic cough on every one of the popular medical websites, I don’t know.  Why in the world the plethora of specialists that my mom had seen over the years had never heard of this, I don’t know. But what is truly disheartening is that none of them, not one, bothered to do any research outside the normal battery of tests that protocol dictates they perform. It astounds me that my mom had to suffer for years when the solution was so simple.

Mom printed the information from the above website and took it to her primary care physician.  Although he was skeptical, he was willing to give the treatment a try because he had watched her suffer for so long. The treatment simply involved taking medication to calm the nerve. Her physician opted not to use the exact medication called for by the web doctor, but tried a similar one instead. The effect was noticeable in 2 to 3 days.  Her coughing was reduced significantly.  It felt like a miracle.  Her doctor was amazed.

It’s been over 5 years now.  Mom has gone from 20 cough drops a day to maybe 3 a week.  She still coughs at times, but the amount is miniscule compared to what she dealt with for 25 years. When she visited a pulmonary specialist a few months ago about an unrelated issue, she told him this story.  After reviewing the information for himself online, he was also amazed. In fact, he confided in mom that this revelation may have solved the mystery for another one of his patients who has been coughing for 15 years. That’s two down! Are there anymore of you out there?

So what is the takeaway from this story? That is for you to determine. I don’t profess to have a fraction of the expertise of any doctor, and I don’t recommend using the internet for all your medical diagnoses; but I do suggest that you take an active role in the process of seeking answers.  I believe this should be the case in every aspect of your life…body, mind, and soul.  Don’t give up. If you have a hopeless day, start over tomorrow. Your answer may be right around the corner, ready to jump out at you. Be ready for it!

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Welcome!

Hello Everyone!  My name is Valerie Myers and I welcome you to my blog!  I suspect the purpose of my blog will evolve with time, but right now my goal is to share the knowledge that I have gained working in the fitness and wellness industry for almost 25 years.  Some of this knowledge is from my own experiences, education, and insight; but some of it comes from people far more wise and insightful than I. My hope is that this knowledge will empower my readers to live the healthiest and happiest lives that they possibly can.

A Bit About Professional Me

My path into wellness started in my 20’s as a certified group fitness instructor teaching a single aerobics class for a free gym membership. Since then I have taught a variety of classes including boot camps, spin, yoga, step, aquatics, and senior fitness. I continue to teach classes geared mainly toward the 65 and older population. They are my heart! I cannot wait to discuss more about this amazing demographic of people and their fantastic accomplishments in future blog posts!

I have also been a NC licensed massage therapist for the past twelve years. Practicing massage has been a true blessing in my life. It has allowed me to fulfill my greater purpose of helping others live more pain-free and stress-free lives. Massage has also afforded me the privilege of scheduling my work life around my daughter.  I was able to attend all of her dance competitions, track meets, awards days, and other events throughout her life. I am so thankful for that!

MY LIFE Bodywork and Wellness

My business name is MY LIFE Bodywork and Wellness. MY LIFE is an acronym for Myers Lifetime Integrated Fitness Enhancement. My mission is to offer you a number of integrative solutions that can be easily maintained throughout your lifetime to improve and enhance your fitness, well-being, and quality of life.

I try to get as much good out of life as I possibly can, and I want to help others do the same. It truly gives me peace of mind to be doing something that contributes to the well-being of others. Nothing thrills me more than to see people strive to be healthier and happier and ultimately achieve their goals!  It’s really a selfish endeavor; I’m no angel.  If the people that fill my world are happier, then I am sure to be happier living among them.

Here are some degrees, certifications, and licensures that give me a little street cred:

  • BA Psychology, UNC Chapel Hill
  • IFTA Certified Personal Trainer
  • IFTA Certified Senior Fitness Instructor
  • IFTA Certified Aquatics Instructor
  • Silver Sneakers Certified Instructor (Silver Classic, CardioFit, and Silver Yoga)
  • Fierce4 Nutrition Coach
  • NC Licensed Massage Therapist, LMBT #4936

A Note to Take to Heart

If you have some changes you would like to make in your life, you must be open to change yourself. In other words, you must be willing to consider new ideas or a different way of doing something than you are accustomed. I have had to learn this lesson a few times in my life. It’s an important one. Someone far more wise and insightful than I said that doing the same thing over and over again and expecting different results is basically insane. Keep that in mind on your life’s journey toward happy and healthy wellness.

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