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DEPRESSION, Planned flow Introduction: care scenario, video introduction…

- - - - mangement of suicide risk
        
        ->mental support: follow up phone calls
        ->psychiatric specialist follow up
        ->psychotherapy: Dialectical Behavior Therapy is used to help an individual recognize disruptive or unhealthy feelings or actions;Cognitive Behavioral Therapy is a common treatment option for individuals suffering from a variety of mental disorders.
        ->family/ caregiver relationship building. community and social connection
        ->limit access/remove potential lethal such as knife, string, pills, poisons
      - community support
        
        ->samaritans of singapore (24hrs/emotion support, specialist counselling)
      - higher risk with attempted suicide history
        feel loneliness, useless, hopeless
    - - Evidence/ supported by
        
        Statement/what are supported in the video
        
        Lack of social support
        
        Death of husband
        
        Lost of only good friend
        
        Patient is a very not a social person
        
        Lives alone prior to helper's arrival
        
        Loss of independency
        
        Unable to perform ADL
        
        Unable to cook what she loves
      - Research or evidence of how depression can result in low motivation?
        
        Depression = low mood resulting in low motivation
      - Definition
      - Impact of low motivation
      - Which part of the motivation may tell us that patient has low motivation
        
        Refuses to move or exercise, except for cooking
      - Management
        
        Lack of social support
        
        Helper
        
        Build rapport
        
        Include in activity
        
        Resolve language barrier
        
        Family
        
        Include other family member other than just the daughter
        
        Loss of independency
    - - Loss of interest / less involve in activities or exercise (daughter encouraging Mdm Lee to exercise to avoid functional decline as per the physiotherapy)
        
        Promote independence, but intervene when the patient is not able to carry out self-care activities
      - Daughter mentioned that Mdm Lee might get frustrated at time and might need help with tasks like dressing and bathing
        
        Consider or use energy-conservation techniques
      - Functional status
        
        wheelchair bound
        
        Lifestyle
        
        Exercise
        
        Overcoming barriers to exercise adherence
        
        ADL'S
        
        Feeding
        
        Independant
        
        Toileting
        
        Maximum assist
        
        Aid patient in eliminating or changing unnecessary clothing.
        
        Transferring
        
        Maximum assist with daughter and helper assistance
        
        Encourage the patient to use his or her arms to assist, as able, and to place them on the caregiver’s forearms
        
        Observe closely patient for loss of balance or fall.
        
        Dressing
        
        Give frequent encouragement and aid with dressing as needed.
      - Malnutrition
        
        Appetite change (dislike what the helper prepared)
        
        Diet
        
        Healthy nutrition and diet (Ask what Mdm Lee wants to eat)
        
        Allow the patient to feed himself or herself as soon as possible . Assist with setup as needed
        
        Place the patient in a comfortable position for feeding
  - - - Daughter
        
        -> Feels helpless
        -> Does not know how to comfort client when she is having depression
        -> Feels heartache and heart bleeding when she is unable to help client
        
        -> Hire helper as unable to cope with care of patient
        -> Quit work to take care of client
      - Helper
        
        -> Possible language barrier, might not know what client wants
        -> Helper need to learn how to take care of patient
        
        -> Client not happy with helper (Cooking terrible)
        and refuse helper's care
      - Management plan for caregiver stress
        
        Social aspect
        -> Depression support group
        -> Give helpline to caregivers
        Cognitive aspect [Helpless, possible burnout strategies
        -> Adult day care services/respite care
        -> Equip caregiver with knowledge and skills to meet client care demands
        Functional aspect
        -> Educate caregivers to care for patient (ADL/transfer technique)
        -> Promote safety at home to prevent falls
- - - - getting monthly payouts
        
        IDAPE ($150-250/month for up to 72 months) & PGDAS ($100/month) application - Dr will need to help in application
      - subsidies home modification
        
        PT/OT to assess
        
        EASE (home mod)/ SMF (getting home equipments) at a subsidies rate
      - reduce out of pocket cost
        
        do mean testing
        
        will help in getting subsidy for other services too
        
        Pioneer generation card
        
        $540 subsidy/year under CHAs CDMP coverage
    - - Free counselling for caregiver
        
        Fei Yue caregiver support and respite services (Free - funded by AIC)
      - option to seek more info for free
        
        CREST - community outreach prog
    - - Free up dgt's time so that she can work part time
        
        IHDC - integrated home and day care
        
        subsidy decided based on mean testing
        
        case manager can help to follow up
    - - Assist in application for funds - FDW levy, homecare giving grant, caregiver training grant
  - - - Evidence by: As verbalized by daughter that Mdm Lee has a strong character and is not a social person
    - - Evidence by: Love to be in a comfortable place by herself
    - - Evidence by: After husband passed away, she lives by herself
      - Evidence by: Used to go out do thing together with her sister. After her passing, she even feels more lonely
      - Evidence by: When Mdm. Lee was having depression, daughter verbalized that Mdm. Lee felt like there’s a rock pressing on her, she couldn’t breathe, move and not able to do anything. Not able to express herself.
    - - Befriending interventions
        
        Befriending interventions- a form of social facilitation with the aim of formulating new friendships and often involved volunteers
        Gardiner & Barnes (2016) indicates that befriending service provided a multidimensional impact on a range of outcomes such as emotional and psychological wellbeing and reducing social isolation
      - Community Gardening
        
        Gardening may be particularly valuable to older persons because of the social contact Shared gardening interests could help overcome the social isolation, through a greater sense of belonging, community and social support (Scott et al., 2020).
      - Day Care Centre
        
        Orellana et al., (2020) indicated that day centre attendance enhanced quality of life for socially isolated people with mobility restrictions and at risk of declining independence and wellbeing whereby attenders’ social participation and involvement and on meaningful occupation was significant (p-value < 0.001, 99% CI), with an average ASCOT gain score of 0.18.