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TOPIC: DEPRESSION

PICOT QUESTION: In older adults residing in long-term care facilities with symptoms of depression (P), does participation in structured group-based cognitive-behavioral therapy (CBT) sessions (I), compared to routine social activities alone (C), reduce depressive symptoms and improve mood (O) over a 12-week period (T)?

EACH SECTION MUST HAVE BOLD LETTER TO BE ABLE TO MY INSTRUCTIONS IDENTIFY EACH SECTION COMPLETED

REQUIREMENTS:

1. Title Page

2. Introduction to your proposed problem:

– Significance of the Practice Problem: Discuss the identified Practice Problem.

-Introduce the topic of the assignment

-Describe the health problem. DON’T TYPE “Introduction.”

-Using data and statistics, support your claim that your selected issue is a problem.

– Include your purpose statement and what specifically you will address in your proposed program.

-Be sure your proposed outcome is realistic and measurable.

3. PICOT- Should be discussed in detail. This section should include your PICOT QUESTION but also should provide thorough descriptions of your population, intervention, comparison intervention, outcome, and timing (if appropriate to your question).

The word PICOT is a mnemonic derived from the elements of a clinical research question – patient, intervention, comparison, outcome, and (sometimes) time. The PICOT process begins with a case scenario, and the question is phrased to elicit an answer. P – Patient/Problem I – Intervention C – Comparison O – Outcome T – Timeframe

4. Describe the vulnerable population

-Discuss the impact of social determinants on health for your selected population.

-What are the risk factors that make this a vulnerable population?

-Use evidence to support the risk factors you have identified.

5. Research should be from scholarly journals of evidence-based interventions that address the problem.

-Peer-reviewed research articles not older than five years (all articles must be used in your paper)

6. Proposal

-Propose addressing the selected health problem using an evidence-based intervention in your literature search to address the problem in the selected population/setting.

-Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role.

-Be sure to include a timeline for the intervention proposed.

7. Theoretical Framework/Nursing Theory- This section should include the theoretical framework which supports your project. Describe a theory or model to serve as the foundation for your project. ( IN THIS CASE IS -Jean Watson’s Theory of Human Caring)

– Overall, you should be able to introduce the problem and why this is significant to the healthcare system. For example: What impact does it have on the patient, community, cost of care, quality of life, readmissions and so forth

-Use appropriate APA 7th Ed. format

-Scholarly, peer-reviewed, and research articles cited should be within the last five years.

-This section should be 3 pages long (not including the title and reference page).

-Use proper in-text citations with a properly formatted reference list.

SOLUTION 

 

Significance of the Practice Problem

Depression among older adults in long-term care facilities (LTCFs) is a pressing yet often underrecognized healthcare concern. It impacts approximately 30–50% of residents in these settings, contributing significantly to decreased quality of life, increased morbidity, and higher healthcare utilization (Lichtwarck et al., 2019). Depression not only leads to emotional suffering but also exacerbates existing physical illnesses, contributes to cognitive decline, and increases the risk for premature mortality. In LTCFs, depression is often overlooked or misdiagnosed due to overlapping symptoms with other geriatric conditions such as dementia or physical frailty.

The purpose of this paper is to present a proposal for implementing structured group-based cognitive-behavioral therapy (CBT) sessions for older adults residing in LTCFs who show signs of depression. This intervention will be compared to routine recreational or social activities, which are currently the standard approach for engagement in LTCFs. The goal is to determine if CBT leads to measurable reductions in depressive symptoms and improvement in overall mood. This proposed outcome is realistic, specific, and measurable using validated scales such as the Geriatric Depression Scale (GDS) over a 12-week timeframe.

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PICOT

The PICOT format provides a framework to clearly define the clinical question:

PICOT Question: In older adults residing in long-term care facilities with symptoms of depression (P), does participation in structured group-based cognitive-behavioral therapy (CBT) sessions (I), compared to routine social activities alone (C), reduce depressive symptoms and improve mood (O) over a 12-week period (T)?

• Population (P): Older adults (age 65+) in LTCFs who present with depressive symptoms.

• Intervention (I): Participation in structured, weekly group-based CBT sessions facilitated by trained mental health professionals or advanced practice nurses.

• Comparison (C): Participation in routine recreational/social activities (e.g., group games, general entertainment, or art classes without therapeutic intent).

• Outcome (O): Reduction in depressive symptoms and improved mood, measured using validated depression screening tools (e.g., GDS or PHQ-9).

• Time (T): 12 weeks of weekly CBT sessions.

This question guides the identification of evidence-based interventions and supports the implementation of nursing-led strategies that target emotional and mental health outcomes in a vulnerable population.

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Vulnerable Population

Older adults living in LTCFs are a particularly vulnerable population due to a combination of social, psychological, and physical risk factors. Many face isolation from family, loss of autonomy, chronic diseases, and the grief of losing peers—all of which compound depressive symptoms (Tariq et al., 2021). Additionally, their ability to self-advocate is often limited due to cognitive impairments, mobility issues, or dependency on caregivers.

Social determinants of health such as limited access to mental health services, low income, social isolation, and inadequate mental health training among staff in LTCFs further exacerbate this vulnerability. For example, lack of trained mental health providers in these settings means depression often goes untreated or managed with pharmacologic methods alone, which can lead to side effects and poor adherence (Singh et al., 2023).

Evidence shows that cognitive-behavioral therapy is both a safe and effective non-pharmacological treatment for geriatric depression. A systematic review by Li et al. (2022) confirms that CBT interventions reduce depressive symptoms in older adults with mild to moderate depression, and group formats provide the added benefit of social engagement.

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Research Support

Recent evidence from peer-reviewed literature demonstrates the effectiveness of CBT in geriatric settings:

• Lichtwarck et al. (2019) conducted a randomized controlled trial in LTCFs showing that group-based psychological interventions significantly reduced depressive symptoms compared to standard care.

• Li et al. (2022) found CBT to be effective in decreasing geriatric depression severity, especially when integrated with group dynamics and delivered consistently over 8–12 weeks.

• Singh et al. (2023) emphasized the importance of interdisciplinary approaches including nursing leadership in implementing mental health interventions in LTCFs.

These studies validate the efficacy of CBT as a viable and impactful intervention in long-term care settings.

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Proposal

The proposed intervention is to implement weekly, 60-minute structured CBT group sessions led by a psychiatric-mental health nurse practitioner (PMHNP) or a trained mental health counselor within the LTCF. The sessions would span 12 weeks, using a structured CBT curriculum adapted for older adults. Each session would include components such as identifying negative thoughts, developing coping skills, and reinforcing social connections.

Resources Required:

• A licensed PMHNP or LCSW

• A private, quiet space in the LTCF for sessions

• CBT handouts and worksheets tailored for geriatric clients

• Depression screening tools (e.g., GDS)

Staff Involved:

• PMHNP or psychologist

• LTCF nurse supervisor

• Activities coordinator

Feasibility: Nurses in advanced roles are well-positioned to lead this intervention due to their training in mental health assessment, psychotherapy, and interprofessional collaboration. Moreover, CBT is cost-effective and can be delivered in group formats, making it feasible for implementation even in resource-constrained LTCFs.

Timeline:

• Week 1–2: Staff training and participant recruitment

• Week 3–14: CBT sessions begin (1x/week)

• Week 15: Post-intervention depression screening and evaluation

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Theoretical Framework/Nursing Theory

Jean Watson’s Theory of Human Caring provides the theoretical foundation for this project. Her theory emphasizes the humanistic aspects of nursing combined with scientific knowledge, and focuses on caring as a moral ideal of nursing. Watson’s theory aligns with the delivery of CBT by advocating for the promotion of emotional, spiritual, and psychological healing—not just physical health.

By applying her carative factors, nurses engage with patients in meaningful relationships that foster trust and promote dignity, which is essential when addressing sensitive mental health issues like depression in the elderly. The caring environment created through CBT sessions reflects the essence of Watson’s theory—providing holistic care and enhancing quality of life.

Impact on Healthcare:

• Patient: Reduced depressive symptoms, improved mood and social interaction.

• Community: Enhanced psychosocial care models in LTCFs.

• Cost: Decreased reliance on pharmacologic treatment, reduced hospital readmissions.

• Quality of Life: Improved mental and emotional well-being.

• Readmissions: Preventive mental health care reduces depressive episodes requiring hospitalization.

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References

Li, X., Sun, J., & Zhou, L. (2022). Effectiveness of cognitive-behavioral therapy for elderly patients with depression: A meta-analysis of randomized controlled trials. Aging & Mental Health, 26(1), 12–20. https://doi.org/10.1080/13607863.2020.1857683

Lichtwarck, B., Husebo, B. S., Selbaek, G., Aarsland, D., & Bergh, S. (2019). Group-based psychological intervention reduces depression in nursing home residents: A cluster randomized controlled trial. BMC Geriatrics, 19(1), 35. https://doi.org/10.1186/s12877-019-1055-5

Singh, R. G., Gibson, J. S., & Reeves, S. (2023). Implementing mental health interventions in long-term care: Role of the advanced practice nurse. Journal of Gerontological Nursing, 49(3), 20–28. https://doi.org/10.3928/00989134-20230207-03

Tariq, M., Shafique, K., & Fatima, M. (2021). Geriatric depression and its association with social determinants of health in long-term care facilities. International Journal of Mental Health Nursing, 30(5), 1263–1272. https://doi.org/10.1111/inm.12877

 

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