FAQs #8

Q8. My 82 year old grandfather recently went into a nursing home due to various health problems, including heart problems. He is on morphine to lessen the pain and seems to be calmer and less anxious than usual. He is a Fundamentalist Christian who is very concerned with the salvation of the people he meets and does not hold in high regard those who believe differently. He has been irritable, worried, and has had noticeable loss of pleasure the past few years. The nursing home has recommended counseling for depression. I am concerned with two factors as I think about its effectiveness: How is the morphine masking his emotional life and would he bond well with a younger, non Christian counselor. Would you recommend counseling for him?

A8.Karla Kauffman:
>Nursing homes sometimes contract with counseling agencies to provide mental health intervention. If that is the case here, you might want to ask who is encouraging intervention: the staff, or the contractual agency? They sometimes have different agendas.<
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I would take seriously the concerns and observations of the staff regarding your grandfathers' behavior. What specifically are they seeing? Is this behavior different from when he was at home? If so, do you believe it is impairing his quality of life.? If it is similar, you my want to discuss with the nursing home or a mental health professional you trust what are the signs of depression in the elderly. There are specific symptoms that can be looked for. If you feel he needs a depression screen, the contracted agency may be able to provide that.

Then we consider appropriate intervention. Is your grandfather willing and able to converse in general? If so, a skilled and understanding counselor, even if not of his faith, can be of use in treating his depression. I think an understanding person of his faith could also meet with him and perhaps work in collaboration with the counselor. This way, he may respond more positively to the counselor and receive more attention as well.

Monica Keefe:
>Your question would seem to address several issues. I will try to break the answer down to address these issues.

USE OF MORPHINE
EFFECTS — It is true that the use of morphine can contribute to depression. But my guess is that its benefits are giving him enough symptom relief from the pain and associated cardiac symptoms, that he may now have the energy and ability to be more introspective. This introspection towards the end of life is often normal - it often looks like depression (and sometimes is), but it also seems to be a necessary part of preparing for death in some way. The morphine is probably very useful, and I would be inclined to not change it unless he is having unpleasant side effects that are more troubling than helpful.

COUNSELING — If your grandfather is willing and open to the idea of counseling, it might be useful, depending on how he feels about it. The counselor should be skilled in working with older individuals and end of life issues. As far as whether or not they will get along, it would probably be well to leave that up to your grandfather and the counselor.