NR 611 Week 1 Discussion; Caring for the Aging Adult Client Situation and Holistic Concerns

2 Plan of Care For John, I would begin with basic laboratory studies to rule out reversible causes of his frailty and mood decline. A complete blood count (CBC) is used to evaluate for anemia, which can worsen fatigue and slow cognitive growth in older adults. A comprehensive metabolic panel (CMP) would assess electrolyte balance and renal and hepatic function, both of which can influence mood and the safe prescribing of medications. Additional testing should include a thyroid-stimulating hormone (TSH) with a reflex to free T4, as hypothyroidism is a well-recognized mimic of depression. Vitamin B12, folate, and vitamin D levels should also be measured, since deficiencies are prevalent in late life and contribute to fatigue, poor concentration, and depressive symptoms. An HbA1c is indicated to evaluate diabetes, which can further complicate frailty and energy levels. Finally, a baseline electrocardiogram (ECG) is recommended before initiating antidepressant therapy due to the increased risk of QTc prolongation in older adults (Devita et al., 2022). Screening will be multidimensional. Because John meets several DSM-consistent symptoms, I would formally assess depression using the GDS-15 or PHQ-9 and document a plan for treatment and follow-up, consistent with USPSTF guidance to screen adults for depression when systems for diagnosis and management are in place (USPSTF, 2023). Although he has not stated intent, his hopelessness warrants a C-SSRS safety screen. Follow-up and reassess at 2 weeks, then 4–6 weeks to monitor trends in GDS/PHQ-9, weekly weights, falls/near-falls, and side effects. For cognitive assessment, I would obtain a Mini-Cog baseline (a brief, validated tool for older adults) and reserve the MoCA only if the Mini-Cog is abnormal (Abayomi et al., 2024). Preventive screening is essential for colorectal cancer; individuals aged 76–85 require individualized decision-making based on overall health and prior screening history (USPSTF, 2021). Since John is frail and has recently experienced weight loss, nutrition is a top priority. I would refer him to a registered dietitian for a comprehensive nutritional assessment, initiate oral nutritional supplements if needed, and monitor his weight weekly for changes. Because poor nutrition and appetite loss can worsen depression, these interventions would be coordinated with his mental health treatment plan (Monette et al., 2023). Mobility and fall prevention are also critical. I would conduct a Timed Up and test and refer him to physical therapy for balance and strength training, while recommending home safety modifications, such as improved lighting and reducing clutter, to reduce his fall risk. If symptoms persist despite counseling, pharmacotherapy may be warranted. SSRIs like sertraline or escitalopram are reasonable first-line choices. However, given John's frailty and weight loss, mirtazapine could be an appropriate alternative because it is associated with improved appetite and weight gain in older patients with depression (Monette et al., 2023). 4 Focused Strategy (Priority: Depression with Hopelessness The immediate priority is to assess the severity of John's depressive symptoms and hopelessness. I would use the Geriatric Depression Scale-15 (GDS-15) or the PHQ-9. Due to his hopeless statements, I would also include the Columbia-Suicide Severity Rating Scale