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  • Subject Name : Mental health

Case Analysis: Panos

Question 1: Relevant Influences of Attitude, Environment, Culture, and Support on Mental Health of Panos

Multiple factors like personal experiences, external environment, family and community support, etc. influence the psychological well being of an individual (Liu et al., 2016). In the given case scenario of Panos, an 85-year-old widower, various influences can be identified that are responsible for his current behavior and psychological health. Panos is exhibiting depressive behavior where is suicidal in nature and he is reluctant to participate in social activities. Along with problems associated with his psychological health, several physical health ailments are also associated with Panos that include unsteady walks and high blood pressure. These health conditions present themselves due to his old age and are also responsible for affecting his overall wellbeing. The behavioral changes in Panos that include loss of appetite, hopelessness, extreme anxiety and sadness, and constant low mood can be associated with the trauma of the loss of Mary, his wife that has triggered his underlying depression. As per Susan, his daughter, Panos had untreated depression after he lost his father, which might have been triggered by the loss of Mary making his current condition worse.

The attitude of an individual significantly impacts his or her psychological wellbeing (Kim et al., 2017). Panos exhibits a negative attitude towards living and expresses hopelessness, he talks of dying and meeting Mary post-life. This is indicative of depression and extreme loneliness that has been encouraged by his social and personal lifestyle. Both his children live away and even though they visit frequently, Panos seems to project a reclusive attitude towards social activity and lives alone. He has also been reluctant in participation with his community activity. According to the transtheoretical model of health, it is important for individuals to be determined for health promotion and have a positive attitude and to “contemplate” the need for change for the adoption of a healthy psychical and psychological wellbeing (Hummel et al., 2017). However, in the case of Panos, he does not demonstrate an attitude where he wishes to improve his overall wellbeing. The environment of an individual also impacts psychological wellbeing.

Panos lives alone with minimal social interaction, this can lead to the development of loneliness. It can also present with difficulty in coping with the loss of a loved one. Loneliness is also associated with increased stress levels and may cause health problems like decreased memory. It also enhances anxiety and therefore takes a heavy toll on the psychological well being of an individual (Awasthi & Grover, 2018). Essential environmental factors that are responsible for the deteriorating mental health of Panos include limited social interaction and living alone. These factors have resulted from a depressive trauma of the loss of his wife and represent themselves with constantly low mood, sadness, anxiety, hopelessness, and lack of determination to live.

Another crucial aspect of the psychological well being of Panos has intricately linked with his environment and his cultural appropriation. Panos is originally from Greece and has migrated to Australia 55 years ago. The major themes of depression revolve around loss, in the case of Panos, he has not only lost his loved ones impacting his mental health but he also been detached to his cultural and social life from Greece in which he grew. This further makes him vulnerable to the development of depression. According to ethnomedical analysis, cultural differences and lack of social groups that you connect to can develop a lingering feeling of withdrawal and loneliness in individuals. This has also been associated with triggering depression. Cultural identity is also associated with how an individual exhibits the symptoms of depression. Cultural differences impact the help seeking behavior and therefore might have resulted in social seclusion in Panos where he might not feel comfortable around people who do not belong to his community.

The community and family support play a crucial role in depression (Liu et al., 2016). Depression is a heterogeneous disorder and therefore requires essential support from the family, carers, and the community (Awasthi & Grover, 2018). An individual suffering from depression may feel detached and a lingering void that requires care and support. In the case of Panos, he has been receiving care and support from his children, David and Susan visit him frequently as he has been living alone after the death of his wife. Family support and the intimating nurturing group aid in providing person-centered care to the patient. Support in depression helps in the treatment and management of the condition and helps in the management of the health condition. Psychological support is important in depression as patients may develop seclusion and isolation (Veronese et al., 2017). Recovery from depression has therefore been considered essential. Social, psychological, and family support aids in recovery through comforting the patient and helping them address the psychological problems they have been facing. Panos has suffered from an untreated depressive episode earlier in life as well. Therefore, support becomes more crucial as the trauma of losing Mary must have impacted him more severely.

Question 2: Main Risk Areas

According to the World Health Organization, older age is one of the essential factors that impact mental health as it is associated with dementia and loss of cognitive function (Scharer& Hibberd, 2019). Further, older adults are also prone to an increased risk of social isolation. The feeling of isolation can also be associated with the loss of a loved one. Several risk factors that are associated with the development of depression in the elderly include sadness, feeling of hopelessness, fear of future, social withdrawal, sleep, and eating problems, and difficulty in problem-solving (Scharer& Hibberd, 2019). For Panos, the main risk areas that can worsen his mental health and overall, wellbeing include hopelessness, social withdrawal, loss of appetite, unsteady walks, and anxiety. He is also suffering from sleep apnea that can affect his psychological condition. Further, his ignorance towards his physical wellbeing is also a major risk area affecting his health. Since stressful changes like loss of a loved one and age are major contributors towards loneliness and depression, they identified as the core risk factors that can impact his psychological wellbeing.

Hopelessness has been associated with people suffering from depression. People who live with depression develop a void that leads to detachment from the social and personal aspects of life in an individual. Panos feels that things are only getting worse and wishes to be with Mary after his death. The loss of a loved one has triggered the trauma that has made him lose hope for a better life. Hopelessness is an emotion that is characterized by a lack of optimism, passion, or hope in an individual (Veronese et al., 2017). It is considered as a powerful emotion that can lead to low mood and perceptions of an individual. The lingering feeling of hopelessness can cause loss of interest in the objects, activities, and people resulting in seclusion in an individual. The feeling has been associated with several mental health disorders and psychiatric conditions.

The feeling is associated with depression, anxiety, eating disorders, bipolar disorder, substance dependency, etc. and can lead to the development of suicidal behavior in an individual. Hopelessness is one of the primary risk factors associated with the condition of Panos. The feeling of hopelessness aggravates the depression and anxiety in him. The second major risk factor that is associated with the health condition of Panos, social withdrawal and lack of social support. Elderly people require constant care and support to meet their psychological needs. Panos lives alone and has been reclusive towards social interaction. Social withdrawal is considered as one of the markers for depression. This is also associated with the loneliness that can further impact the mental health of Panos. It is important to consider that Panos has a major loss due to the death of Mary.

As the two lived together, and their children stayed away. This must have incited a feeling of loneliness and contributed towards his depression. Loneliness has been considered as both a symptom of depression as well as a predictor of depression (Robbins-Welty et al., 2019). Being a widower, Panos spends most of his time alone that can act as a psychological stressor. The two factors are intertwined and can act as both cause and a consequence to one another. Loneliness and depression in Panos can be associated with the feeling of despair and isolation. Depression in the elderly is associated with the loss of purpose and can also result in several health problems. It is also associated with social inhibition and emotional instability.

Further, Panos has also lost his appetite and weight. Depression has also been known to affect appetite. Hormones that suppress appetite are triggered when an individual is depressed. Therefore, this limits the hunger and has resulted in significant weight loss in Panos. This also impacts his physical wellbeing making his deteriorating physical health as an important risk factor associated with the overall well being of Panos. Panos is hypertensive and requires taking medication, however, he has missed his assessments. This can severely impact his physical health and lead to secondary complications like arrhythmia, stroke, and even heart attack. Another essential factor associated with the physical health of Panos is his unsteady walks that may increase his chances of fall. Falls have been identified as the major cause of morbidity and disability in the elderly. Falls occur largely due to cognitive impairment in the old age as the body fails to maintain its balance. The unavoidable fall risks include age above 85 years (Hummel et al., 2017). Panos is therefore at a high risk of developing severe injury due to falls that may occur due to his unsteady walks. It is crucial to, therefore, identify and develop a holistic, person-centered care plan that can promote health and recovery from depression for Panos and also assist in the management of his physical health for his beneficence.

Question 3: Factors that May Assist in His Journey

To help Panos in his journey towards recovery from depression, multiple factors can be of essential importance. These include a supporting family and community (Meichsner et al., 2020). The mental health of an individual is largely mediated by the immediate social contact in which an individual lives, works, and carries out his or her day to day activities. Therefore, family and community attention to an individual can significantly assist in improving the psychological health of an individual and assist in the overall recovery (Nogueras et al., 2016) .Panos has support from both his children, David and Susan who can help him recover from depression along with professional help. The primary need is to make Panos realize that he needs a behavioral change to combat his condition, this will require a transition of Panos from the pre-contemplation stage to the contemplation stage of health behavior. Once Panos realizes that he needs a change in his behavior for his wellbeing, it will possible to undertake suitable actions that can assist in the recovery and management of his condition.

Family support is essential in a situation like these as it helps in advocating the patient's needs more precisely and more clearly than anyone else. The children have known father and have been with him in his toughest of times. Therefore, they can guide the nurse and other care professionals for his needs, and advocate for his priorities for complete care. Family support is also essential as it helps the patient feel confident about the change and therefore enhances his participation and compliance towards recovery (Liu et al., 2016). Since David and Susan have also lost their mother, they can understand the trauma of loss more appropriately than an external healthcare worker. Both Susan and David can inspire Panos for a healthy life and inspire him towards recovery. It can be identified that Panos is deeply hit by the loss of Mary as he visits his grave frequently and has distanced himself from everyone around him. Therefore, support from David and Susan can help him find a reason to live and spend his life with positivity and recover from the loss.

Further, David and Susan can direct Panos to health promotion. Family support plays an essential role in developing and maintain attitudes towards health promotion (Crago& Gardner, 2019). Support of the family can ensure that there are long term benefits for the patient and also advise for the suitability of interventions (Nogueras et al., 2016). A family-focused approach of healthcare can, therefore, be taken for the beneficence of Panos that will encourage a collaborative approach and assist in the recovery. The family of the patient serves as a primary caregiver and thus plays a vital role in the process of rehabilitation. Enforcement of positive attitudes can impact the overall health of the patient and assist in the process of recovery by priming commitment and help in accepting new challenges for the betterment of health and promotion of wellness It has also been noted that family members with an optimistic approach can help in recognition and assisting in the recovery of patients (Meichsner et al., 2020). Therefore, both, David and Susan can play an effective role in the recovery of their father from depression and trauma triggered by the loss of Mary.

Another essential factor that can help in the recovery of Panos is his financial stability, according to the social determinants of health, established by the World Health Organization, economic stability severely impacts the health status of an individual (Scharer& Hibberd, 2019). In the case of Panos, both his children are financially stable and well settled which can help him with his finances and assist in recovery. Susan is a managing director and David is a paramedic. Strong financial conditions and economic stability can help in recovery from depression as economically stable people can get easy access to essential services, therapies, and counseling that are required for the recovery (Scharer& Hibberd, 2019). Affordable access to therapies and counseling can help in the management of the condition and therefore assist in the recovery of Panos.

Another essential factor that can assist in the recovery of Panos is his location in Western Sydney. According to the social determinants of health, the place where an individual, lives and grows severely impacts his or her health condition. Panos is settled in Western Sydney which is one of the highly developed regions of the country. This will ensure easy access to all his needs and therefore enhance the recovery. Moreover, Western Sydney also has several clinics and counseling therapists available in the vicinity (Crago& Gardner, 2019). This will be highly beneficial for Panos he is old and therefore requires treatment in the vicinity for maximum comfort and care. The availability of multiple counselors and psychologists will ensure that Panos gets adequate care. Since Panos exhibits reluctance from social participation and going out, the availability of counseling and therapists in the vicinity will also help Panos to comply with the sessions and recover from depression. Therefore, it can be deduced that the availability of family support, access to mental healthcare services in the vicinity, and a stable financial status are of essential importance and can help Panos recover from depression.

References

Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for management of depression in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S341.

Crago, H., & Gardner, P. (2019). A Safe Place for Change, revised 2nd edition: Skills and Capacities for Counselling and Therapy. Australia: Interactive Publications.

Hummel, J., Weisbrod, C., Boesch, L., Himpler, K., Hauer, K., Hautzinger, M., ... &Dutzi, I. (2017). AIDE–acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: A randomized, controlled trial. Journal of the American Medical Directors Association, 18(4), 341-349.

Kim, J. Y., Liu, N., Tan, H. X., & Chu, C. H. (2017). Unobtrusive monitoring to detect depression for elderly with chronic illnesses. IEEE Sensors Journal, 17(17), 5694-5704.

Liu, L., Gou, Z., &Zuo, J. (2016). Social support mediates loneliness and depression in elderly people. Journal of Health Psychology, 21(5), 750-758.

Meichsner, F., O'Connor, M., Skritskaya, N., & Shear, M. K. (2020). Grief before and after bereavement in the elderly: An approach to care. The American Journal of Geriatric Psychiatry.

Nogueras, D. J., Postma, J., & Van Son, C. (2016). Why didn't I know? Perspectives from adult children of elderly parents with dementia. Journal of the American Association of Nurse Practitioners, 28(12), 668-674.

Robbins-Welty, G. A., Stahl, S. T., & Reynolds, C. F. (2018). Grief Reactions in the Elderly. In Clinical Handbook of Bereavement and Grief Reactions. 4 (2), 103-137. Humana Press, Cham.

Scharer, J. L., & Hibberd, R. (2019). Meaning differentiates depression and grief among suicide survivors. Death Studies, 1-9.

Veronese, N., Stubbs, B., Trevisan, C., Bolzetta, F., De Rui, M., Solmi, M., ... & Baggio, G. (2017). Poor physical performance predicts future onset of depression in elderly people: Progetto Veneto Anziani Longitudinal Study. Physical Therapy, 97(6), 659-668.

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