Liesel V.

Calingangan BSN 4-D

C.I Maam Roselie Aurelio Report/Elective

Potential for Violence Related to Depression

According to (Morrant, 1983)

Depression is the most common psychiatric illness in the elderly, as well as in the general population. Anxiety and anger are always linked to hurt, and depressed patients may display violent behavior toward self or others. Recognizing depression in the elderly is sometimes difficult, as it may present as vague problems like lethargy, anorexia, or insomnia. Any change in usual behavior in an elderly person should always be taken as a serious possibility of depression

According to Gage (1973) He describes a process that differentiates depression in the aged person from normal mourning. This process includes love-object loss, withdrawal of libido, cathexis of own ego, identification of ego to the lost object, feelings of sadness that result in a decrease in interest in the outside world , decrease capacity to love, and a decrease in activity. He identifies a decrease in self-esteem a verbalization of self-reproach, and a need for punishment. Punishment of self can terminate in suicide, and violent behavior toward others is often part of the suicidal phenomenon To assess violence potential in a depressed elderly individual the nurse must have knowledge of the elders previous coping mechanism and of how the elder has responded in the past to frustrations and stressors. If the elder has had some recent series of frustrations and if he or she is confused or showing signs of impaired judgment, potential for violence is more likely.

Unlike the demented person, a depressed elderly individual may possess a weapon. Other cues that may be present include signs

of anxiety such as rigid posture, hypersensitivity, dissatisfaction, and hostile sarcastic verbalizations. Vulnerable self-esteem and signs of depression such as active aggressive suicidal- acts warn of the potential for further violence.

Potential for Violence Related to Altered Processes Secondary to Paranoid Ideations

Thought

Petrie et al (1982) of geriatric admissions to a state psychiatric hospital, diagnosis of late paraphenia or late onset schizophrenia- was significantly associated with the violent group. Another group that surfaces frequently in studies of violence in psychiatric settings is the schizophrenic patients who have been ill for many years. Both of these groups present predominantly paranoid ideations that are not accompanied by confusion or disorientation (Petrie, 1984; 113).

In the late onset groups A delusional state arises in a clear consciousness, and hallucinations and ideas of references may also be present. Patients in the group usually are strongly committed to their delusions and will act on them. All paranoid individuals will exhibit some of the other classic defining characteristics of Potential for Violence before a violent episode. Body language, including: rigid posture, angry facial expressions, and clenched fists- an early indication of impending aggression. Hostile verbalizations, repetitions of complaints, demands, pacing, agitation,

Potential for Violence Related to Inability to Control Behavior Secondary to Distress/Frustration/Anxiety

Distress, Frustrations, and anxiety -are very real and common conditions in the elderly. Losses related to aging can be catastrophic to the person experiencing them.

Having to depend on others for such intimate functions as toileting, or having to cope with wheelchairs, catheters, and prostheses, produces a degree of anger and anxiety in most persons. If the individual has coped with anger through aggressive behavior as a young person, that pattern will continue with aging. Blurring of the senses and slowing of thought processes can further contribute to the inability to cope with a situation and potentiate the possibility of violent behavior. Defining characteristics for this diagnosis may be limited to hostile gestures toward others, hostile affect, or simple lashing out during frustrating situations. As astute diagnostician will recognize the situation that produces this phenomenon. Is too much being expected of the elderly patient Has he or she experienced a recent, disturbing change in lifestyle? Consideration of these and similar questions can alert the nurse to a potentially violent before injury or harm is done.