Electroconvulsive therapy and the elderly client.

Although ECT has been the subject of controversy for decades, ECT has brought increased chances for recovery to many people suffering from severe depression. Crossfield (1988) states the evidence is overwhelming that treatment of some depressive clients with ECT is the best treatment available. Other researchers have found that ECT is equal to, and sometimes superior to, other therapies for major depressive disorders (Gomez & Gomez, 1993). Depression is a treatable condition about which nurses have a responsibility to educate clients and their families (Valente, 1991). If clients and their supportive families and friends are to understand rather than undermine treatment, education about ECT is essential (Valente, 1991). Well-meaning friends and family who are misinformed could strongly discourage ECT, so it is important that their myths about ECT be dispelled (Valente, 1991). Furthermore, if depression in an already at-risk elderly population is not recognized and treated, great suffering will continue to be endured and life-threatening situations may occur. Depression often is manifested differently in older persons than in younger ones. Nurses can improve the quality of care provided to these depressed elderly clients by allowing them to express their fears and anger (Gomez & Gomez, 1993). Furthermore, the nurse's attitude should be hopeful, positive and consistent with them. This action can help clients develop trust with the nurse and further their own quality care. Estimates are that 70% to 90% of individuals who suffer from severe depression and receive ECT do indeed recover (Valente, 1991). ECT should be undertaken only after the outlined treatment protocols have been considered and with the knowledge and understanding of the following statements issued by the United States Department of Health and Human Services in the 1993 Agency for Health Care Policy and Research (AHCPR). First, ECT has not been adequately tested in milder forms of depression. Because of this gap in the research, the efficacy of ECT across the spectrum of depressive symptomatology is unknown. Second, ECT is costly when it entails hospitalization. This factor has great meaning in the changing, increasingly cost-conscious, health care arena. Third, ECT has specific and significant side effects, e.g., short-term retrograde and anterograde amnesia. Not only are these side effects troublesome for inpatient recipients of ECT, but the side effects can be quite dangerous for persons receiving treatment on an outpatient basis. The potential for injury is grave for persons who have memory deficit. Given the present cost-conscious, cost-cutting atmosphere, an anticipated rise in the number of clients receiving ECT on an outpatient basis is a distinct possibility. Fourth, the risks of general anesthesia are present. Age is a well known risk factor for general anesthesia. Fifth, treatment with ECT still carries substantial social stigma for clients. In spite of the increasing acceptance of ECT as a treatment for depression in the elderly, many clients prefer to keep their receipt of treatment secret fearing social repercussions of open discussions with family and friends. Sixth, ECT can be contraindicated when certain other medical conditions are present. Persons suffering from severe cardiac or pulmonary disease are frequently disqualified for treatment due to the risk of receiving anesthesia. Last, people usually require a prophylactic treatment with antidepressant medication, even if a complete, acute phase response to ECT is attained (pp. 26-27).