Managing Insomnia and Depression in an Elderly Widow: Assessing Patient’s Perspective

QUESTION

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

• Metformin 500mg BID
• Januvia 100mg daily
• Losartan 100mg daily
• HCTZ 25mg daily
• Sertraline 100mg daily

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

ANSWER

Managing Insomnia and Depression in an Elderly Widow: Assessing Patient’s Perspective

Introduction

This essay focuses on a case scenario involving an elderly widow who presents with insomnia and worsening depression following the loss of her spouse. The patient’s medical history includes diabetes mellitus (DM), hypertension (HTN), and major depressive disorder (MDD). To provide comprehensive care, it is essential to gather relevant information through effective questioning. This essay explores three questions that could be asked to the patient during the office visit, along with the rationale for each question.

Question 1: “How has your sleep pattern changed since your husband’s passing?”
Rationale: This question aims to assess the patient’s subjective experience of insomnia and its relationship to her recent bereavement. Understanding the nature, severity, and duration of her sleep disturbances can provide valuable insights into the impact of her loss on her sleep habits and overall well-being.

Question 2: “In what ways has your mood been affected since your husband’s passing?”
Rationale: This question explores the patient’s subjective perception of her depression and its progression following her husband’s death. By eliciting information about her emotional state, the healthcare provider can gain insight into the severity and duration of her depressive symptoms, which can aid in diagnosing and formulating an appropriate treatment plan.

Question 3: “How have you been coping with the loss of your spouse?”
Rationale: This question aims to assess the patient’s coping mechanisms and social support network following the significant loss of her husband. Understanding her coping strategies can shed light on her ability to adapt to the grieving process and identify potential sources of support or interventions that may assist her in managing her depression and insomnia.

Conclusion

When assessing an elderly widow who presents with insomnia and worsening depression following the loss of her spouse, a comprehensive understanding of her subjective experiences and emotional well-being is essential. By asking questions about changes in sleep patterns, the impact on mood, and coping strategies, healthcare providers can gain valuable insights into the patient’s unique situation. These questions facilitate a patient-centered approach, allowing for tailored interventions and support to address her specific needs in managing insomnia and depression.