Case Study

Mrs. D.

Mrs. D. is a 77-year-old woman living alone in own apartment who lost her husband 2 years ago.

About 3 years a ago, she was diagnosed with cardiac disease. Her daughter/son (Pat) decided to contact the primary physician’s office for the following reasons.

During the past 2 months:

1. Mrs. D. has complained of not sleeping well, loss of appetite, and back pain.


2. She is not remembering things as well as she used to.


3. She has difficulty concentrating and making decisions.


4. She worries about paying bills.


5. She has stopped playing cards.


6. She is no longer interested in seeing friends or going out.


7. She has related thinking that things would be better if she were not around, “not a burden to my daughter,” but is not suicidal.

Activity #1. Class Discussion

• What information do you collect?


• What are the risk factors?


• What are the symptoms?


• What do you say to Mrs. D. and her daughter?


• What is your assessment and treatment plan?

Activity #2. Role Plays

• Divide students into groups of three.


• Ask students to go on-line and download the PHQ-9.


• Ask the students to take the following roles:


• Mrs. D.
• Pat (daughter)
• Social worker


• If a particular task only requires two people, the third person becomes an observer and after the task provides the following discussion and question feedback to the other participants:


• What did you do that you liked?
• What would you do differently next time?
• This is what you did that I liked…
• This is what you might consider doing differently next time…

  (If time allows—and if appropriate for the particular students, you may ask the client in the role play to provide feedback to the social worker. This is what you did that I liked… This is how I felt when you... This is what you might try next time…)

• Remind students that the case example only provides an outline, they are to improvise additional details as needed. (Be kind to one another. The goal is not to “stump the chump” but to have an opportunity to practice using skills with an older adult and family member.)


• Depending on the level and experience of the students, it may be necessary to model the tasks before doing the role plays.


• Task #1: Social worker role plays an initial review of depression with Mrs. D. (Third student observes.) Use intervention questions for approaching late-life depression, for example:


• How are things at home?
• How have you been coping?
• Have you had any stress lately?
• Have you experienced any losses?
• How are you handling it?

End role play; observer provides feedback.

• Task #2: Rotate roles. Social worker introduces the screening and conducts a PHQ-9 interview with Mrs. D. [Download from http://www.americangeriatrics.org/education/dep_tool_05.pdf]


• Obtain the person’s agreement to be screened.
• Explain the purpose for the screening.
• Administer and score the PHQ-9 as instructions direct.



• Task #3: Rotate roles. Social worker discusses his/her concerns and makes initial treatment referrals for further diagnostic assessment to Mrs. D’s primary care physician for possible psychotherapy and antidepressant medication.


• Discuss your concerns with Mrs. D and Pat.
• You can say:


• Depression is very common.
• Depression is a medical condition.
• Depression is very treatable.



• Task #4 (optional): Ask one student to take the role of the social worker and the other to take the role of the primary care physician ( PCP). Social worker presents his/her concerns and the results of the PHQ-9 to the PCP. (Remind students that the PCPs time is quite limited and that they will need to be concise and focused in their presentation of Mrs. D and her situation.)


• For example: I am concerned that Mrs. D may be depressed, and I think that she would benefit from further diagnostic assessment and treatment. Here is what I have seen that leads to my concern… [present a brief overview of her situation and the results of the PHQ-9].

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