| Course | NUR-7620 Family System Psychopathology and Psychotherapeutics Across the Lifespan |
|---|---|
| Module | Module 5 |
| Paper type | Therapy in later life: problem-solving therapy and caregiver support |
| Length | About 1,035 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7620 Module 5
Twelve Problems, One at a Time: Problem-Solving Therapy for a 74-Year-Old Caregiver With Depression and Slowed Planning After a Small Stroke
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7620: Family System Psychopathology and Psychotherapeutics Across the Lifespan
Mentor Name
Month Day, Year
Twelve Problems, One at a Time: Problem-Solving Therapy for a 74-Year-Old Caregiver With Depression and Slowed Planning After a Small Stroke
A Caregiver Who Cannot Keep Up
Mr. B., an invented patient, is 74 and lives in Wayne with his wife of fifty years, who has moderate Alzheimer disease. He retired from a machine shop twelve years ago. Eight months ago he had a small stroke that left no weakness but slowed his thinking: he now forgets steps when paying bills, struggles to plan meals and loses his temper when several things go wrong at once. His wife wanders at night, and he sleeps in short stretches. His daughter, who lives in Ohio, noticed he sounded flat on the phone. His PHQ-9 is 15, and testing shows slowed processing and difficulty with planning and switching between tasks, the pattern called executive dysfunction. He has no suicidal thoughts and drinks two beers most evenings. He says he does not want "a lot of talk" but would like help "keeping things from piling up."
Why Executive Dysfunction Matters
Older adults with depression and executive dysfunction often respond poorly to antidepressants alone and are at higher risk of disability. Their difficulty is not only mood but the practical skill of breaking problems into parts and acting on them. A therapy that teaches exactly that skill fits the problem better than one that relies on insight or open-ended discussion.
The Evidence for Problem-Solving Therapy
Areán et al. (2010) assigned 221 depressed adults over 60 whose planning and flexibility were impaired to either twelve weeks of problem-solving therapy or twelve weeks of supportive therapy. The two groups improved similarly for six weeks, but by weeks 9 and 12 those in problem-solving therapy had larger reductions in symptoms and higher rates of response and remission, with one additional response or remission for roughly every five patients treated. Alexopoulos et al. (2011), reporting disability outcomes from the same trial, found that problem-solving therapy reduced disability more than supportive therapy, especially in those with greater cognitive impairment, and that the advantage persisted for 24 weeks after treatment ended.
Supporting Him as a Caregiver
Mr. B.'s depression is bound up with caregiving. Mittelman et al. (2006) studied a program for spouses of people with Alzheimer disease that combined individual and family counseling, a support group and on-call help. Over long follow-up, patients whose spouses received the program were placed in nursing homes at a rate about 28 percent lower than controls, a difference of about a year and a half in median time at home. Improvements in caregivers' satisfaction with support, their reactions to behavior problems and their depression explained much of the effect. For Mr. B., who wants to keep his wife at home, caregiver support is not separate from treating his depression.
| Component | Evidence | Plan for Mr. B. |
|---|---|---|
| Problem-solving therapy | Better response, remission and disability than supportive therapy | Twelve weekly sessions |
| Caregiver counseling and support | Delayed nursing home placement; reduced caregiver depression | Referral to a spouse caregiver program and support group |
| Medication | Often less effective alone in executive dysfunction | Discussed; not started yet at his request |
Twelve Sessions
Problem-solving therapy follows the same steps each session, written on a card he keeps by the kitchen phone: define the problem, set a realistic goal, list possible solutions, weigh pros and cons, choose one, make a step-by-step plan and review what happened. The first sessions take small, concrete problems. In session 2 he chooses the unpaid bills and sets up automatic payments with his daughter on speakerphone. In session 4 he tackles night waking by arranging a door alarm and a respite aide two nights a week. Later sessions take on harder problems, such as how to tell his brother he can no longer host Thanksgiving. Each week he completes one action plan. The pace is slow and the language plain, matching his processing speed, and written summaries help him remember.
Alcohol, Sleep and Safety
His two beers a night may worsen sleep, mood and fall risk, and they interact with his slowed thinking. Reducing alcohol is offered as one of his problems to solve rather than as a lecture. His wife's wandering raises safety concerns, and the door alarm and a medical identification bracelet for her are practical first steps. His own stroke risk factors are reviewed with his primary care clinician.
Bringing His Daughter In
His daughter in Ohio is part of the plan by phone. With his permission, she joins the second session on speakerphone to help set up automatic bill payments, and she agrees to a weekly call on Sunday evenings to review his action plan for the coming week. Her involvement gives him a second memory for the steps he loses track of and gives her a way to help from a distance. She also learns about the caregiver program so that she can encourage him to attend when his energy is low.
When Medication Might Be Added
He prefers to start without an antidepressant, and the evidence supports beginning with problem-solving therapy. Medication is not ruled out. If his symptoms have not improved by a third at week 8, or if he develops thoughts of death, an antidepressant with few interactions and little sedation, such as sertraline at a low starting dose, will be discussed, with attention to his fall risk and his blood pressure medicines.
Tracking His Week-by-Week Course
Every fortnight he repeats the PHQ-9, and a short disability scale at baseline, week 12 and three months later. Because problem-solving therapy may not show its advantage until after week six, the plan is reviewed at week 8 rather than earlier, and medication is reconsidered if his score has not fallen by a third by then. His own measure is simpler: whether bills are paid and whether he sleeps more than four hours at a stretch.
Conclusion
Mr. B.'s depression, slowed planning and caregiving strain are intertwined. Problem-solving therapy targets the planning difficulties that make depression in executive dysfunction hard to treat, and a trial shows it outperforms supportive therapy on mood and disability. Pairing it with caregiver counseling and support, which kept people with Alzheimer disease at home longer, addresses the burden that is driving his decline.
References
Alexopoulos, G. S., Raue, P. J., Kiosses, D. N., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Areán, P. A. (2011). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: Effect on disability. Archives of General Psychiatry, 68(1), 33-41. https://doi.org/10.1001/archgenpsychiatry.2010.177
Areán, P. A., Raue, P., Mackin, R. S., Kanellopoulos, D., McCulloch, C., & Alexopoulos, G. S. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. American Journal of Psychiatry, 167(11), 1391-1398. https://doi.org/10.1176/appi.ajp.2010.09091327
Mittelman, M. S., Haley, W. E., Clay, O. J., & Roth, D. L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67(9), 1592-1599. https://doi.org/10.1212/01.wnl.0000242727.81172.91
NUR 7620 Module 5 instructions, in plain terms
The lifespan reach of NUR-7620, as its catalog wording puts it, includes the oldest patients a PMHNP sees, so the fifth module of this rail, drawn up without a public syllabus, takes a case from late life. Expect to adapt a therapy to an older adult's cognition, health and circumstances, use evidence from older populations, involve family or caregivers where relevant and choose measures that capture function as well as mood. Some classrooms set a case of grief, late-onset anxiety or depression in a nursing home instead. Confirm what the prompt asks. Note any cognitive impairment and show how the therapy's pace and materials will change because of it. Bring in family who can help, even from a distance.
How this NUR 7620 Module 5 example is built
Mr. B. is introduced as a 74-year-old caring for his wife with Alzheimer disease after his own small stroke, with his PHQ-9 and test results. A section explains why executive dysfunction changes the treatment choice. Two reports from one trial show problem-solving therapy beating supportive therapy on mood and disability, with a note on the six-week lag. A spouse caregiver trial links support for him to keeping his wife at home, and a three-row table combines the plan. Twelve sessions are described with real problems. Alcohol, sleep and safety follow, then measures timed to the therapy's delayed effect, and the conclusion. Sections on his daughter's role and on when medication would be added complete the plan.
NUR 7620 Module 5 rubric: what earns full marks
Late-life therapy papers are judged on how well the therapy is adapted to the older person, whether the evidence comes from older adults and whether outcomes include function as well as mood. Mentors look for the cognitive profile to shape the plan, for example by slowing the pace and using written aids. Attention to the caregiving context, alcohol use and safety shows a whole-person view. Timing the review to the therapy's known course demonstrates evidence-based judgment. Describe trials with their populations and limits. APA references, complete and current, round out the work, and involving relatives who can support the plan often earns credit.
NUR 7620 Module 5 help: mistakes that cost marks
Students sometimes apply adult evidence to older patients without checking whether trials included people like them. Use studies in older adults. Another frequent gap is ignoring cognitive changes that affect how therapy should be delivered. Adjust pace, language and memory aids. Look at the caregiving situation, since it often drives late-life depression. Measure disability, not just mood. Do not judge the therapy too early if trials show a delayed effect. Raise alcohol as a problem to solve together, and enlist a relative to support the action plans. A first draft fitted to your own NUR-7620 later-life case is available from the desk at no charge.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7620 Module 5 questions, answered
Where can I find a free NUR 7620 Module 5 sample paper?
Mr. B.'s full twelve-session plan, with the trial table and margin notes, appears above.
What is problem-solving therapy?
A structured therapy that teaches patients to define a problem, set a goal, generate and weigh solutions, choose one, act and review, one problem at a time.
Does problem-solving therapy help older adults with depression?
In older adults with depression and executive dysfunction, it produced higher response and remission rates and less disability than supportive therapy by weeks 9 and 12.
What is executive dysfunction in late-life depression?
Difficulty with planning, organizing, switching between tasks and processing information, which is linked to poorer response to antidepressants alone and more disability.
Does caregiver support help people with Alzheimer disease stay home?
A long-term trial found that counseling and support for spouse caregivers delayed nursing home placement, with improvements in caregiver depression and support explaining much of the effect.