Depression is not a normal part of aging, but it is a problem for many seniors.
Depression can affect up to 40 percent of nursing home residents in a given year, according to the American Geriatrics Society. Although seniors in residential settings experience a high incidence of mental health problems, they’re unlikely to receive treatment.
“The people who say they’re depressed will get that treatment, but many people will not say they’re depressed because of the stigma,” says Alisa Tagg, BA, ACC/EDU, AC-BC, CADDCT, CDP, president of the National Association of Activity Professionals.
Depression has many causes and almost always results from a combination of factors. Depressive episodes can vary in their degree of intensity and duration, and they can be a dominant problem or one of many problems related to a specific diagnosis and/or disability, situation or circumstance. Depression can be associated with psychological and physical distress, decreased participation in therapy and activities, decreased functional status and poorer outcomes.
It can be especially difficult for senior living residents who are likely experiencing several changes at once: mourning the loss of loved ones, dealing with chronic illnesses, adjusting to the facility, downsizing to a semiprivate room or a coping with a disagreeable roommate.
Since seniors often isolate themselves, few may notice they’re in distress. And seniors are sometimes reluctant to talk about their feelings or ask for help—emotional problems weren’t openly discussed in their era, even among family. Seeking help could be considered a weakness, deterring many from reaching out. Depression and mental health issues weren’t well-documented until recently, treatments were limited or unproven and some illnesses weren’t even defined in the medical community. Understanding the stigma and shame associated with depression explains why today’s nursing home resident population is especially at risk. Caregivers must be proactive because diagnosis, intervention and treatment, especially among reluctant residents, can greatly improve their quality of life.
Despite its prevalence, depression can be difficult to spot. Physicians and other caregivers may be focused instead of on physical problems. Chronic conditions can cause, mask or exacerbate mental health symptoms. So can medications, which is why it’s important for activities professionals and social workers to work together to identify signs and symptoms of depression, then tackle them head on as a team.
“Quarterly reviews with residents as regulated in the nursing home industry is a great time to capture that, but if we’re seeing symptoms in between quarters, it’s good for everybody to speak up and work together,” Tagg says.
Tagg says activity professionals need to keep residents actively engaged as much as possible and limit how much residents time residents spend alone in their room. Connecting to others is important, as involvement can improve residents’ quality of life. For those with dementia, staying connected may even slow cognitive decline.
Both dementia and depression present similar symptoms, so it’s important for caregivers to determine the cause and appropriate treatment plan. Researchers aren’t sure of the exact connection between depression and dementia, but it seems that what’s good for the mood may also be good for the brain.
Activities can include hobbies or pastimes as well as new interests. Learning, growing and developing is important at any stage and every cognitive level because purpose, productivity and usefulness is connected to self-worth.
Those activities can—and should—be adapted to meet the needs of each individual resident. Activities should also emphasize what residents can do instead of what they can’t. That could mean exercising from a seated position. Excitement, not preciseness, is the goal, Tagg advises.
“The more active people are, whether it’s physically, mentally or socially, the better they will feel,” she says.
Actively engaging residents may mean engaging staff, too. Asking staff members for ideas and giving them the opportunity to develop programs allows them to share their own hobbies and interests with residents. Staff can also help activities personnel spot differences in residents’ mood and understand behavior triggers.
“Depression can happen at any time, so we have to be vigilant,” Tagg says, especially during the time of year when we can all catch a case of the winter blues. “We just came off three months of holidays between Halloween, Thanksgiving and Christmas. Now what? We need programming to keep spirits high as the decorations come down, and we get back to reality again, so to speak.”
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