Are some of your residents feeling blue, restless and/or depressed? It might not be temperament but the weather, especially because much of the country has experienced an early winter. Shorter days, longer nights and diminishing sunlight play a role in seasonal affective disorder (SAD). Most people simply mourn the loss of bright summer days and move on. But for many, the symptoms of SAD appear each year, as surely as the leaves fall in autumn. The classic symptoms of this disorder are fatigue, depression, hopelessness, disinterest and poor sleep.
SAD AND THE ELDERLY
It’s not just always the “blues.” SAD is recognized as a subtype of major depressive disorder that shares the same symptoms as major depression, which may include sadness, loss of interest or pleasure, changes in sleep and appetite, feelings of worthlessness and weight loss, according to G. Allen Power, MD, a geriatrician, author and consultant specializing in dementia care.
Because of chemical changes in the brain and disrupted body rhythms in the fall and winter months, long-term care (LTC) residents have little opportunity to go outdoors to be invigorated by the full spectrum of sunlight. In addition to the general symptoms of SAD, residents with dementia also may exhibit irritability or agitation, social withdrawal and difficulty communicating, Power told Long-Term Living. “They may not even report feelings of sadness or depression,” he says.
Because depression—including SAD—can be a serious mental health issue, a resident may need to be referred to a psychologist for treatment recommendations.
Natural sunlight is the key to alleviating some of the classic symptoms of SAD. Of course, it’s more difficult to do this in LTC environments, because so many residents require assistance with dressing and with transport. Nevertheless, Power stresses the importance of at least bundling up and getting out for a few minutes a few days a week, even in cloudy weather. “Sunlight is far more beneficial for body rhythms than indoor lighting,” he says. “Studies have shown that even people without dementia often have a disrupted sleep cycle after a few weeks of living in a nursing home, due to the lack of natural light.”
Light box therapy (the daily exposure to bright artificial light when symptomatic) can be beneficial. Light therapy should be initiated at the onset of symptoms and used daily until spring or until symptoms resolve naturally. The light box unit provides a special, full-spectrum light, with ultraviolet rays filtered out. “This therapy, however, should be individualized and supervised to prevent overstimulation or eye strain if not properly balanced,” Power advises. For seniors, especially those with dementia, proper supervision is a recommended safety precaution.
Cognitive behavioral therapy (CBT) is another avenue of treatment, as Kelly Rohan, PhD, describes in an American Psychological Association article. In CBT sessions, the person with SAD works with a therapist to learn how to identify and schedule engaging activities throughout the winter. In addition the person learns how to identify negative thoughts, which gives him or her tools to manage mood. Awareness of these coping techniques can help to manage moods the onset of depression each year.
In the LTC setting, activities such as meditation, tai chi and yoga can help to combat depression, according to Power. Find out what works for each individual. It might be aromatherapy or a massage. A bright, sunny environment adds to the pleasure and effectiveness of chasing the blues away.
Dietary supplements also can help a resident turn the “mood” corner. Melatonin can help regulate mood. Omega-3 fatty acid also can fight depression. Before adding supplements, however, talk with the resident’s healthcare provider to ensure that they will not interfere with any medications.
By identifying SAD in a resident, speaking with his or her physician and family about the various options for treatment and instituting a plan of action, you can help someone weather the seasonal blues.
Leaders of Tomorrow: G. Allen Power, MD