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This is the first in a series of articles that will address mental health issues for older adults. Since October is National Depression Education and Awareness Month, this will be the first issue addressed. The information presented is taken from the seminar and handout entitled “Mental Health Issues for Older Adults in Long Term Care”, which was sponsored by SSWANH and presented on 9/27/02 by Linda K. Shumaker, RNC, MA, an instructor at Central PA Psychiatric Institute.
Depression is a common problem among the elderly. The incidence of depression in the general population is 10%, and doubles to 20% for individuals 65 and older. Even more distressing is the fact that depression is 10 times more likely for the elderly in nursing homes than for the elderly residing in the community. In nursing homes, we see a large percentage of our population with symptoms of depression. This seriously compromises our residents’ quality of life and contributes to a variety of other problems, which can compromise health and even shorten lifespan. Suicide should be viewed as a serious risk, since 16-25% of all reported suicides are in the 65 + population.
As social workers in long term care, we are the primary people responsible for addressing the psychosocial needs of the residents. Depression is one of the most significant and challenging problems we must help residents cope with. We should be knowledgeable about the symptoms and treatment since depression is the most common reversible psychopathology.
We know that our residents deal with numerous losses by the time they are admitted to our facilities, and the admission and adjustment process often put additional stress on their mood and coping skills. It is often difficult to determine if a resident is going through the “normal” adjustment difficulties or if a true episode of depression is present. It is helpful to know the most common features of a Major Depressive Episode:
In the nursing home environment, behavioral symptoms can also include hopelessness, preoccupation with pain and somatic functions, withdrawal and isolation, uncooperativeness, anxiety, screaming, and weight loss (depression is the most common cause of weight loss in long-term care).
Depression among residents with dementia should also be considered, since 25-30% of individuals with dementia also suffer from depression. This diagnosis may be more difficult to identify due to communication barriers. Symptoms can include abrupt loss of interest, increased irritability, refusal to eat, crying, and sudden deterioration in skills.
Social workers take a primary role in the assessment and treatment of depression. Intervention and treatment can take the form of behavioral interventions, professional therapies (psychotherapy, family therapy, support groups, life review), or anti-depressant medication. Unless the situation is serious, it is often best to start with the least intrusive form of intervention (behavioral) and move on to therapies and/or medication if these prove ineffective.
The social worker is an integral part of the team that develops a plan of behavioral interventions for residents with depression. Interventions should be based on the individual resident’s wishes, needs, background, lifestyle, abilities and interests. Some general interventions for depression include: structured activities, social contacts, relaxation techniques, consistent staff, issues of autonomy and choice, and spiritual support. If behavioral interventions do not result in significant improvement of symptoms, professionals such as psychiatrists, psychologists, psychiatric nurses, and/or clinical social workers should be used whenever possible to ensure that the highest possible level of mental health treatment is being provided to our residents.
Lori Ammon, LSW