Nursing home residents with depressive disorder were 59% more likely to die than residents who were not depressed.
 

 By recognizing the symptoms of depression and taking corrective action, staff have the potential to greatly reduce the effects of depression within their resident populations.
 
Depression not only affects a person's mental health, but often impacts on a person's physical health. In a one year study by psychiatrists at Johns Hopkins University,The researchers attributed this result due to some of the common symptoms of the disease: nutritional deficits due to lack of appetite, insufficient rest due to insomnia, and immobility due to despondency.
 
Depression is often unrecognized by staff, because it can be masked by other physical and mental illnesses. Many times, the presence of depression interferes with the effective treatment of these illnesses.

 Caregivers can begin to assess if residents are suffering from depression by looking at the residents' behaviors, to see if they reflect the following symptoms:
 
 

  • expression of feelings of guilt, worthlessness, or inability to improve the situation
  • frequent crying
  • persistently sad or anxious; feelings of pessimism
  • loss of interest or pleasure in daily activities; poor personal hygiene
  • easily fatigued; decreased energy
  • loss of appetite; significant weight loss; sometimes increase in appetite
  • difficulty in concentrating; inability to make decisions
  • sleep problems such as inability to fall asleep, or early awakening
  • irritability and anger
  • suicidal thoughts, statements, attempts
  • recurrent aches and pains that are not responsive to treatment

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      If a resident exhibits three or more of the above symptoms persistently for more than a week, the resident may be suffering from depression.
     
     As people get older, their bodies slow down and they may become less flexible in coping with stress. Dramatic changes in their lives become more of a challenge.

     In their daily care activities, caregivers can play a very important role in improving the well-being of depressed residents. The most important thing that they can do is to allow residents with depression to express their feelings. This intervention sounds simple, but often it is not done enough or in the correct manner.

     Nursing home staff must be very aware of their communication  with depressed residents. They must always talk to them in a caring tone of voice. Often, the vocal tone is more important to these residents than the words that are said.
     
     Active listening techniques are very effective. This strategy involves reflecting back to residents what they have said. One can summarize and show empathy resident's feelings by making a statement such as "I'm sorry that you're so sad about the death of your husband. I know your life has been hard without him." This type of reply provides residents support and reassurance.

     Trying to cheer residents without recognizing and validating their feelings is very inappropriate. For instance, saying for the above example, "Let's not talk about your wife's death. You're still alive and you can still enjoy life" would be improper and often counterproductive. This answer doesn't acknowledge the resident's emotions.

     With depression comes a feeling of being out of control. Caregivers can benefit depressed residents by offering them choices whenever possible to increase their self esteem. Even basic choices such as "Would you like to sit by the window or by the
    bed?" can make a difference.

     Caregivers should make every effort to encourage and praise the residents' efforts. As depression can lead to feelings of worthlessness, offering compliments can have a profound effect, even something simple as, "That sweater you're wearing is very pretty." It also may be helpful to encourage good grooming and hygiene, as depressed residents often do not feel a need to take good care of themselves. Looking better may help residents to feel better about themselves.

     Depression causes many residents to withdraw from people and events. Caregivers should slowly encourage these residents to become involved in activity programs through a step by step process. At first, the residents may only feel comfortable in having visits with favorite staff members. Eventually, they may become comfortable in participating in a small group activity. Caregivers should gently encourage but not push depressed residents to become more involved in facility life.

     Depression is a frequently overlooked and misunderstood illness affecting many residents in long term care. In recognizing the symptoms of this disease and making appropriate interventions, nursing home staff can effectively enhance not only the residents' emotional health, but overcome many obstacles in treating their physical health conditions as well.
     

     
     REFERENCES
     

    Parmelee, Patricia A. et al. "The Relation of Pain to Depression Among Institutionalized Aged." Journal of Gerontology. Vol. 46: 15-21, 1991.

    Rovner, Barry W. et al. "Depression and Mortality in Nursing Homes." Journal of the American Medical Association. Vol. 265: 993-996, 1991.
     
     

     
     

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