November 21, 2019 | by Elaine Howley

Treating Depression and Loneliness in SNFs and LTC Facilities

More than just feeling blue, these conditions can threaten the health of your residents.

According to a 2016 report from the Gerontological Advanced Practice Nurses Association, “among all nursing home residents, 12 to 14% meet the criteria for Major Depressive Disorder. The rates of depressive symptoms in general are between 40 and 45%. For long-term care residents with dementia, the prevalence of clinical depression is estimated to be as high as 63%.”

Brian Geyser, APRN-BC, MSN, chief clinical officer, at Inspīr

Brian Geyser, APRN-BC, MSN, chief clinical officer, at Inspīr

Brian Geyser, APRN-BC, MSN, chief clinical officer at Inspīr, a senior living facility in Manhattan, says that depression and loneliness among residents in senior living facilities is “very common. You’re looking at somewhere in the neighborhood of 20 to 25% of older adults who live in senior living who have a diagnosable depressive disorder. Another 25% or so who have depression-related symptoms, but not full-blown depressive disorder.”

Taken all together, you’re talking about roughly half of the resident population at many nursing homes and other post-acute facilities having some form or feelings of depression, he says.

These are concerning figures, given that we know that depression and loneliness are more than just mental health concerns — they translate to reduced overall health and wellbeing and contribute to the development of chronic and long-term health problems.

Meds are Just Part of the Solution

For some skilled nursing and long-term care facilities, the answer to addressing depression and loneliness in residents starts and ends with antidepressant medications. These can be very effective in some patients, but Geyser notes that “geriatrics is complicated. You have so many different variables at play.”

Residents with underlying medical conditions that predispose them to depression may not respond as well to antidepressants, and drug interactions can be a concern, too. Certain medications, such as beta blockers used to treat heart disease, can also trigger depressive symptoms in some people.

In addition, “one thing we find is that many older adults who are on antidepressants don’t take them the way they’re prescribed. They cut the doses in half to save money or don’t believe they need to take them every day so skip doses,” Geyser says. This means they’re not getting the dose they need for the medication to be effective.

Another major concern among older adults when treating them for depression is whether or not dementia symptoms are present. Geyer says that among people 85 years old and older, some 40 to 50% have dementia symptoms, which can make depression harder to treat. Depression can actually be a symptom of dementia, and “antidepressants in people with depression and comorbid dementia can be effective for some people, but not all,” he says.

In addition, depression may manifest somewhat differently in patients who also have dementia. Instead of simply a depressed mood or changes to sleep patterns, those with dementia are more likely to exhibit delusions and hallucinations than depressed people who do not have dementia, Johns Hopkins Medicine reports.

Because of all these factors, Geyser says “antidepressants alone are not the ideal approach” to treating depression among older adults in SNFs and LTC facilities. “Medications should be combined as appropriate with psychotherapy, supportive counseling” and other therapeutic interventions.

What Are the Causative Factors?

You want to address some of the causative variables, such as social isolation, loneliness, and other situational factors that can contribute to feelings of depression, says Geyser. For example, “people at this stage of life are experiencing an incredible sense of loss, grief, and bereavement, and there’s often a lack of integration and engagement with society.” Many are lonely as they outlive spouses and friends.

This is why it’s important to find ways to bring the community into your SNF or LTC to help seniors connect with younger people and the wider community beyond your facility’s walls.

Geyser tells the story of a woman he recently met with, a 97-year-old Fortune 500 executive. “She was very successful in her life. She never married and had no children and lived in the Midwest. As she got older and frailer, she reached out to family in New York City.” She ended up moving into an assisted living facility but soon began struggling with depression and anxiety.

Geyser says that despite the woman receiving the correct dosage of her medicine, she wasn’t getting enough social stimulus to keep her depression at bay. “The big issue is that this person thrives on friendship and companionships. In the couple of years she lived in that assisted living community, she wasn’t able to connect with a friend or even a small group of friends.”

How does this happen? “That’s one of those peel-back-the-onion questions,” Geyser says, and there are many potential reasons. But in this person’s case, the biggest issue was hearing loss. “When she has conversations with other people, she can’t hear them well, and they have a hard time communicating with her.”

Hearing loss is a common reason for social isolation and loneliness among older adults, and for that reason, checking residents’ hearing regularly and adjusting their hearing aids as needed should be one aspect of addressing depression in your facility.

Figure Out What Your Residents Enjoy Doing

In addition, creating socialization opportunities centered around activities your residents enjoy can help foster connections that can reduce feelings of loneliness and isolation. And we’re not just talking bingo here. “Not everyone likes bingo,” Geyser notes.

Instead, look at other types of stimulating activities that provide opportunities for interaction, such as bridge, board games, or book clubs. “One of the challenges in a community is how do you offer truly person-centered programming and recreation,” says Geyser. “Lifelong learning programs that are geared specifically to the needs and wants of residents,” are a good way to do this.

At Inspīr, Geyser says “the first thing we do with every new resident is a full, holistic, and very comprehensive whole-person assessment, which includes a head-to-toe physical assessment but also includes an assessment of the family dynamic and psycho-social and social needs.” They also talk about the person’s background and their likes and dislikes.

“What things did they enjoy? What are the cultural and social and religious needs, wants, and desires? What are their goals at this stage of life? And how can we align programming with those goals?” It’s a multi-dimensional assessment that takes into account the whole person, to help caregivers from the geriatrician and social worker to the physical therapist and the chef to help head off depression and loneliness before they crop up. “We create a whole-person health and wellness plan that becomes the road map for how we interact with that individual resident on a daily basis.”

Other Opportunities for Meaning

Providing opportunities for residents to find a purpose — whether that’s mentoring young people or assisting in research projects that help science better understand the effects of aging or a specific medical condition — can also provide a powerful antidote to depression, Geyser says. Having an opportunity to give back to other people in such a way can help some residents feel relevant and less isolated and like their contributions still matter.

Setting up such a program can be challenging, particularly for smaller facilities, but the costs in the long run in terms of resident health and satisfaction with your facility may pay dividends.

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Topics: Activities , Clinical , Resident Care