Blog by Mark Wolfe, Customer Account Representative, GrandView Pharmacy

Depression is more than just feeling sad or experiencing a rough patch. Depression is a very serious mental illness that requires patience, understanding and medical care. If left untreated, depression can decrease the quality of life for those afflicted as well as their families and loved ones. Approximately 20 percent of all nursing home residents have major depression and an additional 30 percent have significant depressive symptoms. (NAMI, National Alliance on Mental Illness; Dec. 2018) That means in any long-term care facility, every other resident is likely to have some form of depression — and many also have dementia to some degree. For those with severe dementia, depression can be difficult to identify from other causes of behavioral disturbances.

Elderly individuals with depression then suffer with a diminished quality of life and are at increased risk for their physical health.

In the United States, nearly one in two nursing home residents, including those with dementia, receive antidepressant medications. However, there are generally mixed reviews about the efficacy in this population. Additionally, home residents taking antidepressants experience a greater risk of recurrent falls (ZA Marcum, 2016, The Annals of Pharmacotherapy) and other negative side effects. Resident health care spirals out of control once falls are brought into the equation. Ninety-five percent of all hip fractures in the elderly result from falls and one in five patients die within one year of their injury. (Centers for Disease Control, Morbidity and Mortality Weekly Review;2016;65:9938. E Burns).

As with any therapy used in health care a risk, benefit analysis should be used in treating depression in the elderly. The question comes down to proper diagnosis and finding a balance between prescribing antidepressants and substituting non-pharmacological therapies for those residents that can select the activities in which they choose to participate. These activities could be walking, exercising, playing bingo, playing games on the Wii, just to name a few.

Among nursing home residents, social losses and environmental stressors frequently combine with genetic, medical and neurologic factors to result in depression symptoms. (Journal of Catholic Health Association of the United States, Nov-Dec 2014; Jules Rosen, MD).

The DSM, or Diagnostic and Statistical Manual of Mental Disorders, is the tool frequently used to assess mental illness or depression in the elderly. The psychiatrists differ on the use of the DSM conflicted that it indicates the symptoms of the depression, rather than the causes of the resident’s depression. A medical social worker in northeastern Indiana that is known to this author frequently sees that if two people indicate various symptoms of sadness, loss of pleasure, feeling sick, poor sleep, or loss of appetite, if two people report symptoms of sadness, loss of pleasure, low energy, feeling sick, poor sleep and appetite, and they express a death wish — in the absence of a specific medical condition causing these symptoms, they both are likely to be diagnosed with major depression, even though there might be a specific medical condition causing these symptoms, (recently receiving a life changing medical diagnosis, loss of a loved one or spouse, etc.)

The problem is that elderly residing in long term care facilities that manifest depressions that are not all the same as other residents. They have medical conditions associated with depression, such as dementia, diabetes, heart disease and stroke. Some may bring with them a history of recurrent depression, which puts them at high risk for recurrence. All experience profound social changes: they are no longer in their own home, eating their own food and conducting personal business and social activities according to their own schedules. Having staff members present at the most personal of times, and perhaps sharing a room with a stranger, are additional stressors. Residents with comorbid dementia are less able to understand and adjust to these environmental changes, adding to the feelings of loss and depression.

This study confirms that self-determined social interventions effectively treat depression among nursing home residents, if the resident can participate in activities of their own choosing. Allowing residents to engage in pleasurable activities decreases their risk of depression. Many of the participants reported that they enjoyed looking forward to the activity as much as actually doing the activity. (Simply watch residents cue up when the transportation bus arrives for shopping excursions, or bingo day, etc.)

Antidepressant medications may help, but combining medication and social activities to reduce isolation, increase social interactions is a highly effective treatment to reducing the cost of those medications, while effectively decreasing the depression.

SYMPTOMS:   Just like any mental illness, people with depression experience symptoms differently. Depression in most people affects how they function day-to-day. Some common symptoms of depression include:

  • Change in sleep
  • Change in appetite
  • Lack of concentration
  • Loss of energy
  • Lack of interest
  • Low self esteem
  • Hopelessness
  • Changes in movement
  • Physical aches and pains

TREATMENTS:  Depression quite often responds to treatment. Early and accurate evaluation is key. Treatments can include one or a combination of the following:

  • Medications: antidepressants, mood stabilizers and anti-psychotic medications
  • Psychotherapy
  • Light Therapy
  • Physical exercise
  • Proper nutrition
  • Mind/Body/Spirit approaches: meditation, faith, and prayer

(NAMI: National Alliance on Mental Illness brochure, March 2015).

About the Author

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