Depression should not be considered a normal part of aging and should never be taken lightly. Feeling sad is a common reaction to loss, life struggles, or weakened self-esteem, but when those feelings become overwhelming, cause physical symptoms, or impact daily functioning, they prevent one from living a fulfilling life.
The prevalence of clinical depression in aging seniors can't be ignored, nor can the added barriers to behavioral healthcare in senior living facilities. Access to high-quality, comprehensive, and convenient depression treatment should be available to all residents of skilled nursing and assisted living facilities, and this care should be normalized for those facing hardship.
Mental Health and Seniors: Why the Stigma?
The stigma preventing mental health intervention in seniors needs to be resolved -- both among the older population as well as healthcare providers. The generation of seniors today grew up during a time when the stigma around mental health was even greater than it is now. Turning a blind eye to mental health has been ingrained in them for decades. Even as the topic becomes more mainstream and accepted, older populations may be more resistant to the idea.
On the other side, the aging population with depression is often misunderstood and abandoned by the healthcare system. Depression in the senior population tends to differ from younger generations because of their more common preexisting physical health problems. These ailments may provoke depression and overshadow it when being diagnosed.
The stigma of mental health issues in seniors deprives them of their right to well-being and reinforces patterns of hopelessness and isolation. Senior care professionals need more effective training processes with a greater focus on how to manage depressive health alongside physical issues. More belief in and access to care and treatment plans for depressed, aging adults will lead to more desirable health outcomes, patient and loved one satisfaction, and a higher quality of life.
Comprehensive Treatment Options
With the population of older adults in the U.S. projected to increase from 56 million to 94.7 million through 2060, it's important to understand how to identify and treat symptoms of depression effectively in this group. As with all psychiatric care, patients and their families need to feel engaged with providers and be informed of safe treatment options and therapies to reduce the symptoms of depression.
Treating depression in senior living facilities should be comprehensive -- not a one-method approach -- that combines psychotherapy and medication (if needed). While patients are often prescribed medications, such as benzodiazepines, to combat symptoms, many would benefit from non-pharmacological interventions as the first line of treatment.
Just as with younger patients, a psychotherapy approach uses talk therapy to treat depression. Different types of psychotherapy can be effective for depression in seniors, such as cognitive behavioral therapy or interpersonal therapy, and are just as effective to:
- Identify negative beliefs, behaviors, and issues that contribute to the depression, then replace them with positive ones
- Explore relationships and experiences, and develop positive interactions with others
- Regain a sense of satisfaction and control later in life and help ease depression symptoms, such as hopelessness and anger
- Develop the ability to tolerate and accept distress using healthier behaviors; behavior change is possible, even in seniors
Research from the University of Rochester School of Medicine and Dentistry shows that up to 30% of nursing home residents experience minor or major depression, but approximately that same percentage (20% to 40%) of nursing facilities nationwide say providing basic behavioral health services is "difficult" or "very difficult." Too many older adults are falling through the cracks.
Care access barriers are greater for older age groups in part due to their limited mobility and short supply of mental health providers who specialize in depression care for seniors, especially in rural areas. Those with mobility challenges may worry about packing up to leave the community and wonder if the doctor's office is accessible to their physical limitations. This can add more stress if the senior is experiencing apathy or amotivation. All this makes it especially difficult to pursue treatment outside the community and ask for help.
Whether it's situational or clinical depression, staffing shortages, prolonged wait times, quarantine regulations, and transportation issues all inhibit the ability to treat patients properly. The pandemic escalated the need for federal approval of telehealth appointments, and emphasized their value in improving care access, especially among the aging population. More mediums must become available for seniors to address their behavioral health.
Expanded access to telehealth is one viable option. Offering behavioral health services from a remote location can lead to better patient outcomes if they have the option to stay in an environment that's conducive to their needs. Patients feel more comfortable because sessions are conducted in a familiar setting, and it eliminates the hassle of securing transportation and traveling to a doctor's office. Appointments are made digitally and facilitated remotely, adding an extra layer of privacy for the resident. They also feel more secure seeing the doctor online because they are surrounded by their belongings and in their own space, which may help them dive deeper into their challenges and lead to workable solutions sooner.
Depression Treatment Delivery for the Future
Despite progress over the last several years, the stigma of depression and psychotherapy for today's aging adults still exists. The added stress of the COVID-19 pandemic led seniors to experience isolation like never before. The industry is quickly realizing how innovative ways to deliver depression care is the disruptive force needed for caregivers to reach older adults effectively.
The future of treatment delivery for mental healthcare is bright. Functional access to depression care is the cultural shift needed in the senior care industry, and telehealth is one medium lighting the way.
Sherie Friedrich, PsyD, is chief psychology officer at MediTelecare, a company providing behavioral telemedicine services to residents of skilled nursing and assisted living facilities.
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