Depression in Nursing Homes

Nursing home residents are at risk of developing mental health issues, including depression. If someone you care about lives in a nursing home, it is important to understand why people living in nursing homes get depressed, what are the signs of depression in nursing homes, and what to do to get them the help they might need.

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Is nursing home depression common?

According to Johns Hopkins Medicine, about one out of every ten adults will experience a major depressive disorder each year. Statistically speaking, women are much more likely to experience depression than men.

Unfortunately, it appears that the risk of depression is much higher in nursing homes. One study found that about 30 percent of nursing home residents suffer from depression each year. An estimated 1,246,079 people live in nursing homes nationwide. Based on those statistics, more than 373,800 nursing home residents are struggling with depression at any given time.

Why do nursing home residents get depressed?

Nursing homes can be a great source of support, community, and care for aging and elderly individuals. However, the nursing home care system in the United States often falls short when it comes to protecting the mental health of its residents.

Research suggests that nursing homes—and nursing assistants, in particular—are generally not well-equipped to identify depression and other mental health issues in residents. Families need to understand the potential signs of depression, so they can help to look out for their loved ones.

The more we know about nursing home depression, the better prepared we can be to help our loved ones reduce the chances of suffering from a major depressive episode. There are a few different factors that contribute to the increased risk of depression for people living in nursing homes.

Grief and Loss

Death is a part of life as we grow older. That is most certainly true for people who live in nursing homes. Not only do they hear about friends and family members who have passed. They also live with people who are nearing the end of their lives. It can be a lot to handle multiple losses and grieve those losses without spiraling into depression.

Isolation

Nursing homes can be incredibly lonely places at times. Residents don’t live with their close friends and family anymore. They are often not near their loved ones, and may no longer see or speak with them every day.

While they might (quite literally) be surrounded by people, those people are strangers. Building connections and bonds takes time, and that can often be difficult in nursing homes—especially when many residents struggle with dementia, Alzheimer’s, and other mental health disorders. In addition, it’s not uncommon for a resident to lose a new friend in the nursing home to serious illness or death.

Declining Physical Health

One study published in the journal Clinical Interventions in Aging found that elderly people who struggle with chronic pain are 2.5 to 4.1 times more likely to be depressed. Unfortunately, chronic pain is a reality for many nursing home residents, who are generally experiencing declining health.

Chronic pain can be exacerbated by limited mobility and exercise, little or no time outside for fresh air and sunshine, and the minimally nutritious meals that are often served in nursing homes. As a resident’s physical health declines, they are more likely to experience feelings of loneliness, hopelessness, and depression.

Declining Cognitive Function

Dementia, including Alzheimer’s disease and other types of cognitive decline, is a reality for an increasing number of elderly people around the world. As it becomes more difficult to remember things, concentrate, and think clearly, nursing home residents may begin to experience stress, a loss of interest in what they once enjoyed, and feelings of depression.

Nursing Home Abuse

Nursing home abuse is all too common in facilities across the United States. Residents can be subjected to physical abuse, emotional abuse, financial abuse, sexual abuse, abandonment, verbal abuse, and neglect, which occur at staggering rates. When a resident is abused, they are more likely to feel depressed.

What are the signs of depression in nursing home residents?

So how can you know whether someone you love in a nursing home might be depressed? Here are some important signs to look for:

Agitation
Irritability
Mood swings
Loss of interest in things they used to enjoy
Reluctance or refusal to see or speak with family members
Self-isolation
Withdrawal from the community and social activities
Insomnia
Sleeping more than usual
Unexplained changes in weight
Apathy
Expressing negative thoughts and feelings
Difficulty concentrating
Sadness

Any unusual changes in a resident’s emotional state and/or overall health could be indicative of depression.

How can I help a depressed family member in a nursing home?

If you suspect that a family member living in a long-term care facility is depressed, you should:

Check in regularly and sit down with them to get a better sense of how they feel. Make sure that they know you are there for them and that they are not alone. Let them know that you want them to talk to you about how they feel, and that there’s nothing they can’t share with you.

Many nursing home residents hesitate to share negative feelings, because they don’t want to be a burden on their family members. Tell your loved one that their feelings are never a burden to you, and that you feel honored to be trusted by them.

Nursing aides are responsible for between 80 and 90 percent of direct contact with residents. It is important to address your concerns with the people who spend the most time with your family member. Tell your loved one’s nursing aide what you have noticed, and ask for their input.

While many CNAs (certified nursing aides) don’t have specific training in behavioral management—which can be used in long-term care to help residents with depression—they can be attuned to potential problems and can alert others involved in the resident’s care, which helps to get the mental health care that the resident needs.

Depression in nursing home residents can be a serious cause for concern, so addressing the matter with nursing home administrators can be helpful. Administrators may have more power and authority to get your family member the help that they need.

You should definitely speak with the administration if you suspect that your loved one is depressed because of abuse or neglect. It’s important that this issue be addressed as soon as possible, to protect your loved one as well as others in the facility.

Some nursing homes allow residents to work with outside therapists and counselors. By bringing in a counselor, you don’t have to rely on the potentially limited resources of the nursing home to get your family member the support they need.

Check your family member’s nursing facility policies first. Not all facilities allow outside therapists on the premises. If your loved one’s facility doesn’t allow this, you could consider taking them to therapy sessions off-site.

Ultimately, you are the resident’s biggest advocate, and should work to get them the immediate assistance they need to begin their road to recovery.

Resources Available to Help Depressed Nursing Home Residents

Dealing with depression can be overwhelming, even if you are not the one struggling with mental health issues. It can be difficult to know where to turn or what to do to get your family member the help they need. You might feel overwhelmed and stressed out, worried that you won’t be able to make a difference.

Fortunately, resources are available to help depressed nursing home residents and their families. The Substance Abuse and Mental Health Services Administration—a division of the US Department of Health and Human Services—has a confidential hotline that you can call 24 hours a day, 7 days a week. You can call 1-800-622-4357 at any time to speak with someone about your loved one’s struggle with depression.

You can also find resources on the Substance Abuse and Mental Health Services Administration’s website.

Many organizations and agencies also offer a wealth of resources for individuals with depression, including:

The National Alliance on Mental Illness
988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline)
The CDC
The National Network of Depression Centers
The National Institute of Mental Health

Reach out for help and guidance today if you suspect that someone you love in a nursing home is struggling with depression.

Medically Reviewed by:

Dr. Patricia Shelton, MD

Education:

University of Washington, Doctor of Medicine – MD. June 2008
University of Washington, Bachelor of Science – BS, Jun 2003

Background:

Neuroscience and Medicine

Career:

Dr. Shelton primarily writes content for health-related websites, but has also written test prep materials, white papers, published research articles, court documents, and more.
Dr. Shelton teaches anatomy and physiology at the college level for the National Institutes of Health.

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