Today’s skilled nursing facilities are considerably different from the nursing homes of yesteryear. They feature larger rooms, visits from pets and even gardens. Still, for many seniors, the move to one of these long-term care facilities is representative of the end of the road. The simultaneous loss of independence, a long-time home, an established routine and cherished friends would be difficult for anyone to handle.

According to the American Geriatrics Society, such a monumental change can lead to depression, ranging from mild to chronic, in approximately 40 percent of nursing home residents. Despite its prevalence, few elders in nursing homes openly admit that they are experiencing symptoms of depression, therefore this mental condition often goes undiagnosed and untreated in seniors. In many cases, the symptoms are simply written off as a “normal” part of aging or even misdiagnosed as dementia. That means family members and nursing home staff must be on the lookout for warning signs, which can be very subtle.

Diagnosing and Treating Depression in Seniors

Kenneth M. Sakauye, a geriatric psychiatrist and professor emeritus at the University of Tennessee Health Science Center in Memphis says getting to the root cause of depression is key. “Depression can have a biological cause or a psychological cause,” Dr. Sakauye explains. “While medication, therapy or both could be prescribed for any patient displaying symptoms, knowing the underlying cause can lead to more effective treatment.”

For example, it is estimated that up to 50 percent of people develop depression following a stroke. Dr. Sakauye posits that changes to the brain (like reduced blood flow) caused by health conditions like Alzheimer’s disease and stroke can result in a sort of vascular depression. If the cause is a biological factor like this, medication may be more effective than therapy because it treats the underlying chemical imbalance.

On the other hand, if depression is mild and caused by psychological factors, such as lack of socialization and stimulation, therapy could be more helpful. “Following placement in a long-term care facility, elderly patients often say the best times of their lives are over,” Dr. Sakauye notes. “They have been forced to move from home and feel as if they don’t have anything left to live for.”

Therapy and Lifestyle Changes for Senior Depression

Medication is a useful treatment option for depression, but some individuals can benefit from nonpharmaceutical treatments in lieu of or in conjunction with prescription drugs. If a senior is open to it, talk therapy can be especially helpful for working through concerns and fears that may arise or deepen following a move to a nursing home.

Involving family members in therapy sessions can be helpful as well. “It’s up to the patient,” Dr. Sakauye says. “Most seniors won’t even come in without their family.” But what role should family play in therapy: active participant or passive listener? “They are there as observers,” he emphasizes. “It’s not traditional family therapy; the family member is there in a purely supportive role.”

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Dr. Sakauye typically engages any family members present at the end of the session and recommends they only speak when asked. Afterward, those present can help the senior implement the therapy plan by providing reminders about assignments, like joining an activity group or walking outside, and assisting in their completion.

In addition to therapy, Dr. Sakauye also recommends the following strategies to family caregivers who wish to help their loved ones integrate into their new environment and keep their spirits up during the transition period:

  • Encourage social interaction. Being around other people with similar interests and life experiences can be therapeutic. Nursing homes provide plenty of opportunities for developing friendships and personal connections. If your loved one has never been socially outgoing, help them start slowly by finding activities they enjoy that are held in a group setting. Even if they don’t interact with the other participants, just being around their peers may help them feel less isolated and develop a sense of community.
  • Help your loved one find a hobby. Boredom and lack of purpose in life can contribute to depression. A hobby like gardening or playing cards is stimulating, keeps the brain active and encourages interaction with like-minded people. Most nursing homes have a daily calendar of activities and events for a variety of interests and ability levels. Even partaking in a solitary pastime can be beneficial.
  • Talk openly. Your loved one may want to talk to you about how they’re feeling, but they may not know how to start the conversation. Open the door for sharing feelings by asking them how they’re honestly feeling, but don’t force it. Let your parent know it’s okay to talk to someone other than you if it’s more comfortable, such as a therapist, a nurse with whom a special bond has been formed or a fellow resident who has become a trusted friend.
  • Enhance their environment. Making your loved one’s nursing home room feel like their own special space can dramatically improve their mood. Add personal touches like low-maintenance house plants, treasured keepsakes, their favorite armchair and family photos—whatever makes the space feel homey and personalized.
  • Encourage exercise. Even mild physical activity like walking has psychological benefits. Suggest activities based on your loved one’s physical abilities. Elders who can’t adhere to a “typical” exercise regimen due to physical limitations can still go outside and benefit from the fresh air and sun.
  • Advocate for your loved one. Maintain open communication with the nursing home staff about your parent’s condition and request regular check-ups and care plan assessments to ensure their depression is carefully monitored and treated.

Keep in mind that it is relatively normal to get overwhelmed and become emotional during a major life change. These feelings can be fleeting for some new nursing home residents, while others may struggle through each day for weeks after moving. Each person experiences depression differently and some respond to certain treatment methods better than others. Even if your loved one starts to improve after making some of these lifestyle changes or starting therapy, it’s important that they continue taking all prescribed medications until their doctor gives the okay to stop. With the love of their family and the support of their professional care team, most seniors are able to adapt to their new surroundings in a few weeks or months.