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Geriatrician offers advice for managing depression in nursing-home patients

Nurse Leader Weekly, June 25, 2004

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Walking through your facility every day, greeting residents or stopping by during resident activities, you probably recognize many of the same faces. But what about those residents whom you don't see? If a usually active resident is missing from the social scene, spending more time in his or her room, or coming to meals less frequently you might want to take a closer look.

Depression is estimated to affect 60% of nursing home residents, as compared to 15% of the general population, yet it continues to be one of the most underdiagnosed nursing-home conditions, said David Henry, MD, ABFP, CMP, a geriatrician in Shreveport, LA, during an audioconference sponsored by Louisiana Health Care Review, the state's quality improvement organization (QIO).

Henry offered the following tips to step up the management of depression in nursing homes:

1. Keep a watchful eye. Fatigue and isolation are key signs of depression. When the resident begins withdrawing from social activities, such as dining with other residents, nursing staff should take notice and alert the physician. Make sure that certified nursing assistants are part of the equation, too, because they deliver 80%-90% of the hands-on care, Henry recommended.

2. Ask the resident how he or she is feeling. When staff suspect that a resident with whom they have a friendly, trusting relationship is feeling depressed, the resident will most often truthfully share how he or she feels. But you have to ask. The majority of the nursing-home population are women-women who were not culturally conditioned to complain or talk about how they feel. Instead, they may have been taught since childhood to hide negative feelings, said Henry.

3. Don't underestimate the effects of pain management. "Sometimes the best antidepressant you can give an older person is to take them out of pain," Henry explained. A consistent pain-medication routine may be more effective for residents. "In today's geriatrics, we recommend not doing PRN, or as necessary, pain medicine as much as offering regular, routine pain-control measures," he added.  This is not to say that a strong pain medication is always necessary. For example, working with a resident to increase range of motion is one approach to skeletal pain, Henry advised.

4. Take the side effects of medications into account. "All medications can cause drowsiness in the elderly, and when you add a drug, you add a side effect," said Henry. If a resident begins a regimen of antidepressants and pain medication at the same time, it can increase drowsiness, which will increase the risk of falls. Allowing the resident to adjust to the pain medication before starting an antidepressant may reduce the chance of complications, he added.

-Adapted from Briefings on Long-Term Care Regulations, published by HCPro, Inc.

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