Depression and anxiety are prevalent Excerpt of a flipbook on
but under-recognized in residents1
anxiety in LTC residents; written for nurses in long-term care facilities Depression
•   Depression is 3.5 times more prevalent in
•   Generalized anxiety disorder (GAD) and  long-term care settings than in the general
phobias are the most common anxiety  population.2
•   In one survey, 45% of residents with symptoms  •   Almost 40% of residents have symptoms of
of depression had no treatment history for this  anxiety.5
60 to 90% of older adults with GAD have
concurrent case-level depression.4
“[An] untreated mental disorder
can lead to a more severe,
more difficult-to-treat illness,
and to the development of co-
occurring mental illnesses.”
in general population
in long-term care
— National Institute of Mental Health, National  Comorbidity Survey Replication Study7 9 Challenges in recognizing depression or anxiety in
•   The elderly may have symptoms that are not 
•   Residents rarely will use a term like “depressed”  typical of adult-onset depression.4 to describe symptoms. Instead, they may feel  •   Residents may complain of anxiety or “nerves”  “low,” “empty,” “lazy”—or they may not use any  when, actually, they are depressed.4 •   Many symptoms of depression and anxiety overlap.4 Depression
Irritability         Restlessness
9 Challenges (continued)
•   Residents will more frequently present with 
•   Some medical conditions can predispose a  resident to anxiety or depression.9,11  •   Somatic symptoms* may be due to physical  ➡ Examples: chronic pain, stroke, hypothyroidism,
conditions, a mental health condition, or both.9  ➡ Example: Sleep disturbances may be caused by
disorders, some infectious diseases, sleep medications, respiratory disorders, restless leg syndrome, or depression.
•   Some medications can cause symptoms  •   Symptoms of known medical conditions can  mimicking mental health problems.12,13 mimic, overlap, mask, or distort symptoms of  ➡ Examples: heart medications, cholesterol-
lowering drugs, sedatives, some anti-parkinson ➡ Example: Differentiating depression from
neurologic disorders such as dementia, stroke, or Parkinson’s disease can be difficult. * Somatic symptoms may include, but not be limited to, unusual loss of energy, gastrointestinal disturbances, sleep disturbances, muscle aches, headaches, backaches, and hypochondria.
What depression and anxiety look and feel like14,15

exAMples oF HoW tHis MAy
Be MAniFesteD in resiDents
Physical complaints that don’t respond to Loss of interest and pleasure in activities that were previously pleasurable (food, friends, hobbies, etc.) For example, residents may give excuses for not engaging in previously enjoy- THIS IS THE KEY INDICATOR FOR
Sleep disturbance: difficulty falling or Early morning waking (e.g., 2 am or 4 am) staying asleep; or restless, unsatisfying Agitation: inability to sit still, hand-wringing, pulling at clothing, skin, or other objects Retardation: slowed thinking, speech, body Tension: muscle tightness or spasms, can’t relax, heart “pounds,” headache, IBS, Simple activities like getting dressed may Self-blame, overly negative self-evaluation, Difficulty concentrating or forgetfulness; “Others would be better off if I were dead.” a $ 5 of these 9 symptoms need to be present for most of the day, nearly every day, for $ 2 weeks
$ 3 of these 6 symptoms need to be present nearly every day, all day, for $ 6 months
Information adapted from the DSM-IV-TR.
physical conditions and medications may
contribute to depression or anxiety
residents with certain medical conditions may be some medications may affect one’s mood,12

predisposed to depression11 or anxiety.16
increasing the likelihood for depressive
these conditions include:
•   Beta blockers and calcium channel blockers •   Hormone replacement products •   Endocrine disorders (especially thyroid  •   Brain tumors and other cancers •   Some anti-parkinson drugs  •   Neurological disorders (e.g. Alzheimer’s,  •   Autoimmune disorders (e.g. rheumatoid  •   Infectious diseases (e.g. Lyme disease, HIV/AIDS)•   Sleep disorders (obstructive sleep apnea) How do depression and anxiety affect your
Depression11 and anxiety4 affect their physical health and quality of life.
•   Untreated depression11 and anxiety17 adversely
•   Untreated anxiety causes greater disability,
affect health outcomes, resulting in:
more functional limitations, and poorer quality
➡ Longer recovery from surgeries, acute illnesses, of life than chronic illnesses such as diabetes
and congestive heart failure.18
•   Generalized anxiety that co-occurs with late-
life depression adversely affects treatment
➡ Impaired management of chronic conditions response and long-term outcomes.4
How to advocate for your residents
Knowing how to recognize anxiety and depression can help you develop the best care regimen  
for your residents.
•   remember that clinical depression and
• if you see changes, first rule out the obvious:
anxiety are not a normal part of aging.19,20
➡ Drug interactions: was the resident started  ➡ Know the symptoms of both.
•   employ “watchful awareness.”
➡ New medical conditions: simple issues (like  ➡ Look for changes over time (weeks or  a urinary tract infection) can trigger odd  •   Be concerned about sustained changes that
➡ Dehydration: causes loss of energy and  are severe enough to interfere with your
other symptoms mimicking depression.24 resident’s life.14
•   if depression or anxiety is suspected:
➡ Loss and bereavement are “normal.” In  ➡ Perform assessments and add these results  contrast, a depressive disorder makes a  person feel worthless, helpless, hopeless.13 ➡ Notify a qualified physician or other  ➡ Situational anxiety and worrying are  prescriber if assessment results exceed  “normal.” In contrast, an anxiety disorder is  threshold values or you feel the resident’s  exaggerated, almost constant worry that the  references
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