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Key Points
➤ Depression among nursing home residents is common and is often
under-diagnosed and under-treated as sadness may not be the
primary symptom.
➤ Older adults with depression may present with atypical symptoms,
such as physical complaints (fatigue, weight loss, pain, multiple
unexplained medical symptoms, memory complaints, social
withdrawal, refusal to eat/drink/take medication, problems with self-
care).
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➤ All health care workers in the PALTC setting should maintain a high
level of suspicion for presence of depression in their patients.
➤ Treatment for depression can be effective, even in frail elderly.
➤ Antidepressants may be more effective in treating cases of major
depression in dementia than of dysthymia but are less likely to be
lastingly effective if the patient also had dementia.
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➤ When cognitive impairment results from depression, it may be
partially or completely improved with depression treatment.
➤ Consider preventive strategies which enable residents to lead their
lives in the most pleasant way. For example, interactions between
staff and residents should aim to build a sense of community and
encourage residents to contribute to the life around them.
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➤ Treatment options should be consistent with patient's and family's
goals of care.
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Depression
STEP 1: Does the patient have any risk factors?
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• Female
• Chronic medical illness, such as cancer, diabetes, heart disease, stroke and
Parkinson's disease
• Physical/functional disability or loss of a body part
• Poor sleep
• Lonely or socially isolated
• Personal or family history of depression
• Use of certain medications (See Step 4 in Depression)
• Alcohol or drug abuse
• Experienced stressful life events such as death of a family member or friend, divorce,
loss of autonomy, loss of privacy
• New admission or change of environment
Recognition
