Mental Health Assessments for SLC Patients are More Important Than Ever

By Katlyn Jolly, PT, DPT, GCS
Physical Therapist

Due to the isolation and uncertainty caused by the COVID-19 pandemic, instances of decreased motivation, poor activity levels, and increased prevalence of anxiety and depression have been noted within all age ranges. As clinicians, we want our patients to succeed physically and functionally. It is imperative that we are available to assess, educate and treat the mental health needs of our patients when appropriate. If we fail to address potential mental health issues such as depression and anxiety, our patients will struggle to achieve and sustain overall wellness.

Why Mental Health Matters

As we all know, living through the COVID-19 pandemic has been extremely stressful for all age groups. Many are struggling with anxiety and depression due to fear of the unknown and lack of socialization. Along with being isolated from family and friends, senior living residents are also having to cope with a significant loss of control in a majority of aspects of their lives. Not only are they required to be separated from their families, but they are often told when or if they can leave their room, where they can sit for meals, or how they can interact with other residents.

Although all requirements are made to protect residents, it is understandable why many have become frustrated and lonely. These emotions play a major role in a patient’s motivation for participation in treatment and in turn their ability to regain functional independence and wellness.

How To Identify An Issue And Who to Tell

Often, clinicians have the benefit of getting more one-on-one time with patients than senior living staff, family and especially physicians. This means that we are more apt to notice changes in patient behavior than other parties that communicate with these residents. Depression and anxiety have multiple ways of presenting themselves. The most common being irritability, mood swings, lethargy, sleep difficulties, and anger. Many people can have episodes of anxiety or depression and bounce back with little to no intervention from others. However, if a trend is noted over several days or weeks, it is highly likely that outside help should be sought out.

Clinicians need to inform changes noted to the patient, senior living staff and the patient’s physician and family as appropriate. Along with this communication, there are several strategies that can be used to assist with patient symptoms within a physical, occupational or speech therapy treatment session.

How to Incorporate Into Sessions

Regardless of your discipline, there are a multitude of ways that we can incorporate mental health into our treatment sessions. Some ideas include video chatting family members during standing balance. You can use the phone or tablet to facilitate head turns in various directions, or incorporate a foam mat for training on compliant surfaces. Another idea for gross motor activities could be dual tasking during ambulation training with reminiscence therapy, looking at pictures around the home. With this activity you would be able to not only improve their ambulation independence but also, improve obstacle negotiation, incorporate quick stopping, direction changes, head turns during gait among others. Fine motor and memory training can be incorporated by writing letters to family, creating memory books, scrap-booking, or video chatting family playing checkers.

By incorporating activities that are meaningful to our patients we are giving them an opportunity to connect with their families and us in a way that they haven’t been unable to connect since the pandemic started. The ideas are endless with a little bit of creativity. These interventions are beneficial to all patients. They will not only spark joy and relieve anxiety, but also increase buy-in to treatment and potentially prevent future episodes of mental health disorders.

Thoughts to Put Into Practice

We are privileged to have ample one-on-one time with our patients that lend us to be the ideal provider to notice changes in patient mood and status. If you observe any changes in a patient and are questioning if they may be depressed or anxious, say something. It is likely that the patient will either not recognize a need for intervention or will be uneasy advocating for themselves due to generational stigmas on mental health conditions. If we can be better advocates for our patients, we vastly improve their chances to obtain true functional wellness, which is our philosophy and objective.