Depression in Senior Living Communities and the Occupational Therapist’s Role

By Liz Slaughter, MS, OTR/L

Occupational Therapist

Overcoming Depression in Senior Living Communities

Mental health. A topic that has not been addressed for many years, but now is making headlines in the news, discussed more in classrooms and addressed more in healthcare.

Senior living community (SLC). A place some individuals look forward to living one day because of all the friends they will meet, while others view this as the beginning of the end. A SLC can include independent living, assisted living, and memory care, or it can be just independent living, and just assisted living.

Both of the above are topics that can be sensitive to the elderly population. It can be difficult for an older adult to talk to a family member about their mental health. Moving from a house that may have been home for 30+ years is something not many of us can relate to; therefore, family members may not feel open to expressing their emotions. Many new SLC residents give up their cars when they move in, which can also lead to feelings of lost identity or hopelessness. Some individuals may move into a SLC due to a loss of a loved one, a recent fall, or a decline in functional independence. Along with these losses, and functional declines, comes a grieving process. The grieving process is not always identified by the individual and takes some longer than others to overcome. For residents who have lived in the SLC, may have moved there to be closer to their family yet still never have visitors. Others may have a history of depression. Whatever the situation may be when the individual sits in their apartment all day thinking about what they had to give up or who they miss seeing, feelings of hopelessness may escalate. Occupational therapists are part of the rehabilitation team and can assist individuals with enhancing participation in activities of daily living, daily routines, and community engagements.

For the purpose of this article, depression in the geriatric population is the main focus. However, it is not uncommon for someone with depression to have anxiety as well, along with other co-morbidities. Among the elderly population, 80% have a chronic illness, and 77% have at least two. Mental health conditions are associated with cardiovascular disease and declined cognitive performance.

Depression in SLCs: Signs & Symptoms

One in four adults has symptoms or diagnosis of a mental health disorder, including depression, anxiety, and/or dementia. Two-thirds of individuals with mental health conditions do not receive the medical treatment they need to have productive lives. Along with friends and family members, occupational therapists in senior living communities can help identify signs and symptoms of depression. Occupational therapists build relationships beyond the residents, including residents’ families and friends, which allows conversations about any changes in moods or declines in functional abilities the resident may have. These conversations can lead to the appropriate professions getting on board to care for the individual’s needs and improve their quality of life.

A few signs and symptoms of depression include:

• apathy
• memory loss
• trouble sleeping
• sleeping too much
• irritability
• social isolation
• guilt, hopelessness
• loss of interest in doing things once loved

Benefits of Occupational Therapy for Residents in SLC

For some, depression can be so bad that the individual does not want to shower or get dressed. For others, they may look “fine” but be more irritable and just want to be left alone. Depression can lead to isolation, which can result in loneliness. Loneliness has been correlated with less physical activity, less sleep, and poorer physical health. Throughout a care plan, occupational therapists are providing services to an individual anywhere from two to four days a week, which can contribute to the resident feeling less lonely. During therapy sessions, occupational therapists address the decreased strength that could have been caused by the resident’s lack of physical activity and poor physical health. Along with physical interventions, education is provided to manage healthy eating and sleep habits to improve quality of life and functional mobility to increase independence with daily activities and social engagement.

Sometimes residents can be depressed because their roles have recently changed causing them to feel like their identity has been taken from them. Roles can be as basic as no longer completing their own laundry. Occupational therapists can address functional limitations that are hindering the individual from being able to put their clothes away, and assisting them with regaining parts of the tasks they once thought was taken away from them. From being a grandparent or churchgoer to rarely seeing their grandchildren and not able to drive to church anymore. However, an occupational therapist can educate and assist the individual in ways that he or she can maintain these roles while living in the SLC. For example, assisting the individual with becoming independent with their cellphone to call their grandchildren or improve their grip strength and fine motor coordination in order to write letters to send in the mail. Also, providing therapeutic interventions to improve balance, functional strength, or endurance for the individual to walk to the community room each Sunday where they hold church for all the residents.

Occupational therapists can assist individuals living in senior living communities to improve their participation in leisure activities and social engagement. For example, they can assist residents in using the community’s social calendar, building functional strength, and increasing confidence in order to participate in social activities. Occupational therapists can also address health management and maintenance, including medication management and meal preparation, to optimize functional independence and increase residents’ participation in roles that they used to have in their homes. The roles and occupations that our loved ones have are who they are and who they should continue to be no matter where they call home. Occupational therapists can rehabilitate lives to make this possible.

A resident, 72 years young, at a SLC told me once, “No matter the age of the person, they deserve the best quality of life.” This quote will always stick with me. As an occupational therapist, I hope every patient of mine knows that I want them to have the best and I am there to provide the tools to get them there. While many times the conversations about depression can be uncomfortable, I hope that if anything this will shed some light on the prevalence of mental health in the geriatric population and the need for occupational therapy in the senior living communities.

National Council on Aging (2018 July). Mental health. Healthy aging.