Depression is a major public health issue, and it’s especially important to understand in long-term care. While sadness and grief are part of life – especially later in life – persistent low mood that doesn’t improve may be a sign of something more serious: clinical depression.
Understanding and recognizing depression in long-term care settings can dramatically improve quality of life for residents. It can also help staff and families feel more confident and supported in their caregiving role.
How Common Is Depression in Long-Term Care?
Depression often goes undiagnosed in older adults. According to the World Health Organization, about 14% of adults aged 60 and over live with a mental disorder, with depression being one of the most common. In long-term care specifically, the numbers are even higher:
- Among community-dwelling older adults, 1% to 5% experience major depression
- That number rises to about 11.5% among hospitalized older adults
- For those receiving home health care, the rate climbs to 13.5% (Source: National Institute of Mental Health, 2020; WHO, 2023)
In nursing homes, the rates are even more concerning. Some studies estimate that up to 30% of residents may have significant depressive symptoms — and half of those cases go unrecognized.
When Is Low Mood a Problem?
Everyone feels down sometimes — after a loss, during a health setback, or on a hard day—that’s normal. However, when those feelings persist, interfere with daily life, or don’t improve with time or support, it may be a sign of a depressive disorder.
In long-term care, signs of depression may look different than in younger people. Instead of talking about sadness, residents may:
- Withdraw socially
- Show changes in appetite or sleep
- Appear irritable or confused
- Complain more about pain
- Lose interest in things they once enjoyed
That’s why it’s so important for staff and family members to pay attention to changes and speak up when something doesn’t feel right.
How Do Clinicians Diagnose Depression in Older Adults?
Diagnosis isn’t based on a single moment or feeling. Clinicians use a structured framework that considers:
- Duration: Has the low mood lasted for more than two weeks?
- Severity: Is it interfering with daily activities or relationships?
- Symptoms: Are there changes in sleep, appetite, energy, or concentration?
- Medical factors: Could a medication or illness be contributing?
- Context: Has the person recently experienced a major loss or transition?
One tool that’s often used is the PHQ-9, a short questionnaire that helps screen for depressive symptoms. But screening is just a first step. Proper diagnosis requires talking with the resident, understanding their story, and involving family and staff when needed.
What Diagnoses Might Be Considered?
- Major Depressive Disorder (MDD): Significant symptoms lasting at least two weeks and interfering with functioning
- Adjustment Disorder with Depressed Mood: A shorter-term reaction to a stressful event
- Persistent Depressive Disorder (Dysthymia): Ongoing low mood lasting two years or more
- Depressive Disorder due to another condition: When mood changes are linked to dementia or chronic illness
No matter the diagnosis, the goal is always the same: to understand the resident’s experience and provide the right support.
Non-Medication Approaches that Work
Many older adults respond well to non-pharmacological treatments, which can be especially important when medications carry risks or interact with other conditions.
Here are three proven approaches:
- Behavioral Activation Encourages residents to re-engage in meaningful or enjoyable activities, even when motivation is low. This builds small successes and breaks the cycle of isolation.
- Cognitive Behavioral Therapy (CBT) Helps individuals recognize and shift unhelpful thinking patterns. In long-term care, this can be adapted to focus on adjusting to life changes, grief, or illness.
- Mindfulness and Acceptance-Based Strategies These help residents observe difficult thoughts and emotions without becoming overwhelmed by them – especially helpful for those facing chronic illness or loss.
Sometimes, a structured therapy program is available onsite. In other cases, social workers, psychologists, or trained nursing staff can support these approaches informally during everyday care.
What You Can Do as Staff or Family
- Notice changes in mood, behavior, or engagement
- Ask questions gently — “You seem quieter than usual. How are you feeling today?”
- Share concerns with nurses or the care team – don’t assume someone else has already flagged it
- Offer support — sometimes just sitting with someone or bringing a photo album can help
- Encourage activities that are enjoyable, meaningful, or social
If you’re unsure whether something is normal sadness or a sign of depression, err on the side of asking. It’s better to speak up than to miss an opportunity to help.
Final Thoughts
Depression is not a normal part of again – it is treatable. In long-term care, recognizing and addressing depression can be improve not only mood, but also sleep, appetite, physical health, and relationships. Every staff member and family caregiver have a role to play. By being observant, compassionate, and proactive, we can make sure residents aren’t just safe – they’re truly cared for.
