“Getting older” is a way of explaining a wide range of conditions, including confusion, sadness, isolation, insomnia, irritability, and forgetfulness, among others. Therein lies the problem: sometimes the effects of aging are benign, other times “getting older” may be inadvertently used to marginalize serious mental health problems. This article reports the current thinking on how to keep people in their later years mentally healthy at home.

The confluence of old age and depression

In clinical circles, “depression” is defined in DSM-IV diagnostic language: “Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day.” The most common symptoms include depressed mood, weight loss, insomnia, fatigue, and confusion.

For older people, however, a diagnosis of depression can be complicated. In addition to possible genetic predispositions, there is often genuine sadness from the loss of loved ones, isolation due to the pandemic, the losing battles of failing health, and side effects of multiple medications.

The field of geropsychology, which began in the 1970s and 80s, addresses mental health care for older people, signifying a greater understanding that older people have specific mental health challenges that overlap with emotional and physical health.

Anxiety may have a larger effect than depression on reported pain levels

The link between mental states and pain

Pain is often part of aging. However a 2020 Journal of Clinical Medicine study details how some older adults develop emotional states that have “negative effects on cognition and pain. Particularly, we found that anxiety had a larger effect than depression [on reported pain levels].”

Objective measurement of pain is a relatively new medical discipline. For many years, ER patients in pain were asked to choose from a series of cartooned faces indicating different levels of pain, known as the “visual analogue scale.” New methods involve an electroencephalography-based testing to measure pain-specific brain activity.

As our understanding of pain evolves, medically directed home care professionals need to understand that older people face daily difficulties in managing mental and physical health, and their reported pain levels needs to be taken seriously. Then the caregiver and the client can work together on ways of reducing pain.

Objective measurement of pain is a relatively new medical discipline

How home care can create a mentally healthier environment

Safety 1st and last

A study in the American Journal of Geriatric Psychiatry found that antidepressant medications are linked to a 70% increased risk of falls. Home health professionals can reduce this risk by managing the environment and the client. Regular exercise, the right nonslip shoes, adequate lighting, and grab bars and handrails are just a few examples.

Relaxation interventions

There’s evidence that practices such as muscle relaxation, music, and yoga result in lower depression and anxiety levels for older adults. Home care, in conjunction with the client’s medical team, can facilitate these measures and make them a regular practice.

Minding meds

In an article on mental health in older people, Erin Emery-Tiburcio, an associate professor of geriatric and rehabilitation psychology at the Rush Center for Excellence in Aging in Chicago, said, “I had a patient several years ago who was sharp as a tack. Then when he came to see me three weeks later he was very confused and stumbling.” She explained that the patient in question had been prescribed medicine for incontinence, whose side effects are falls and confusion. The lesson is that medication management and communication across care channels is critical. Medically directed home care can facilitate both.

Remaining positive

A 2021 Kiplinger article entitled “When mental health and aging collide” said that when families discuss matters together and focus on the positive aspects of life, “The older person may forget the session, but the feeling of emotional resolution can continue.” Home care professionals are often experts in focusing on positive feelings and happenings, drawing the client’s attention away from negativity.

Social connection

Social contact reduces loneliness and improves mental states in older people. Support in navigating emotional problems often has the same effect. Home care professionals (which at SeniorBridge include LCSWs) can facilitate these action steps.

Conclusion:Depression may be unavoidable in later years, but there are many ways to confront and treat it that are not pharmacologically based. Home care services can play a significant role in alleviating depress/anxiety and improving the quality of clients’ lives.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on medically directed home care, contact SeniorBridge.

Sources consulted:
National Library of Medicine (2008)
Springer 2017
National Library of Medicine (2020)
Science Daily (2018)
Taylor Francis (2015)
Kiplinger (2021)

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