Changing Minds: Prioritizing Mental Health Among LTC Residents During the Holidays

The holiday season, often celebrated as a time of joy and connection, can present unique challenges for residents in nursing homes and other long-term care (LTC) settings. For many older adults, this time of year amplifies feelings of loss, isolation, and sadness. According to the National Institutes of Health (NIH), up to 90% of nursing home residents experience a mental health disorder, ranging from anxiety and depression to more severe illnesses like schizophrenia and bipolar disorder. Recognizing, managing, and supporting residents’ mental health is critical to ensuring their overall well-being all year long, but especially during the holidays.

The Prevalence of Mental Health Issues in Long-Term Care

The Centers for Disease Control and Prevention (CDC) reports that nearly half (49%) of nursing home residents have a diagnosis of depression, a rate twice as high as individuals in other care settings such as adult day services or residential care communities. Depression is often accompanied by comorbidities such as dementia or anxiety, making diagnosis and treatment even more complex. The symptoms of depression or anxiety can mimic normal aging processes, such as changes in mood, sleep patterns, and activity levels. This overlap can make it difficult to identify when a resident’s behavior is indicative of a mental health condition rather than age-related changes.

Around the holidays, mental health professionals note a rise in depressive symptoms among older adults. The reasons are multifaceted: reflections on the loss of loved ones, increased awareness of physical or financial limitations, and diminished independence. Social isolation, a common issue for many LTC residents, becomes particularly poignant during a season characterized by togetherness and celebration.

Challenges and Risks of Treating Depression in Older Adults 

Nearly 50% of nursing home residents take antidepressant medications, yet evidence shows inconsistent results regarding their effectiveness in older populations. Moreover, psychotropic medications, including antidepressants, carry risks such as falls and other adverse drug events. This highlights the importance of conducting careful risk-benefit analyses when prescribing these medications for older adults.

Non-pharmacological treatments for depression, such as cognitive-behavioral therapy, structured social activities, and exercise, have proven effective and may provide safer alternatives. However, implementing these treatments requires a coordinated approach involving caregivers, healthcare providers, and family members.

The Role of Senior Care Pharmacists 

Pharmacists play a vital role in managing mental health conditions among LTC residents. They are instrumental in ensuring the safe and appropriate use of psychotropic medications, particularly in light of national policy initiatives aimed at reducing the inappropriate use of antipsychotic drugs for behavioral symptoms of dementia. By identifying issues such as polypharmacy and drug-drug interactions, pharmacists can intervene to prevent medication-related harm.

In addition to managing medications, pharmacists provide valuable education to care staff on current clinical practice guidelines and treatment protocols for mental health disorders. This collaboration fosters a more informed care environment, ensuring that treatment plans are tailored to each resident’s unique needs.

Holiday Blues vs. Clinical Depression 

The “holiday blues” are a common and typically mild phenomenon, but clinical depression requires prompt intervention. Symptoms of depression in older adults include:

• Loss of interest or pleasure in activities
• Changes in appetite or weight
• Restlessness or fatigue
• Difficulty concentrating
• Sleep disturbances
• Behavioral changes such as neglecting personal hygiene or withdrawing from social interactions

Recognizing these symptoms is crucial, as untreated depression can significantly impact a resident’s quality of life. Encouraging residents to engage in activities they find pleasurable and meaningful is one effective way to combat depressive symptoms. Studies have shown that the anticipation of enjoyable events can be just as beneficial as the activities themselves, providing residents with a sense of purpose and excitement.

Supporting Emotional Well-Being During the Holidays 

Protecting the emotional well-being of residents is as important as safeguarding their physical health. Care teams can take proactive steps to support mental health during the holiday season:

1. Increase Awareness: Educate staff on recognizing subtle changes in mood and behavior that may indicate depression or anxiety.
2. Promote Social Engagement: Facilitate group activities, such as holiday crafts or music sessions, to reduce feelings of isolation.
3. Encourage Family Involvement: Work with families to include residents in holiday traditions, even virtually, when in-person visits are not possible.
4. Personalize Activities: Tailor events to residents’ interests, fostering a sense of connection and fulfillment.
5. Monitor Closely: Pay extra attention to residents who exhibit signs of emotional distress and communicate concerns to healthcare providers promptly.

A Positive Outlook for Older Adults 

The good news is that depression in older adults is highly treatable when addressed appropriately. With increased awareness of residents’ mental health needs, careful monitoring, and a commitment to prioritizing emotional well-being, care teams can make a meaningful difference in the lives of residents. By taking a proactive approach, we can help ensure that the holiday season becomes a time of comfort, connection, and care for every resident.

Protecting mental health is an ongoing process that requires the collaboration of everyone involved in long-term care. This holiday season, let’s commit to fostering an environment where emotional well-being is not just a priority but a promise.

Bethany Bramwell, RPh, BCGP
Senior Director, Marketing

Bethany is a board-certified geriatric pharmacist with over 20 years of experience in senior care pharmacy. She is a passionate advocate for the health and well-being of older adults and dedicated to empowering caregivers to deliver exceptional care. A seasoned writer and public speaker, she has contributed to numerous health-related publications and events. In her role as Senior Director of Marketing for Guardian Pharmacy Services, Bethany creates compelling content to promote awareness of senior care topics and long-term care pharmacy services.