Depression among older Americans in long-term care settings is both prevalent and difficult to treat. According to the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, depression was diagnosed in 49% of residents in nursing homes; 35% of those in home health agencies and 25% of those in assisted-living communities.
Like members from younger generations, difficulty adapting to profound changes, a loss of self-determination and broken social bonds can lead to depression in long-term living residents.
However, the addition of cognitive impairment or medical conditions typically associated with aging complicates the proper diagnosis and treatment of depression in older generations.
For example, symptoms of depression in older adults can be difficult to distinguish from other causes, such as dementia, diabetes, heart disease and other comorbidities. Other residents may have a history of recurrent depression that they have been managing most of their lives.
Culturally, depression — or at least, its symptoms — is often left untreated due to mistaken assumptions that it’s a natural part of the aging process.
In truth, depression is a serious illness that often puts residents on the path to shorter lives and poorer health outcomes.
Jules Rosen, a clinical professor of psychiatry at the University of Colorado, wrote: “Depression in these vulnerable seniors has a profound negative impact on both their quality of life and physical health. Family members, unable to relieve the despair, suffer along with the resident; and nursing home staff and administrators struggle to meet the needs of these residents who find little comfort or pleasure.”
The medication default
The go-to treatment for many cases of depression is medication.
Unfortunately, this treatment option can cause as many issues as the problem it is trying to solve. Antidepressants can put residents at greater risk of falls, negative health complications and other poor conditions. Some studies indicate that antidepressants may not be effective for most older Americans.
Medication adherence is another significant challenge. According to a study by Topolovec-Vranic, et al., “individuals with depression are … three times less compliant in the adherence to medical regimens in chronic illness compared to those without depression.”
Twenty percent of the U.S. population will be over the age of 65 by 2029, so incidence of depression in older Americans is expected to increase dramatically. Efficacy and deleterious side-effects aside, medication may soon be financially prohibitive.
Why technology is a game-changer
These days, many long-term care communities are utilizing engagement technology as a more creative and connected approach to caring for residents with depression, especially those with memory loss or cognitive decline. According to a LeadingAge survey of its long-term community members, 92% of communities provide their residents with internet access, a community internet portal or senior networking sites.
It makes sense. Engagement technology is ubiquitous in society — and most fit right in our front pockets. According to a study by Pew Research Center, most older adults make Internet use a part of their daily lives. For most older adults, internet use is a daily fixture with 67% accessing the news on mobile devices and 77% of adults over 65 owning a mobile phone.
While most commercial tablets, laptops and monitors may be too complicated for those with dementia or memory loss to use, those specially designed to meet their needs have proved to work.
It’s important to realize that the dramatic impact seen with technology and dementia over the years has not usually come from new and groundbreaking technologies. Instead, it typically comes from repurposing tools already at our fingertips.
Arguably, those experiencing cognitive decline have the most to gain from adopting technology of any group. And the good news is that finding ways to help this group through technology isn’t very complicated.
Computers, tablets or smartboards with touchscreen versatility and adaptive devices for individuals with physical and cognitive disabilities. These devices are loaded with picture-based interfaces to launch senior-friendly applications with continually updated content for brain fitness, education, virtual travel, spirituality, music, games, trivia, exercise and specialized dementia programming. They offer family communication tools including webcams for video chat and user-friendly email.
A study in the Journals of Gerontology found that Internet use among retired older adults reduces the probability of depression by 33 percent. Other studies found that engaging with computer technology can be playing certain computer games as just as effective — if not more — reducing symptoms of depression as antidepressants. Executive function — those mental skills required for planning and organizing behavior — also improved.
A gateway to purposeful living
We are social animals, and crave interaction with others. This hardly changes as we advance in age or if our cognitive abilities become impaired. Computer technology — in particular, smartphones — has been derided for making us both more connected to the world but more isolated from each other.
That may be true, but in a long-term care environment comparable technology can be used to facilitate more meaningful interactions between caregivers and the older adults they care for. What matters is not technology for its own sake, but searching to find the right technology that is most relevant to that one person. We all have our own quirks and interests, and the communities that do it right are the ones that proactively look for technology solutions that match the needs of each person.
For example, residents with cognitive decline may be overwhelmed by the changes to their daily lives, which can intensify feelings of depression. Engagement technology with applications specially designed with their needs in mind make it easy to explore music, art, spiritual enlightenment — everything that gives an individual a sense of agency, control and dignity.
Communication features — like video chat, text and email — enable residents to maintain and strengthen the social bonds of community and family. GPS and mapping functionality can bring the warm rush of memory of places and experiences from the past.
Improved socialization and quality of life, enriched communication with family and community, enhanced independence and increased cognitive stimulation through engagement technology technology can lead to a reduction in antidepressant use. Most certainly, providing communities with dignified, state-of-the art activities and therapy experiences, as well as creative and meaningful dementia programming differentiates communities in the marketplace.
Despite the excitement over technology’s positive effects on older adults, much of it still centers on the concept of aging in place. Expanding the utilization of engagement technology can also have tremendous and meaningful benefits to those older adults living in long-term care environments.
We have a responsibility to make these extended years as enriching as possible. With engagement technology and compassionate caregivers, older adults have an opportunity to improve their quality of care, socialize with friends and family members and mitigate the risks of depression without the use of medication.
Juliet Kerlin is Director of Research and Program Partnerships at It’s Never 2 Late® (iN2L), a provider of person-centered digital engagement. She holds a master’s degree in Gerontology and has served on the advisory board of the Dementia Action Alliance and the Board of Directors of A Little Help.