Preventing and managing depression

We can implement various strategies to improve an older person’s outcomes during their stay in hospital, contribute to their recovery and prevent the risk of functional decline.^{1, 2, 3, 4}

We know it’s the simple things that actually significantly improve the care of older people, straightforward things, such as …a team-based approach …involving and listening to patients and their families and carers is so important… whether the meal tray is in reach during meal time, whether there’s plenty of fluid available during the day to prevent dehydration, it’s getting people out of bed and making sure they are kept ambulant and mobilising during the course of the day. It’s making sure that we look out for the problems of depression and anxiety and actively manage those with the patient.
- Geriatrician

Encourage patients to be active

Assist and encourage patients to participate in their care and to keep mentally, socially and physically active.

• Encourage and help patients to eat and drink well and help prevent constipation. Depressed patients have more eating and digestive problems and there is a significant link between under-nutrition and depression⁵.
• Encourage patients to care for themselves when they can, such as washing, dressing etc.
• Provide stimulation and interaction.
• Encourage or assist patients to get out of bed and move regularly.
• Implement and monitor strategies to reduce the patient’s risk of falls and pressure injuries.
• Minimise isolation. Frequent brief visits from staff, volunteers, family and friends can help maintain the patient’s morale. If family, friends and carers can’t visit, encourage them to telephone the patient.

Communicate with patients

Communicate with patients and provide reassurance, encouragement and comfort.

• Acknowledge the patient and help them maintain their sense of self; consider their physical, emotional, social and spiritual needs.
• Encourage communication by demonstrating warmth, concern, a non-judgemental attitude and patience.
• Give the patient time to respond to questions and requests. Speak calmly and give clear and concise explanations about care and treatment.
• Use gentle but persistent encouragement and reassurance to engage the patient in tasks. Ask the whole healthcare team to adopt a consistent approach.
• Encourage patients to talk about their mood. Respond with respect; gently challenge negative thoughts by providing an alternative perspective; avoid dismissive statements such as “It can’t be that bad”.
• Reinforce positive responses; reinforce the patient’s strengths and positive attributes; avoid criticism.
• Point out progress in the patient’s condition no matter how small (patients may not recognise these).

Consider night-time strategies

Difficulty getting to sleep, restlessness, nightmares, waking early, loneliness, and the lack of distractions can lead patients to ponder over fears or feelings of hopelessness.

• Encourage habits that promote sleep, for example don't have caffeine before bedtime, avoid afternoon napping, make sure the room is dark and noise is minimal.
• A familiar staff member who listens can be comforting. It may be easier for some people to express their thoughts and feelings when the ward is quieter.

Explore treatment options

Talk to the person and the healthcare team about treatment options.

• Encourage strategies to reduce anxiety, such as relaxation techniques.
• Request a medication review to determine whether pharmacological treatment is appropriate. Note that antidepressants may be overprescribed and should be reserved for patients with chronic, recurrent or severe depression.
• Discuss whether a referral to a psychologist for Cognitive Behavioural Therapy (to change negative thought patterns) and Interpersonal Therapy (to improve relationships and cope with grief) may be appropriate. In mild cases of depression therapy may be more effective than medication.
• During admission have volunteers and pastoral care workers spend time with patients, helping them explore their feelings of loneliness, and keeping them company.
• Explain the importance of maintaining social connections. If someone is socially isolated, encourage them to initiate new social activities and contact their local council, neighbourhood house or library to find out about activities in their area.

Involve patients and families

Always involve the patient and their carers and family in the care plan and decision making. Give patients and their family and carers information about depression and how to stay well.

Discuss lifestyle changes

Talk to the older person about incorporating some lifestyle changes to manage their symptoms, such as diet, nutritional supplements, exercise and social activities.

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1. Snowdon, J., Late-life depression: what can be done? Australian Prescriber, 2001. 24(3): pp. 65-67.

2. Thomas, H., Assessing and managing depression in older people. Nursing Times, 2013. 109(43): pp. 16-18.

3. State of Queensland (Queensland Health), Queensland mind essentials: mental health nursing documents., 2010.

4. Let's Respect. Depression. 2014.

5. German, L., et al., Depressive symptoms and risk for malnutrition among hospitalized elderly people. The Journal of Nutrition, Health & Ageing, 2008. 12(5): pp. 313-318.