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Mental health diagnosis and treatment among nursing home residents: take a step forward as a society!

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Individuals find it hard to adjust to their life in long-term care facilities, and maintaining good mental health could be challenging. About 65-90% of residents have behavioral and mental health problems. Depression is the most common mental health problem in nursing home residents (NHRs), ranging from 6 to 78%. The other common issues include dementia, anxiety, stress, and schizophrenia. If left untreated or unacknowledged, this could severely impair their quality of life, leading to other serious health issues such as stroke, cardiac failure, and cancer. Often, the residents go undiagnosed and do not receive any treatment (popularly known as the “treatment gap”). There could be several reasons for the mental health issues, such as emotional abuse in nursing homes, natural aging, poor lifestyle, adverse effects of medications, etc. There is abundant evidence of depression among NHRs. However, we do not understand the effect of mental health issues on the community and the extent to which they are identified and treated. We explore the need to diagnose, treat, and educate NHRs about mental health, aging, and accessing treatments.
 

Diagnosis and treatment of mental health problems

Diagnosis
More often, the mental health of NHRs is unnoticed as psychiatric consultation requests in nursing homes are mostly related to the resident’s behavior and less often about their mood. Although there are tools to diagnose depression or dementia in NHRs, it could be a challenge due to several factors. Most people think that mood swings, difficulty in thinking, and behavior are a natural part of aging and do not pay any heed. Instead of ignoring such signs or dismissing them based on age, such individuals require attention and professional help. The commonly used diagnostic procedures include resident examination (physical and psychiatric), caregiver interview, chart information, and personalized questionnaires. The outcomes of depression are generally evaluated using the Hamilton Rating Scale for Depression, the Cornell Scale, and the Geriatric Depression Scale (GDS).
 
Depression leads to several mental health issues
Although death in a nursing home is not uncommon, it affects the residents due to their intimate personal relationships, and they feel like losing a family member. Residents with minor or major depression may develop cognitive impairment, functional disability, Alzheimer’s disease, bipolar disorder, and cardiac and respiratory failure. The most affected population is the elderly, as they feel helpless due to solidarity, limited mobility, and dependency on caregivers.
 
Quality of life of NHRs
Quality of life (QoL) is a subjective term and encompasses many layers. Most QoL questionnaires/surveys investigate autonomy, food appreciation, independence, comfort, privacy, social interactions, relationships, security, spiritual well-being, and dignity. Many nursing homes focus on these domains to maintain good mental health and the overall well-being of the residents. Lack of research and paucity of literature makes it challenging to guide the caregivers to make meaningful choices to satisfy the residents. A positive approach may help reduce the chances of encountering mental health issues. Individualized assessment of daily existence may help in planning care programs.
 
Treatment and management
Treatment data for depression, anxiety, and other related mental health issues in NHRs, were collected from randomized clinical trials (RCTs), uncontrolled pilot studies, population-based studies, and surveys in various nursing homes. Psychologists and psychiatrists could help NHRs manage their emotions and work through stress and trauma. Individuals without a clinical diagnosis of depression generally receive a personal structured day with caregivers and a recreational therapist. Antidepressants and pharmacological therapy should be prescribed to manage conditions like dementia and Alzheimer’s. Residents could benefit from social connections, support groups, and more interactions with their friends and family to overcome their solidarity and cope with their mental health problems. Physicians and healthcare providers can play a vital role in integrating themselves into nursing homes to promote the significance of mental health among the residents. Government and stakeholders need to recognize this issue and include them during planning and policymaking.
 
The mental health of NHRs: Final Note
Staying mentally healthy in a nursing home facility is tricky but achievable. Additionally, with the ongoing COVID-19 pandemic, maintaining good emotional health has been overwhelming. You can encourage residents to be more physically active, involve them in communities, and provide them with a safe and warm feeling. The nursing staff should receive frequent education and training sessions on mental health management to help the residents. Mental health advocates have been vocal about the reforms and regulations intended to enhance the QoL of residents. You can always check out more details here.