By: Kathryn M. Quirk, M. Ed
“Getting out of bed and eating in the dining hall is the first step we ask residents to take to reduce symptoms of depression,” says Dr. Scott Crespy, Vice President for Quality Improvement at the Madlyn and Leonard Abramson Center for Jewish Life, North Wales, PA. “Whether a senior is living independently or in a nursing facility, by eliminating or reducing environmental sources of depression and promoting alternative behaviors we hope to reduce depressive symptoms.”
Seniors make up 12.4 percent of the U.S. population, yet they account for almost a fifth of all suicides. Although most people with depression do not die by suicide, untreated depression can increase the risk of suicide. According to the Public Library of Science Medicine Report (May 2010), seniors who move into residential homes can be at risk for suicide, but facilities are often not properly equipped to respond to these sensitive mental health needs.
Recently, I had an opportunity to talk with Dr. Crespy, who along with a team of social workers, psychologists, chaplains, therapeutic and recreation specialists as well as nurses at the Madlyn and Leonard Abramson Center for Jewish Life, created a three-level depression management program at their skilled nursing facility.
While seniors are a high-risk population for developing depression, there are opportunities to prevent situational or environmental sadness from becoming a major depressive disorder.
The program is based on a well-known theoretical model that “posits depression is the result of an interaction of individual vulnerabilities, environmental stressors, disruptions of preferred behavioral patterns, and emotional responses,” says Crespy. Using this definition of depression, Crespy and his team set out to create a program that focuses at first on incorporating positive events and activities into the client’s routine and advancing to more individualized care from social workers, psychologists and psychiatrists if the positive activities are not enough to combat the depression symptoms.
The program involves screening, intervention and review at six-week intervals, throughout the year. Recommended by the American Psychiatric Association, six weeks is considered enough time to determine whether a treatment is robust enough to reduce the depression symptoms in half. While Crespy’s program was implemented in a residential nursing facility, the model for the program is such that the activities can be adjusted to help seniors living independently and/or with family.
Level 1 – Activities and Exercise
Based on the individual assessment, a team puts together a plan connecting seniors with activities, such as gardening, pet therapy, bingo and music. Almost all at this level participate in some kind of exercise program, but are first screened by a physical therapist to make sure participation is safe and advantageous for the client. Certified nurse assistants monitor a client’s pre and post vital signs during the exercise sessions, keep track of the exercise regimen, and if necessary, assist them on and off equipment.
Level 2 – Social Work
This phase is designed for residents whose depression symptoms don’t significantly diminish after participating in Level 1 activities for six weeks. “We recognize that at any point there are adjustment issues that can have an impact on a senior’s emotional well-being,” says Crespy. Social workers play a vital role at this stage, looking for the causes of the depressive symptoms from a biological, psychological and social standpoint, and working to connect seniors to services that will meet their needs. Services can include visiting with the client, arranging chaplaincy services or working with the family to change family visits.
Level 3 – Psychology and Psychiatry
Interestingly, Crespy points out that the intervention activities at Level 3 “is what traditionally has been considered in the nursing facility a first-line treatment approach.” Referring a client to a psychologist/psychiatrist is always an option, but usually is considered only after the senior has completed six weeks on Level 1 and Level 2.
Crespy and his team believe that regular screening is the key to identifying “sub-clinical levels of depression earlier.” Participants in the Abramson Resident Depression Management Program are reviewed every six weeks until their screening for depression is negative and their participation in activities has become habit, at which point participants are discharged from the program. All residents at the Abramson Center are screened quarterly. According to data provided by Crespy, 67 percent of program participants saw an improvement in their depressive symptoms. Of the participants who saw a remission of the depression symptoms, an overwhelming 67 percent of participants saw an improvement with only Level 1 interventions; 14 percent got better with a combination of Level 1 and 2 interventions and 7 percent saw an improvement with Level 2 interventions only. Only 7 percent of residents required all three levels of depression management.
Dr. Crespy recently served as guest speaker for a free CommunityResponse educational webinar on Wednesday, October 19 sponsored by Screening for Mental Health®. If you like to view the PowerPoint and listen to the webinar, please contact Sara Herman at [email protected].