Collaborative working to treat depression in care home residents
New report offers examples of good practice for care home staff
New report offers examples of good practice for care home staff
Ida’s story is, sadly, all too common in the care home sector.
She is 81 and has lived in a care home for six months.
She has multiple health conditions, including vascular dementia, osteoporosis and poor vision, and takes nine different medications.
Until recently, she was regularly complaining of abdominal pain. It got so bad she told staff she wanted to die.
But – and this is where her case differs – she was lucky. Ida's care home is supported by specialist staff, including older people’s nurses, who took the time to find out what was causing her problems.
She was correctly identified as having ‘depressive symptoms’ and action was taken. She was given antidepressants, moved to another floor of the care home to be closer to residents in a similar situation and, after discussions with her found she previously had a pet dog, referred for pet therapy.
The transformation was immediate. She made friends on the new floor, her abdominal pain eased and her mood improved.
Ida's story is highlighted in a joint report by the British Geriatrics Society (BGS) and Royal College of Psychiatrists (RCPsych) as an example of how care home residents' mental and physical health can improve when they are supported and listened to, and when solutions to their problems are tailored to meet their needs.
But such cases are the exception rather than the rule.
of nursing home residents could have depression
The report states that depression is often ‘under-diagnosed and under-treated’ in care homes.
So much so that the estimates of the number of people with depression in nursing homes range from 11-78%.
‘The fact we don’t know proves we are not very good at recognising it,’ says independent nurse consultant, and BGS nurses and allied health professionals council member, Jane Buswell. ‘I would say it is more towards the upper end.’
Ms Buswell would like to see screening for depression become as routine as checks for pressure ulcer development and blood pressure.
‘It should be a default question. Staff should be screening for depression and then alerting GPs if there is a concern.’
Of course, once a diagnosis has been made a treatment plan needs to be put in place.
The report says the research shows a ‘collaborative approach’ is needed and it highlights a number of local areas where this is being taken.
They include care home liaison services where experts from mental health, primary care, social work and district nursing collaborate.
of people aged 85 and over live in care homes
There are also examples of mental health nurses who have provided care home staff with training workshops on recognising signs of depression.
Approaches to treatment are also questioned. Antidepressants are used widely, but are not necessarily the best solution, according to the report.
The BGS and RCPsych want to see more use of psychotherapy, but also put forward a strong case for keeping people active and socialising – as in Ida’s case.
Alongside pet therapy, their report lists exercise classes, arts and cinema events and trips out of care homes as examples of successful approaches to tackling depression.
Care England nursing adviser Deborah Sturdy (pictured left) says taking simple steps, such as increasing the amount of activities, can make a huge difference.
‘Depression is often wrapped up with loneliness. It can be assumed that, because older people are in care homes and being cared for, they are not lonely.
‘So the quiet person in the corner can get left and the loneliness triggers depression.
increase in multimorbidity estimated by 2035
‘There are some brilliant examples of community mental health teams doing in-reach work, but this doesn’t happen everywhere.
‘Depression has perhaps lost out because of the focus on dementia.’
Royal College of Nursing professional lead for older people and dementia care Dawne Garrett agrees.
‘Of the three Ds – dementia, delirium and depression – depression is the one we are weakest on.
‘It is complex. Often, people have multiple conditions, may be in pain and may have had a bereavement.’
Dr Garrett (pictured left) says she is a big fan of intergenerational work in which, for example, children come into care homes.
But she also says more needs to be done to support those working in the sector. ‘Nurses are normally good at recognising depression, but there is a wide variation in the training given to care home staff who are not registered nurses. This is concerning.’
She adds that there is a need to educate families. ‘There is still a stigma about depression particularly among older generations.
‘We need to help them recognise that depression is physiological as well as psychological.’
Good practice in tackling depression among care home residents
Camden and Islington NHS Foundation Trust runs a care home liaison service aimed at improving mental health support.
It includes mental health nurses and a consultant old age psychiatrist.
The team identified that activity coordinators could not always engage with some of the more vulnerable residents.
An occupational therapist was employed to work alongside the team to ensure residents at risk of under-stimulation and isolation were reached.
Weekly ‘virtual ward rounds’
In Gateshead, nursing homes and some care homes have dedicated older person’s specialist nurses attached to them.
Working alongside GPs, these nurses cover between one and three homes each.
Every week there is a virtual ward meeting in which the nurses are joined by psychiatrists to discuss cases with care home staff so that care plans can be put in place.
About one third of the cases involve depression.
The scheme – known as the Gateshead Care Home Initiative – is funded by the local clinical commissioning group.
Mental health in-reach
The clinical commissioning groups covering the south London boroughs of Lambeth, Southwark, Lewisham and Croydon fund an in-reach service for care homes.
Most older people referred to the service have dementia, but also have symptoms and behaviours of other mental illnesses that are challenging for staff, including depression, anxiety and personality disorders.
The team, which includes consultants in psychology and psychiatry, community psychiatric nurses and occupational therapists, prioritises family involvement inviting them to attend meetings and develop care plans.
In Poole, Dorset, a community mental health team and care home staff work closely with the local social prescribing service.
This involves taking residents out of the care homes to participate in a wide range of social activities including singing, clubs and exercise groups.
Mementos, a charitable organisation part-funded by the local authority, also works with care homes to run cinema and arts events.
A psychological therapy called cognitive analytical therapy, which focuses on relationships by looking at different ways of coping with emotions and mental health problems, is also offered.
- British Geriatrics Society and Royal College of Psychiatrists (2018) Collaborative Approaches to Treatment: Depression Among Older people Living in Care Homes.
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