Key Takeaways
- Depression is NOT a normal part of aging—it is a treatable medical condition
- Elderly often present with physical symptoms of depression rather than expressing sadness
- Anxiety is the most common mental health condition in older adults
- Take all statements about suicide seriously and report to the nurse immediately
- CNAs support mental health through relationship-building, active listening, and reporting changes
Depression and Anxiety in the Elderly
Mental health conditions like depression and anxiety are common in older adults, especially those in long-term care. CNAs play a vital role in recognizing symptoms and providing supportive care.
Depression in the Elderly
Depression is a serious medical condition—NOT a normal part of aging. It is often undiagnosed in elderly because symptoms may differ from younger adults.
Risk Factors:
- Chronic illness or pain
- Loss of spouse, family, friends
- Loss of independence
- Social isolation
- Multiple medications
- Cognitive decline
- History of depression
- Recent move (to facility)
Symptoms of Depression
Emotional Symptoms:
- Persistent sadness or "empty" feeling
- Hopelessness
- Irritability
- Loss of interest in activities once enjoyed
- Feelings of worthlessness or guilt
- Thoughts of death or suicide
Physical Symptoms:
- Changes in sleep (too much or too little)
- Changes in appetite/weight
- Fatigue, low energy
- Slowed movements or speech
- Unexplained aches and pains
- Neglected personal hygiene
How Depression May Present Differently in Elderly:
| Younger Adults | Elderly Adults |
|---|---|
| Express sadness | May deny sadness |
| Focus on emotional symptoms | Complain of physical symptoms |
| Cry frequently | May seem irritable or withdrawn |
| Clearly articulate feelings | "I just don't feel right" |
Anxiety in the Elderly
Anxiety is excessive worry or fear that interferes with daily functioning. It is the most common mental health condition in older adults.
Types of Anxiety:
- Generalized Anxiety Disorder - Chronic worry about many things
- Panic Disorder - Sudden episodes of intense fear
- Phobias - Fear of specific things (falls, medical procedures)
- Social Anxiety - Fear of social situations
Symptoms of Anxiety:
- Excessive worry
- Restlessness, can't relax
- Sleep problems
- Muscle tension
- Rapid heart rate
- Shortness of breath
- Stomach upset
- Avoiding situations that cause fear
CNA Role in Mental Health Care
Observation and Reporting:
Report to the nurse:
- Changes in mood, appetite, sleep, or activity level
- Withdrawal from activities or social interaction
- Statements about feeling hopeless, worthless, or wanting to die
- Crying or emotional outbursts
- Increased physical complaints with no apparent cause
- Neglect of personal care
- Signs of anxiety (pacing, trembling, fearfulness)
Providing Supportive Care:
| Strategy | How to Apply |
|---|---|
| Build relationship | Consistent care; take time to talk |
| Listen actively | Don't minimize feelings; show you care |
| Encourage participation | Invite to activities; don't force |
| Maintain routine | Predictability reduces anxiety |
| Promote independence | Depression worsens with helplessness |
| Provide physical comfort | Good hygiene, comfortable position |
| Report concerns | Don't try to counsel—notify nurse |
Suicide Risk
Warning Signs:
- Talking about wanting to die or suicide
- Looking for ways to harm self
- Talking about being a burden
- Giving away possessions
- Saying goodbye as if final
- Increased substance use
- Extreme mood changes
- Withdrawal and isolation
- Expressing hopelessness
What to Do:
- Take all statements seriously - Never dismiss talk of suicide
- Stay with the person - Don't leave them alone
- Remove dangerous items - If possible
- Report IMMEDIATELY - Tell the nurse right away
- Document - What was said, when, to whom reported
Medications for Mental Health
Many elderly take medications for depression and anxiety. CNAs should know:
| Class | Examples | Important Notes |
|---|---|---|
| Antidepressants | Prozac, Zoloft, Lexapro | May take 2-4 weeks to work; watch for side effects |
| Anti-anxiety | Ativan, Xanax, Valium | Can cause drowsiness, falls; risk of dependence |
| Sleep aids | Ambien, trazodone | Increased fall risk; confusion in elderly |
CNA Observations to Report:
- Medication side effects (drowsiness, confusion, falls)
- Whether medications seem to be helping
- Patient complaints about medications
Which statement about depression in the elderly is TRUE?
A resident tells you, "I just want to go to sleep and never wake up." What should you do?
What is the MOST common mental health condition in older adults?