Social Frailty and Depression
Frailty, as a state of vulnerability, diminishes physiological reserve, coping mechanisms, and the ability to master many circumstances. Our current nursing home population is also currently experiencing excessive vulnerability to social frailty as a result of the pandemic’s required isolation and the removal of the support systems that previously were part of their coping mechanisms. This is referred to as “social vulnerability,” the degree to which a person’s overall social situation leaves them susceptible to further insults (either health-related or social). (Andrew, 2015) We need to consider what this means and what we can do to help.
Our residents have been experiencing losses that impact their physical and mental health. For instance, their usual coping skills have been impacted by the change in routine, the move from in-person clinician visits to telemedicine, and limited family visits and contact. Since all of these social factors are stacked against our frail residents, the end result is what we have seen more depression and, beyond that, the state of isolation-induced psychological and emotional trauma will increase their existing risk from frailty for adverse outcomes including susceptibility to infection and death. (Tsutsumimoto, 2018)
Our role as post-acute and long-term care practitioners must include an approach to interrupt the flow of factors aligned to worsen the mental health of our residents. October 8 is National Depression Screening Day (NDSD), and this may be an opportunity for us to recognize that social frailty may be contributing to depression in our residents, along with other mood and anxiety disorders exacerbated by the current situation.
Many tools exist for screening for depression in our residents including the PHQ-9 and PHQ-OV within the MDS. Either of these tools can be reviewed and a plan of care written if depression is present. In other settings, where the MDS is not completed but residents are frail, the presence of depression should be considered if any of these signs and symptoms are present:
- Frequent negative statements
- Persistent anger
- Expressions of unrealistic fears
- Repetitive health complaints
- Repetitive anxious complaints
- Sad/pained/worried facial expression and tearfulness (The Depression Rating Scale)
When assessing for depression it is important to remember in older adults that they may not report feeling depressed or even recognize their mood as being depressed. They may be tearless and verbalize their mood as part of getting older. Our role is to assess them for we know that circumstances are aligned to increase their risk for depression. As clinicians, we have an obligation to consider the diagnosis of depression and incorporate approaches from the Interdisciplinary Team to address the diagnosis with recreational therapy, counseling, medication, and any other option available in our setting.
For more information on frailty and best practices in geriatric medicine contact our team today. We can help you navigate frailty-related issues and challenges during this difficult time and keep your vulnerable patients safe both physically and mentally.
For additional reading:
- Tsutsumimoto K, Doi T. Social Frailty Has a Stronger Impact on the Onset of Depressive Symptoms than Physical Frailty or Cognitive Impairment: A 4-Year Follow-up Longitudinal Cohort Study. 2018 Jun;19(6):504-510. doi: 10.1016/j.jamda.2018.02.008. Epub 2018 Apr 24.
- Canadian Institute for Health Information. Depression Among Seniors in Residential Care Highlights of Study Findings. May 2010