8.4 Depression and Anxiety in the Elderly

Recognizing Depression in Older Adults

Depression is a serious, treatable medical illness, not an unavoidable part of growing old. It is widely underdiagnosed in long-term care because older adults often hide or somatize their feelings. Exam stems repeatedly test the single fact: depression is not a normal change of aging.

Risk Factors

Depression clusters around loss and isolation:

• Chronic illness, pain, or disability
• Death of a spouse, friends, or siblings
• Loss of independence and of a former role
• Recent move into a facility (a major trigger)
• Social isolation and few visitors
• Polypharmacy (many medications)
• Prior history of depression

Emotional vs. Physical Symptoms

How Depression Looks Different in the Elderly

This comparison is a favorite exam point. Older adults often deny sadness and instead report the body.

Because the signs are so quiet, a CNA's daily observation, noticing a resident stopped going to the dining room or stopped grooming, is often the first clue that triggers treatment. Loss of interest in food, activities, and personal care is a red flag to report.

Anxiety, the CNA's Role, and Suicide Risk

Anxiety in the Elderly

Anxiety is excessive worry or fear that interferes with daily life. Along with depression it is among the most common mental health conditions in older adults, and the two often occur together.

Physical signs of anxiety, restlessness, muscle tension, rapid heartbeat, shortness of breath, sleeplessness, stomach upset, mimic heart and lung disease, so a CNA reports them rather than assuming the cause.

The CNA's Supportive Role

A CNA never diagnoses or counsels, but is the team's eyes and the resident's steady companion.

Do not say "things could be worse," "you have so much to be thankful for," or "cheer up", these minimize feelings and are scored as wrong.

Suicide Risk, a Tested Emergency

Older adults, especially men over 75, have among the highest suicide rates of any age group. Take every statement seriously, even an indirect one like "I just want to go to sleep and not wake up."

Warning signs: talking about death or being a burden, giving away possessions, saying goodbye, sudden calm after deep sadness, withdrawal, increased substance use, and hoarding pills.

Required CNA steps, in order:

1. Take it seriously, never dismiss or argue.
2. Stay with the resident, do not leave them alone.
3. Remove obvious dangers if you safely can.
4. Report to the nurse IMMEDIATELY, this is not an end-of-shift note.
5. Document objectively, the exact words, time, and to whom you reported.

Common Medications to Observe

The CNA reports drowsiness, new confusion, falls, or whether a medication seems to be helping; the CNA does not adjust or withhold doses.

Worked Scenario

A resident who moved into the facility six weeks ago after her husband died now skips meals, stays in bed, and stopped attending the music group she once loved. A new CNA might say "She's just adjusting" and let it go. The skilled CNA recognizes the cluster, recent loss, a move, withdrawal, appetite change, lost interest, as classic late-life depression and reports each specific observation to the nurse. After evaluation the resident starts an antidepressant and counseling and slowly re-engages. The exam point: depression is treatable, and the CNA's daily observations are what get it diagnosed.

Section Cheat Sheet

• Depression and anxiety are not normal aging and are treatable.
• Older adults often show physical complaints and deny sadness.
• Watch for lost interest, withdrawal, appetite/sleep change, neglected hygiene.
• Never minimize feelings ("cheer up" is wrong); listen and report.
• Suicide talk: take it seriously, stay, remove danger, report now, document.
• CNAs observe and report medication effects; they never adjust doses.