I recently attended the funeral of my dear 94-year old aunt.  She was from a large family and had experienced the death of all of her siblings except one.  A spunky, very independent woman, she was still driving, still independent at home and often delivered “treats” to her elderly neighbors.

After experiencing the death of yet another sister 4 months ago, some of the “spunk” was gone and in spite of a strong family support system, she reported feeling “sad” and “lonely” – stating most of her family and friends had either died or were in a nursing home. She said this was the first year she “dreaded” the holidays rather than looking forward to them. I don’t think this is unusual.

Our senior home care clients often experience sadness and perhaps depression, especially during the holiday season.  Depression is sometimes overlooked as we concentrate on typical medical co-morbidities. However, it is important to recognize depression and take action to mitigate it.  Symptoms of depression may include the following:

• Sadness
• Fatigue
• Giving up or losing interest in hobbies or other activities formerly enjoyed
• Social withdrawal and isolation
• Weight loss; loss of appetite
• Sleep disturbances (difficulty falling asleep or staying asleep, oversleeping)
• Loss of self-worth (worries about being a burden, loss of self-worth)
• Increased use of alcohol or other drugs
• Fixation on death; suicidal thoughts or attempts

While my aunt reported feeling sad and lonely, not all depressed elderly do so. Instead they may simply report that they no longer have the same energy, or they lack motivation to do what they used to do. Additionally, they may report more physical problems or seem more irritable or anxious.  So what can you do? Home care workers are in the ideal position to be an advocate for the client. In that advocacy role, some action steps to assist the client may include:

• Offer emotional support – if available, enlist the help of a social worker or other community resources such as a peer support person.
• Help ensure a healthy diet by initiating meals-on-wheels or seeking the assistance of friends, neighbors or church members to temporarily provide healthy meals.
• Review the client’s diet to make sure it does not include a lot of sugar, high sodium products or junk food and provide instructions for a healthy diet.
• When possible, contact family members to encourage them to get their loved one out of the house for fun activities and family time.
• Review the client’s medications with a focus on determining if any of them contribute to the depression.  Check the medications against the Beers criteria – a list of medications contraindicated for the elderly.
• Complete a depression screening and if issue are found, notify the physician and seek advice for further interventions.
• If possible, engage the client in volunteer work. For example, a client who likes to crochet could make baby hats or mittens for the local day-care center or hospital nursery.
• Encourage the client to talk about some funny stories in her life, share a joke, or recommend a funny movie or book.  Laughter is known to help boost the mood.
• Instruct the client on simple exercise activities.

This list is not intended to be all-inclusive. Take the time to individualize your approach to each client as you attempt to mitigate depression or sadness and make the holiday season more enjoyable for our precious seniors.