How to improve elderly mental health in care home settings

Mental health is a critical concern for the elderly living in care settings. In 2021, the Office for National Statistics reported there were almost 280,000 individuals aged 65 and over in care homes across England and Wales, and that number has only risen in the last four years. 

Care home residents are at risk of depression and other mental health conditions – a 2019 policy paper by Age UK estimated that up to four in ten care home residents experienced depression. A change in living circumstances and the sense of losing autonomy can contribute to feelings of depression and a dip in mental health, so having strategies in place that promote mental well-being is vital for care home teams. 

In this guide, we show you how to spot the signs of low mood and declining mental health among your residents – and what action you can take to prevent and mitigate it.

According to a 2020 study by Chau et al., “loss of environmental mastery and meaningful existence have been identified as significant risk factors for depression in care homes”. The term “environmental mastery” refers to a person’s ability to control their life and their environment – so it is natural for people who move into residential care to experience emotional upheaval.

As well as feeling in control of their life and surroundings, there are several other factors that play a key role in supporting the mental health of care home residents:

• Individualised care: Treating residents as individuals with their own unique needs, experiences, opinions and preferences
• Good physical healthcare: Ensuring residents receive proper medical attention when required
• Social engagement: Encouraging visits and calls from family and friends
• Staying active: Promoting physical activity tailored to residents' abilities
• Emotional expression: Providing opportunities for residents to express their feelings

Identifying signs of depression and low mood is crucial for providing timely support. Train your teams to look out for the following symptoms that indicate a resident may be experiencing mental health difficulties:

• Loss of self-esteem and confidence
• Cognitive impairment
• Slow, monotonous speech
• Changes in movement, e.g. increased restlessness or slowed reactions
• Feelings of guilt
• Impaired concentration
• Sleep disturbances
• Appetite and weight changes
• Somatic complaints
• Lethargy

A key driver of good mental health is an individual feeling able to exercise their free will, and make their own choices regarding diet, activities, and social contact. So, taking a person-led approach is essential, and supporting this with a roster of varied activities that stimulate both mental and physical exercise. The following strategies all contribute to maintaining good mental health among residents in your care home:

• A personalised approach to care
  Develop care plans that consider each resident's individual preferences, needs, and histories. This approach helps residents feel valued and respected, enhancing their sense of autonomy and self-worth.
• Varied activities and social engagement
  • Organise group activities such as book clubs, music sessions, art classes, and outings to local events where possible. These activities foster social connections, reduce feelings of isolation, and promote a sense of belonging
  • Engage residents in cognitive activities like puzzles, memory games, and quizzes to maintain mental acuity and challenge their minds
• Emotional expression and support
  Provide safe spaces for emotional expression, whether that is through group discussions or via one-on-one conversations with trained staff. This helps residents manage emotions and cope with challenges like grief or loss
• Physical activity
  Offer regular exercise classes – depending on residents’ mobility, of course. Physical activity not only improves health but also boosts mood and reduces stress
• Environmental enhancements
  Create a nurturing environment with nature-inspired spaces, calming colours, and comfortable seating areas. This helps evoke feelings of tranquility and positivity
• Staff training
  Train staff to recognise signs of depression or anxiety and provide immediate support. Early intervention can significantly improve residents' mental health outcomes
• Community integration
  Arrange regular outings or invite guests to keep residents connected with the outside world, fostering a sense of purpose and belonging

The National Institute for Health and Care Excellence (NICE) has further information on how to promote mental well-being for older people living in care homes.

Taking care of residents’ emotional well-being is crucial for care home teams, given that depression and similar mental health conditions are common among people in residential care. 

A combination of an individualised approach to care, a roster of varied activities that promote both mental and physical exercise, and opportunities for emotional expression and social contact provides the best possible foundation for good mental health in care settings. 

By integrating these different strategies, care homes can create supportive environments that enhance emotional well-being and reduce mental health issues among elderly residents.