Addressing seasonal affective disorder with residents
By Patti Cullen, CAE | November 22, 2023 | All members
The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance, and resources to certified Medicare and Medicaid nursing facilities who care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for assistance, complete the online request form by clicking
HERE. The following is from their latest newsletter:
Seasonal changes affect nursing facility (and assisted living) residents in positive and negative ways. Some experience joy in watching the leaves change color and saying goodbye to some seasonal allergies during the fall. Some, however, experience sadness, low mood, and depression, also called “winter depression.” This type of depression typically begins in late fall and early winter and ends by spring. This is due to days getting shorter and sunlight exposure decreasing. This is very common in nursing facility populations and is generally mild. A diagnosis of seasonal depression can be made after two consecutive occurrences of depression that occur and end at the same time every year, with the symptoms subsiding the rest of the year. However, for some residents, this turns into major depression.
Ways to reduce the impact of seasonal changes on the mood of nursing facility residents
There are several ways to reduce the negative impact of seasonal changes (seasonal affective disorder or SAD) on the mood of nursing facility residents.
- Education: Provide residents and their families with education and resources about seasonal affective disorder (SAD) and how it manifests; education can also be provided in group settings and during activities; share resources from trusted organizations like the Center of Excellence for Behavioral Health in Nursing Facilities
- Environmental considerations: Place comfortable chairs near large windows with lots of natural light; consider this feature for all new nursing facility designs; pull curtains open to also allow more natural light
- Group activities: Conduct group activities in rooms with large amounts of natural light; hold activities on an outdoor patio or courtyard when weather permits
- Vitamin D: Vitamin D supplements can help boost serotonin activity
- Monitor: Routinely and periodically monitor residents for depression once a month starting in November and more frequently in residents with a known history of SAD; the Patient Health Questionnaire 2 and 9 are effective screening tools
- Referral: If there are signs and symptoms of significant depression, refer the resident to a qualified healthcare provider for a more thorough assessment and diagnosis; report any changes in a resident’s mood to the clinical team
- Prevention and treatment: SAD follows a predictable pattern; therefore, preventative measures can be taken to reduce the symptoms, including the following:
- Increase exposure to sunlight by having the resident sit close to a window that provides natural light for at least 30 minutes a day; it doesn’t have to be all at once; if feasible, brief outdoor sunlight exposure is recommended
- Use bright light therapy/light therapy—use a lightbox with at least 10,000 lux exposure; duration is individualized and can be used daily for 30 minutes
- Antidepressants, individual counseling, behavioral activation, and other evidence-based interventions may also be needed if the resident has major depressive symptoms as part of SAD
Please note, the CMS State Operations Manual (SOM) does not explicitly reference SAD, but a facility should consider it when evaluating residents’ care and interventions, particularly around the winter months. Since SAD is considered a type of depression, facilities should assess for the signs and symptoms of depression, in addition to creating person-centered care plans with appropriate interventions.
Patti Cullen, CAE | President/CEO |
pcullen@careproviders.org | 952-851-2487