CAPSTONE PART 3

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Title

Student’s name

Instructor

Course

Date

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Reducing Depression in Long-Term Care Older Adults Using Group-Based CBT

Introduction

Depression is a prevalent mental health disorder among older adults residing in long-term

care facilities (LTCFs). Factors that contribute to this are social isolation, chronic disease, loss of

autonomy and loss of individuals in a loved ones. Poole et al. (2022) report that approximately

one in four LTCF residents experience severe depressive symptoms, yet many cases go

undiagnosed or untreated. In this context, depression is related to worse overall health state,

mortality rate, the quality of life, and higher health care costs because of higher rates of

hospitalization and dependence on drugs. Research indicates that untreated depression can add

an estimated $2,000 to $3,500 per resident annually in health care expenditures, whereas

Cognitive Behavioral Therapy (CBT) has been shown to reduce hospitalizations and medication

dependence. This recommendation includes the adoption of a more elaborate, group-oriented

CBT program to decrease the symptoms of depression and improve the mood of LTCF residents.

Effectiveness will be measured by changes in Geriatric Depression Scale (GDS) scores over a

12-week period. The intervention is evidence-based and provides an evidence-based, cost-

effective, non-pharmacologic form of intercession, which fits nurse-led models of care

frameworks.

Comprehensive PICOT Analysis

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P (Population): Older persons over 65 years with depwho lives in LTCFs with depression

symptoms. They are usually diagnosed with mild and moderate depression or screened using

standardized assessment tools such as the GDS.

I (Intervention): Formulated group-focused CBT, two times a week. The therapy is designed to

assist participants in terminating negative thought patterns and offering positive social

interaction.

C (Comparison): Social activities of daily living, like bingo playing, movie evenings, or

uncompensated group free-time visits, not therapeutic intervention or mental health counseling.

O (Outcome): Reduction in depressive symptoms and enhanced mood as measured by pre- and

post-treatment GDS scores.

T (Time): A 12-week intervention period with sufficient time for involvement and perceptible

outcomes.

PICOT question: “In older adults residing in long-term care facilities with symptoms of

depression (P), does participation in structured group-based cognitive-behavioral therapy (CBT)

sessions (I), compared to routine social activities alone (C), reduce depressive symptoms and

improve mood (O) over a 12-week period (T)?”

Description of the Vulnerable Population

Older adults in LTCFs are greatly at risk due to some social determinants of health. They

include financial constraint, mobility problems, cognitive decline, compromised access to good-

quality mental health care, and loneliness. Studies have established that isolation is the best

predictor of depression among older individuals (Li, Bai, & Chen, 2022).

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Risk indicators for depression among this group are recent bereavement of a spouse, co-

morbid chronic diseases, absence of family engagement, and the institution itself. Up to 50% of

residents in LTCFs have substantial depressive symptoms, yet most receive no evidence-based

treatments (Matos Queirós et al., 2021).

The additive effects of ageism, mental illness stigma, and inadequate staffing in mental

health in LTCFs render this group susceptible (Al-Dwaikat et al., 2022). Such vulnerabilities

necessitate the use of existing and effective interventions like CBT that are not dependent on

psychiatric referral.

Evidence-Based Research Supporting the Intervention

Several recent peer-reviewed reviews support the application of CBT as an effective

depression treatment among the elderly. Mijnster et al. (2022) carried out a randomized

controlled trial, observing that LTCF residents undergoing group-based CBT reported fewer

signs of depression compared to a control group undertaking standard social activities. Data

shows that “58% of individuals in the CBT group achieved remission across all diagnoses, with

remission rates for depression reaching 88% and anxiety at 63%. In contrast, the control group

showed remission rates of 27% for all diagnoses, 54% for depression, and 35% for anxiety”

(SupportiveCare. 2025).

Chen et al. (2020) illustrated the effectiveness of nurse practitioner-delivered CBT and

improved depression scores with increased social interaction. The result highlights that not only

is CBT effective, but it can also be implemented if provided by competent advanced practice

nurses within long-term care.

Proposed Intervention

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This proposal sets forth the implementation of a 12-week group-based evidence-based

CBT intervention among LTCF residents experiencing depressive symptoms. The intervention

would last 45 minutes, twice a week, and be delivered by an advanced practice nurse (APN) or a

licensed clinical psychologist with training in CBT principles.

Each session will include:

• A brief mood check-in

• Discussion of cognitive distortions

• Behavioral activation exercises

• Group interaction to foster social support

Resources required include a private meeting space, printed CBT materials, training

sessions for APNs, and standardized evaluation tools like the GDS.

Timeline:

• Weeks 1–2: Staff training and participant recruitment/screening

• Weeks 3–14: CBT sessions begin (24 sessions total)

• Week 15: Post-intervention data collection

• Week 16: Program evaluation and feedback

Theoretical Framework: Jean Watson’s Theory of Human Caring

This theory encompasses the psychological and emotional healing aspects and is

therefore highly applicable to mental health care of the elderly.

Watson's transpersonal caring theory is best applied in transpersonal caring relationships,

which are most critical in CBT groups where empathy, trust, and respect towards one another are

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needed for successful therapy. This is consistent with the process of CBT, which promotes

cognitive restructuring and emotional security through positive interpersonal contact.

Using Watson's framework ensures that this intervention is clinical and not only that, but

also firmly humanistic, reaching the emotional and spiritual well-being of residents. Some of the

benefits that may accrue from this are decreased readmissions, improved emotional resilience,

and improved quality of life, all of which map to health outcomes and cost-effectiveness

positively.

Conclusion

Depression among the residents of an LTCF is a health issue of extreme priority since not

only does it influence the quality of life, but also burdens the health system in terms of its

financial cost. Evidence supports group-based CBT as an effective, low-cost intervention that

can be implemented within LTCFs by trained advanced practice nurses (APNs) without

exceeding their scope of practice. Confidential and conventionalized screenings will identify

residents, and the outcomes will be documented with anonymized codes to respect privacy with

the help of the GDS. The residents who will be found with depressive symptoms will be given

instant support and referred to an adequate mental health provider so that they can be given

timely support without the involvement of APNs in the provision of direct psychiatric care.

According to literature, untreated depression may cost up to 2000 US dollars to 3500 dollars per

resident per year as health care costs yet CBT minimizes the cases of hospitalization and

dependence on medications. Data shows that 58% of individuals in the CBT group achieved

remission across all diagnoses, with remission rates for depression reaching 88% and anxiety at

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63%. In contrast, the control group showed remission rates of 27% for all diagnoses, 54% for

depression, and 35% for anxiety.

References

Al-Dwaikat, T. N., Rababa, M., & Alaloul, F. (2022). Relationship of stigmatization and social

support with depression and anxiety among cognitively intact older adults. Heliyon, 8(9),

e10722. https://doi.org/10.1016/j.heliyon.2022.e10722

Chen, J. T.-H., Wuthrich, V. M., Rapee, R. M., Draper, B., Brodaty, H., Cutler, H., Low, L.-F.,

Georgiou, A., Johnco, C., Jones, M., Meuldijk, D., & Partington, A. (2022). Improving

mental health and social participation outcomes in older adults with depression and

anxiety: Study protocol for a randomised controlled trial. PLOS ONE, 17(6), e0269981.

https://doi.org/10.1371/journal.pone.0269981

Li, Y., Bai, X., & Chen, H. (2022). Social Isolation, Cognitive Function, and Depression Among

Chinese Older Adults: Examining Internet Use as a Predictor and a Moderator. Frontiers

in Public Health, 10. https://doi.org/10.3389/fpubh.2022.809713

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Matos Queirós, A., von Gunten, A., Martins, M., Wellens, Nathalie I. H., & Verloo, H. (2021).

The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call

for Evidence-Based Practice. Dementia and Geriatric Cognitive Disorders Extra, 11(1),

38–44. https://doi.org/10.1159/000514118

Poole, L., Frost, R., Rowlands, H., & Black, G. (2022). Experience of depression in older adults

with and without a physical long-term condition: findings from a qualitative interview

study. BMJ Open, 12(2), e056566. https://doi.org/10.1136/bmjopen-2021-056566

SupportiveCare. (2025). Evaluating the Efficacy of Cognitive-Behavioral Therapy for Senior

Residents - Supportive Care. Thesupportivecare.com. https://

www.thesupportivecare.com/blog/evaluating-the-efficacy-of-cognitive-behavioral-

therapy-for-senior-residents