Capstone PowerPoint Presentation

1

Final Capstone Project Part I, II, III

Student's name:

Instructor:

Course: MSN Capstone Project-DBX-DL01

Date: August 16, 2025

2

Integrating CBT and Telehealth to Improve Depression Outcomes in Long-Term

Care Facilities

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 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

3

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).

4

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

5

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

6

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.

Literature Review

The purpose of this literature review is to evaluate whether the Cognitive Behavioral

Therapy (CBT), which is prescribed by computer-assisted and telemedicine-based systems, is

equally effective to improve depressive symptoms of Long-term care (LTC) patients or residents.

This review will enable an in-depth insight into the recent changes made in terms of the

outcomes, feasibility, cost-effectiveness, and ethical questions of using CBT to treat depression

in this population. The proposed PICOT question is supported by the review: Among Older

Adults aged 65 and older living in long-terminal care facilities (P), does Cognitive Behavioral

Therapy (CBT) (I) compared to usual care or doing nothing (C) reduce symptoms of depression

(O)?

Effectiveness of CBT in Reducing Depression Among Older Adults

CBT has been proven by various studies to be an effective psychotherapeutic

management of depression in the elderly. CBT interventions delivered in the residential setting

7

reported that participants receiving CBT in LTC facilities achieved a clinically significant

reduction of more than 58% in depressive symptoms in older adults. CBT interventions for

depression and anxiety are acceptable to Residential Aged Care Facilities (RACFs) residents and

judged positively by staff members. The review was performed that included randomized

controlled trials (RCTs) and concluded that CBT, depending on the cognitive and physical

abilities of older adults, led to better mood, less negative thinking styles, and more coping

strategies. More recent evidence from SupportiveCare (2025) supports these findings, reporting

that 58% of participants receiving CBT in LTC facilities achieved a clinically significant

reduction in depressive symptoms compared with 27% in the usual-care group. According to

SupportiveCare (2025), “In a long-term study spanning 10 years, participants who received CBT

exhibited notably higher remission rates compared to control groups. Specifically, 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”.

Equally similar, Morgado et al. (2024) conducted a meta-analysis type of studies focusing

on psychotherapeutic interventions to treatment of depressive signs and symptoms in aging

adults living under community care and concluded CBT showed roughly 15-30 percent

superiority in lowering depressive symptoms over usual care and the probability of being more

effective than control groups is at 73-83 percent among treatment recipients. Morgado et al.

(2024) found that, “Group and individual psychotherapeutic interventions reduce depressive

symptoms in community-dwelling older adults, with group psychotherapeutic interventions

being more effective”.

8

The structured and goal-oriented features of CBT are interestingly beneficial to the

elderly patient because they have practical suggestions to adopt in cognitive and emotional

requirements. Dafsari et al. (2024) compared CBT and supportive psychotherapy randomized

clinical trials studies in adults with late-life depression. It has been discovered that patients in

CBT received more improvement in depressive symptoms and perception of physical health as

compared to patients in supportive therapy. The authors state that “patients with high PPH at

baseline showed 12–14% greater reductions in depressive symptoms compared to SUI across

week 5, end of treatment, and 6-month follow-up”. These findings support the hypothesis that

CBT reduces depressive symptoms.

Synthesis and Relevance to the PICOT Question

Studies find that CBT, and internet-delivered CBT or embedded in collaborative care, can

decrease depression by large amounts at a minimal incremental cost, typically 2-5 dollars per

depression-free day or <5,100 per QALY with some models gaining net healthcare savings over

time. This implies that there is high potential of cost-effectiveness when implemented in the

setting of long-term care (Morgado et al. 2024). The evidence indicates that traditional and

telehealth-based CBT interventions demonstrate a great degree of improvement in the symptoms

of depression, preserve physical wellbeing, and can be economically sustainable. Such findings

are near those of the PICOT question.

The research by SupportiveCare, (2025), Morgado et al. (2024) and Dafsari et al. (2024)

combines high-quality empirical evidence of the usefulness of CBT in obtaining substantial

improvements in depression across the older adult population. In parallel, Ali et al. (2024) and

Witlox et al. (2022) indicate that the relatively cost-effective implementation of such

9

interventions is achievable, in particular through the application of telemedicine services. The

literature also reported that a 6-month implementation window suffices in detecting quantifiable

changes in depressive symptoms and therefore concurs with the duration in the PICOT. Besides

this, the articles studied herein provide an urgent need for proper screening along with ethical

service delivery and further discuss how the usage of CBT should be made in a conscientious,

competent, and continuous assessment type.

Evidence for my Practice Change

In their study, Witlox et al. (2022) compared Acceptance and Commitment Therapy

(ACT) and Cognitive Behavioral Therapy (CBT). Although the Unified Protocol (UP) was

effective, evidence showed that the more cost-effective and applicable was CBT to be studied.

Notably, the study indicated the effectiveness of the telehealth-based ACT on the one hand and

CBT on the other, which implies the adaptability of distance-delivered therapies to geriatric

groups. This will promote the use of CBT through digital medium in LTC facilities, particularly

for persons with mobility or transport access obstructions. In their study, Ali et al. (2024) found

that computer-assisted modality substantiated the assumption that it ensures equal and even

better outcomes than are achieved by in-patient therapy, and costs are substantially lower.

Similarly, Shahsavar, & Choudhury, (2025), observed that CCBT can be a potentially

effective intervention that can be used in LTC facilities. The study's relevance lies in its strong

support for digital mental health interventions, which can be adapted for use in LTC facilities

with minimal investment in infrastructure. With many LTC facilities set up short on staffing and

physical capacity, telemedicine and computer-aided CBT (CCBT) appear to be potential

solutions to providing effective mental care.

10

Bell et al. (2023) conducted a systematic review and meta-analysis to assess the

effectiveness of CBT based on telemedicine on the depression and anxiety of older adults. The

researchers found out that the telehealth approaches (videoconferencing and using the phone)

reduced the symptoms of depression similarly to face-to-face interventions.

Objectives for my Practice Change

Objective 1: Implement CBT to reduce depression in older adults residing in LTC

In order to achieve this, I will start by choosing a CBT protocol that is specifically

tailored to older adults and use age-appropriate language, examples, and pace. Depending on

residents and their needs, the intervention will either be provided in individual or small-group

sessions. I shall involve the mental health professionals to make sure that the therapy fits into the

clinical best practice and is operable within an LTC setting. There will be regular meetings to

facilitate compliance, and the progress will be observed utilizing the standardized depression

rating tools, which will enable timely changes to treatment plans.

Objective 2: Integrate telehealth and computer-assisted delivery models to expand access

I will leverage both telehealth platforms and computer-assisted CBT (CCBT) programs to

increase accessibility for residents with varying mobility and cognitive capacities. Tele-CBT will

encompass the deployment of licensed therapists to give moment-by-moment sessions through

stable video-conferencing, whereas CCBT modules will permit residents to access structured

therapeutic material at their convenience. A satisfactory technological infrastructure in the form

of tablets, headsets, and uninterrupted internet connectivity within the facility will back this dual

11

delivery method. Employees will help residents orient themselves with technology in order to

enjoy equal participation irrespective of their previous digital literacy.

Objective 3: Train LTC staff in basic CBT principles to support therapy efforts.

In order to maintain the practice change, I will create and implement the training of LTC

staff on the principles of CBT underlying practice, active listening techniques, and methods of

strengthening therapeutic principles in regular interactions. This will enable the employees to

detect issues regarding mood early, motivate residents to implement the techniques taught in

CBT, and act as an intermediary to formal therapy sessions. Refresher training and regular

check-ins at the supervising level would help maintain staff skills and confidence in mental

health support.

Objective 4: Establish standardized depression screening and referral protocols

In cooperation with the leadership at the facility, I plan to integrate depression screening

instruments that are evidence-based, and in this case, these are the Geriatric Depression Scale, to

be implemented periodically across the facility to all residents. The screening outcome will be

used to determine timely referrals to competent mental health professionals and proper enrolment

into CBT programs. Documentation processes and channels of communication will be clearly

defined, ensuring that all care team members are informed about mental health conditions and

the progress of residents.

Objective 5: Improve residents’ quality of life through evidence-based mental health care

The utmost goal is to ensure the enhancement of the emotional health status, social

interaction, and sense of purpose of the residents due to regular high-quality mental health

services. Incorporating CBT with the available delivery models, trained staff, and screening

12

patterns, the program will establish a positive therapeutic setting where caring about mental

health in LTC would be normal. The intervention should be responsive to the changing needs by

regularly assessing the performance outcomes of residents and through resident and staff input,

so that the intervention can attain a more favorable and fulfilling experience of living

environment on the part of older adults.

Where the Problem Exists, Why It Exists, and the Proposition for Change

Barriers and Facilitators to CBT in Long-Term Care

Although CBT proved to be a worthwhile measure in various environments, there are

certain issues with applying it to an LTC facility. The Atchison et al. (2023) study investigated

both the barriers and facilitators to anxiety management among LTC residents and revealed that

the following structural and systemic factors hindered the application of psychotherapeutic

measures among the majority of residents: staff workload, absence of mental health-specific

training, and stigma attached to mental health. Nonetheless, support factors including employee

education, family engagement, and flexible delivery models of therapy (e.g., group CBT or tele-

CBT) enhanced engagement and response.

Furthermore, Sen (2024) addressed the issue of organizational social work (OSW)

practices and defined a number of obstacles hindering the use of CBT, among which it is possible

to distinguish the lack of funds, available staff trained in CBT, and organizational predisposition

to rejecting any possible changes. Nonetheless, the study pointed out that the awareness activities

and institutional support to evidence-based practices were instrumental in raising the adoption

levels. These results are relevant in terms of approaching the question of how CBT could be

13

implemented in LTC institutions where the organizational culture and limited funding may

hamper innovations. Gerhards et al. (2025) took one step further and examined the extent to

which educational level in older adults determined the impacts of CBT. According to the authors,

the execution of CBT should be adapted to people who have different levels of health literacy

and cognitive abilities in LTC residents.

Current State of the Problem: Pros vs. Cons

The existing mental health care is a moderately prone and reactive system as compared to

an active one in LTC facilities. Among the advantages of using CBT, one may note high clinical

effectiveness, the possibility of digital treatment practice, and good patient compliance. As

demonstrated in the research by Bell et al. (2023) and Ali et al. (2024), telehealth CBT is

versatile and cost-effective, and this factor may play a critical role in an LTC facility.

Relevance, Feasibility, and Ethical Considerations

Cost-Effectiveness and Feasibility

Cost-effectiveness measures in healthcare are one of the principal factors to be

considered when planning interventions, especially in a poorly funded medical system like that

in LTC. According to Ali et al. (2024), CCBT combined with clinician support was proven to

enhance quality-adjusted life years (QALYs) at a modest incremental cost with an incremental

cost-effectiveness ratio (ICER) of approximately US $37,300 per QALY, and of roughly US

$3,623 per successful case of treatment-a cost-effective intervention with a willingness-to-pay of

US $50,000 per QALY. Its cost-effectiveness was also especially prominent among the older

adult population that normally takes significantly longer sessions of therapy because of comorbid

disorders and cognitive decline.

14

Witlox et al. (2022) used a randomized controlled trial, which compared the treatments of

CBT with ACT for older adults and measured their cost-utility ratios. CBT turned out to be the

less expensive treatment offering larger symptom decreases at the dollar cost. The authors came

to the conclusion that CBT should become a priority in environments where money is limited,

i.e., LTC facilities.

Bell et al. (2023) pointed out the economic and logistical viability of the telemedicine-

based CBT, as the mentioned model demands fewer resources in terms of staff and infrastructure

to implement compared to conventional models. It is especially beneficial to LTC facilities with

constant shortages of staff and patient-to-caregiver ratios that are too high. Therefore, even the

prerequisite of introducing CBT via telemedicine platforms can sound not only possible but also

rather sustainable over the long run.

Ethical Considerations and Screening Protocols

Ethical considerations need to be applied before any mental healthcare intervention, more

so when the population in question is vulnerable or in need, such as those staying in LTC.

Among them is the employment of appropriate screening instruments to select residents who are

good candidates for CBT.

Sen (2024) noted, the presence of organizational barriers might undermine the ethical

standards of using mental health interventions in case such practices are introduced without

training and support. The research advocated policies that would require the creation of

guidelines to be used by the institution regarding therapy that will incorporate regular screenings,

frequent reviews, and culturally relevant practices. This suggestion is consistent with the best

15

practice in mental health care and with the ethical practice of CBT in LTC facilities (Dafsari et

al. 2024).

Implementation and Conclusion

Proposed Practice Change

The proposed practice change involves implementing a structured, group-based Cognitive

Behavioral Therapy (CBT) program in long-term care facilities (LTCFs) for residents aged 65

and older who present with symptoms of depression. This intervention is organizational,

occurring within the LTCF setting, and will be delivered by advanced practice nurses (APNs) or

licensed clinical psychologists with specialized training in CBT. The integration of CBT in the

usual care system will allow the facility to fill the existing data-driven gap in the field of mental

care of the oldest patients in the institutional context. The program is evidence-based, cost-

effective, and a non-pharmacologic intervention, designed to decrease depressive symptoms and

enhance social interaction and quality of life at the same time. The intervention model is well

designed so that it fits and can integrate well into the lead nurse models of care without

overworking the staff members or risking them moving beyond their scope of work.

Implementation Plan

The intervention will take place in the involved LTCFs in accordance with selected rooms

in the LTCFs, to furnish amenities of privacy and support, in allocated restricted areas of therapy

or activity rooms. Participants will be selected based on screening using the Geriatric Depression

Scale (GDS-15), a validated and widely used tool for assessing depression in older adults. The

criteria of inclusion will include residents 65 years or older with mild-to-moderate depressive

16

symptoms and cognitive abilities to take part in structured therapy. Individuals who are

cognitively impaired to the point of not satisfactorily benefiting, needing acute psychiatric

intervention that warrants intense intervention, or refusal to participate will be eliminated to

carry out program efficacy and group integrity within the group.

The groups will be created with approximately six to eight adults to facilitate effective

interaction and individual attention. The implementation of the program will last a total of 12

weeks with 2 sessions of 45 minutes per week, equaling 24 sessions. APNs or licensed

psychologists who have been trained in the principles of CBT will be used as facilitators. The

part of the sessions will comprise a quick mood monitoring, explanation of distortions of

thoughts, behavioral activation, and shared group discussion to promote social support.

Homework will also be issued in order to reinforce the skill or build new behavior that will last

even after the therapy session.

The execution schedule will take a span of sixteen weeks. The first two weeks will be

aimed at training the staff and recruiting the interested subjects, as well as conducting the

baseline GDS assessment. Weeks three to fourteen will be taken to include the provision of CBT

sessions as per the planned program. The fifteenth week will involve the administration of post-

intervention GDS to determine the change in depressive symptoms, and the sixteenth week will

comprise program evaluation as well as debriefings of the staff and the formulation of outcome

reports.

Possible Barriers, Possible Barriers and Control Measures

A number of internal and external obstacles can affect the process of implementation.

Internally, staff shortages or other clinical demands may decrease access to people to facilitate or

17

run CBT sessions. It can be resolved through organizing meetings at times of reduced clinical

requirements, incorporating the plan into the regular activities calendar of the facility, and

training other staff members who would be backup facilitators. The other internal facilitator

could be the resident's unwillingness to participate based on a stigmatization of mental health

treatment. This may be overcome by conducting residents and family educational workshops,

emphasizing the advantages of CBT, and giving positive testimonials of other peers who have

attended such programs.

There can also be a problem of a lack of physical space, especially in buildings where the

activity level is high. Multiple-use rooms should be booked, and the times of sessions can be

synchronized with other departments so as not to clash. On the external side, the budget

necessary to finance the staff training, printed copies of CBT materials, and evaluation tools may

become a barrier. This can be alleviated by submitting mental health improvement grants,

utilizing facility quality improvement budgets, or collaborating with community mental health

organizations to share resources. Lastly, there is a risk of any infection control limits, as there

were during the COVID-19 pandemic, interfering with the face-to-face meetings. To avoid this

risk, a contingency plan should be devised for telehealth or a hybrid form of CBT delivery model

so that care can be continued in case such an eventuality occurs.

Change Process evaluation

The evaluation plan for this program will be based on the measurable, objective outcomes

that show the change in depressive symptoms. The primary evaluation tool will be the GDS-15,

administered at three points: baseline (weeks one to two), post-intervention (week fifteen), and

optionally at a three-month follow-up to assess sustained effects. The pre-post change in the

18

mean GDS scores will be used as the main outcome measure, where a clinically significant

reduction will signify the success of the program.

Further outcomes will be the session attendance rates and participant satisfaction, which

will be evaluated by Likert-scale questionnaires, and qualitative feedback that will be gathered in

the last session. Additionally, changes in the frequency of as-needed (PRN) psychotropic

medication use will be tracked through medical records, providing an indirect measure of

reduced depression-related distress. The combination of these measures will enable the

quantitative and qualitative evaluation of the success of the program and its viability. Data will

be interpreted by pinpointing patterns of improvement, areas to be improved, and possible

predictors of improved outcomes to ensure that the future iterations of the program will be

prepared to be good.

Literature Support

The literature synthesis presented in Part II gives strong evidence in favor of the

recommended intervention. Li, et al., (2022) demonstrated through a randomized controlled trial

that group-based CBT significantly reduces depressive symptoms in LTC residents compared to

non-therapeutic social activities. SupportiveCare (2025) reported remission rates of 88% for

depression in the CBT group versus 54% in the control group, highlighting the potential for

substantial clinical improvement. Morgado et al. (2024) found CBT to be 15–30% more effective

than usual care in reducing depressive symptoms among older adults, with group-based

interventions yielding superior results. Dafsari et al. (2024) further supported these findings,

showing that CBT participants experienced greater improvements in both depression and

perceived physical health compared to those receiving supportive psychotherapy. The above

19

studies as a whole provide evidence of the utility, practicality, and cost-effectiveness of CBT and

further justification of its application in LTCFs.

Stakeholders, Leadership Strengths and Abilities to be Implemented

Such a change will necessitate good transformational leadership to guarantee buy-in of all

the stakeholders as well as to sustain project momentum. Good leaders should be able to

communicate the program vision clearly to everyone by highlighting how it will positively affect

the well-being of residents and their quality of life. Empowerment will become one of the key

strategies, and APNs and psychologists will have resources, training, and autonomy to give high-

quality sessions. Interdisciplinary cooperation between nursing, activities coordination, social

work, and mental health experts will be required to facilitate a smooth flow into the functioning

of the facilities. Leaders should also involve evidence-based decision-making where all forms of

planning and assessment are based on recent research. The ability to manage change, such as

dealing with resistance to change, building a culture of acceptance, and celebrating early results,

will play an instrumental role in helping the program to succeed over time.

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

20

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

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

depression, and 35% for anxiety. The current literature review has supported that CBT is an

effective, feasible, and ethically correct intervention in the reduction of depressive symptoms

among older adults living in LTC facilities. The treatment, both on clinical and through a

telehealth delivery and computer-assisted interventions formats, has displayed similar success in

various high-quality studies. The implementation of CBT in LTC is both clinically supported and

defensible with regard to the notion of cost-effectiveness and ethical positioning point of view.

The use of CBT can therefore be taken very seriously as a mental health intervention in practice

in long-term care settings in line with the project's aims and scopes of the PICOT question.

In summation, the implementation of a program of CBT in the form of group therapy in

LTCFs is a great chance to deal with the problem of high rates of depression among older adults

placed in the institutions of care. With the help of the current facility resources, specific training

of staff, and the provision of the validated instruments (like GDS-15) to be used as evaluative

tools, this intervention provides the measurement and evidence-based results that correspond to

the logic of nurse-led care. The program has fully obtained clinical and humanistic backgrounds,

notably Jean Watson's Theory of Human Caring, which ensures that the program not only

21

focuses on relieving symptoms but also on the emotional and spiritual health of those individuals

who have taken part in the program. Provided that it is applied successfully, the initiative can

lead to hospitalization prevention, positive shifts in mood and resilience, as well as the overall

quality of life of LTCF residents. The powerhouse of literature underpinning this strategy, well-

defined roles and plans of the leadership, and the sound evaluation plan mean that the program

will be well-positioned to sustain itself, as well as become embedded in the conventional care

practice.

22

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

Ali, S., Alemu, F. W., Owen, J., Eells, T. D., Antle, B., Lee, J. T., & Wright, J. H. (2024). Cost-

Effectiveness of Computer-Assisted Cognitive Behavioral Therapy for Depression

Among Adults in Primary Care. JAMA Network Open, 7(11), e2444599–e2444599.

https://doi.org/10.1001/jamanetworkopen.2024.44599

Atchison, K., Toohey, A. M., Ismail, Z., & Goodarzi, Z. (2023). Understanding the Barriers to

and Facilitators of Anxiety Management in Residents of Long-Term Care. Canadian

Journal on Aging =, 1–18. https://doi.org/10.1017/s0714980823000417

Bell, P., Thayane Martins Dornelles, Natan Pereira Gosmann, & de, C. (2023). Efficacy of

telemedicine interventions for depression and anxiety in older people: A systematic

review and meta-analysis. International Journal of Geriatric Psychiatry, 38(5). https://

doi.org/10.1002/gps.5920

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

23

Dafsari, F. S., Bewernick, B., Böhringer, S., Domschke, K., Elsaesser, M., Margrit Löbner,

Luppa, M., Schmitt, S., Katja Wingenfeld, Wolf, E., Zehender, N., Hellmich, M., Wiebke

Müller, Wagner, M., Peters, O., Lutz Frölich, Steffi Riedel-Heller, Schramm, E.,

Hautzinger, M., & Jessen, F. (2024). Perceived Physical Health and Cognitive Behavioral

Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression.

JAMA Network Open, 7(4), e245841–e245841. https://doi.org/10.1001/

jamanetworkopen.2024.5841

Gerhards, S. K., Luppa, M., Zülke, A. E., Pabst, A., Claus, M., Bewernick, B., Elsaesser, M.,

Zehender, N., Wagner, M., Peters, O., Frölich, L., Schramm, E., Hautzinger, M., Jessen,

F., Dafsari, F. S., & Riedel-Heller, S. G. (2025). Educational attainment and cognitive

behavioral therapy treatment outcome in late-life depression: A secondary analysis of a

randomized controlled trial. Journal of Affective Disorders, 380, 576–583. https://doi.org/

10.1016/j.jad.2025.03.189

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

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

Morgado, B., Silva, C., Agostinho, I., Filipe Brás, Amaro, P., Lusquinhos, L., Silva, M. R.,

Fonseca, C., Núria Albacar-Riobóo, & Guedes, L. (2024). Psychotherapeutic

24

Interventions for Depressive Symptoms in Community-Dwelling Older Adults: A

Systematic Review with Meta-Analysis. Healthcare, 12(24), 2551–2551. https://doi.org/

10.3390/healthcare12242551

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

sen, S. (2024). Exploring the Barriers to Use of CBT in OSW Practice in Organizations -

ProQuest. Proquest.com. https://www.proquest.com/openview/

a8933eb5e3237dff139f12b9d87ed441/1?pq-origsite=gscholar&cbl=18750&diss=y

Shahsavar, Y., & Choudhury, A. (2025). Effectiveness of evidence based mental health apps on

user health outcome: A systematic literature review. PLOS ONE, 20(3), e0319983. https://

doi.org/10.1371/journal.pone.0319983

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

Witlox, M., Kraaij, V., Garnefski, N., Bohlmeijer, E., Smit, F., & Spinhoven, P. (2022). Cost-

effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs.

a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A

randomized controlled trial. PLOS ONE, 17(1), e0262220. https://doi.org/10.1371/

journal.pone.0262220

25