Depression in care homes: when sadness goes unnoticed

In a care home, the resident who shouts, gets up at night or refuses a bath gets the whole team's attention. The resident who sits in the same place, eats little and answers "I'm fine" gets nobody's. That is often where depression hides.

Depression is not a normal part of ageing, and it is not an "understandable" reaction to be left alone because the person lives in a care home. It is an illness that can be assessed and treated. This article is for people who work in care homes and residences: how it tends to show up, why it goes unnoticed and what the team can do day to day, alongside clinical care.

More common than it looks

A systematic review published in 2010 (Seitz and colleagues, in International Psychogeriatrics), which pooled studies carried out in long-term care, found major depression in about one in ten people and depressive symptoms in nearly three in ten. The figures vary widely from study to study, depending on the instrument and the population, but the order of magnitude keeps coming back: it is far more frequent than among people of the same age living at home.

There are reasons for this. Moving into a care home brings several losses at once — the house, the neighbours, the routine, often independence. Add chronic illness, pain, loss of sight or hearing, the death of people close to them and, in many cases, dementia.

Why it goes unnoticed

In older people, depression does not always look like sadness. Many people do not say "I'm sad"; they say everything hurts, they can't sleep, they're not hungry, they're tired. And the team, who know these complaints well, put them down to age or illness.

Signs worth watching for:

• loss of interest in things the person used to enjoy — Mass, cards, a grandchild's visit;
• withdrawal: stops coming to the lounge, prefers their room, stops talking to the people they used to talk to;
• physical complaints that increase without a clear cause, especially pain and tiredness;
• changes in sleep and appetite: waking very early, eating much less, losing weight;
• irritability, or refusing care they used to accept;
• self-deprecating remarks: "I'm no use to anyone", "I'm a burden", "there's nothing left for me here".

None of these signs, on its own, is a diagnosis. What matters is the change from how the person used to be, and how long it lasts.

Depression, apathy and dementia

Three things that look alike from the outside and differ on the inside:

• In depression there is suffering: sadness, guilt, hopelessness, a sense that nothing is worth it.
• In apathy motivation and initiative are missing, but the person does not seem to suffer from it. It is common in dementia and was covered in when the person stops wanting.
• In dementia there is a progressive loss of memory and other abilities — and depression can coexist with it, or even come first.

Telling them apart is a clinical job. For screening there is the Geriatric Depression Scale (GDS), with short versions validated in many languages. The chapter the RVer team wrote on cognitive impairment and depression in older people, in the study library, reviews these instruments. Screening points the way; diagnosis and treatment are for the doctor.

What the team can do day to day

Treating depression is clinical work — psychological support, sometimes medication, always decided by the doctor. But there is a great deal the care home team does every day that matters:

• Notice and record. A short note when someone changes — eats less, has stopped coming to the lounge, talks about dying — is what lets the next shift and the doctor see the pattern.
• Keep in touch. A five-minute chat, with the same person at the same time, is worth more than one big activity once a month.
• Offer something meaningful to do. Tasks linked to the person's life story: watering the plants, helping to lay the table, reading the paper aloud. Being useful to someone is one of the most protective things there is.
• Get outside and move. Daylight, a walk in the garden, adapted exercise. Even a little, even seated.
• Bring the family closer. Visits, phone calls, photographs. When the family is far away, video calls shorten the distance.
• Don't brush it off. "It'll pass" or "you need to cheer up" close the conversation. "I've noticed you've been a bit low lately" opens it.

Isolation and loneliness, which often go hand in hand with depression, were covered in loneliness and social isolation.

When it is urgent

Ask for a prompt medical assessment when the change is sudden, when the person has stopped eating or drinking, or when they talk about dying, "ending it" or not wanting to live. These remarks are always taken seriously, even when said in passing. Contact the person's doctor or your local health line; in immediate danger, call the emergency number (112 in Europe).

Where RVer can fit, and where it can't

RVer does not treat depression, and it does not replace clinical care or any medication the doctor decides on. What it can offer the team is one more way to open a conversation and break the sameness of the days.

In practice, that means a short session, seated and always accompanied, in a place that means something to the person: the beach where they spent their holidays, the village where they grew up, the church, Fátima. The person looks; the professional beside them asks about what they see and listens to what they say. The thinking behind familiar places is in reminiscence, and the free Life story tool helps gather those places with the family.

Research in this area is mostly small studies carried out in care homes, and not with RVer. A feasibility study with 13 residents of a care home in Brisbane assessed one facilitated virtual reality session for mood and apathy (Brimelow and colleagues, 2020). A study in two Australian care homes observed 34 residents before, during and after guided virtual reality trips (Stefan and colleagues, 2025). And a qualitative study heard from 52 staff at 31 French facilities who ran sessions with personalised 360° video (Restout and colleagues, 2026). They are gathered, with summaries, under the quality of life theme of the study library.

Not everyone enjoys it, and the session ends whenever the person wants. If the answer is no, when a resident says no covers what to do next.

In summary

• Depression is not a normal part of ageing: it can be assessed and treated.
• In long-term care it is far more frequent than at home — in a 2010 review, major depression in about one in ten people.
• In older people it often shows up as pain, tiredness, poor appetite or withdrawal, rather than sadness.
• Depression, apathy and dementia look alike from the outside; telling them apart is clinical.
• The team helps by noticing, recording, keeping in touch and offering meaningful things to do.
• Talk of dying is always taken seriously: contact the doctor or, in immediate danger, 112.

This article is for information only and does not replace clinical assessment. If you notice signs of depression in a resident, speak to their doctor or care team.

RVer is a virtual reality system for clinical use designed for healthcare settings, whose base product is registered as a Class I Medical Device in EUDAMED (Basic UDI-DI 56006195127RVERTZ) and with INFARMED (Portugal, CDM 94571546) and bears the CE mark under MDR 2017/745. The RVer Motion, RVer Neuro and RVer Exposure modules are in development and are not covered by that registration.